click on the Newspaper Logos to read full story

2009 December, “German Center for Neurology & Psychiatry: “Depression in children, Psychology”

2009 December, “German Center for Neurology & Psychiatry: “Brain Activity, German Emirates Club”

2009 December, “German Center for Neurology & Psychiatry: “Anger Management, Psychology”

2009 November, “German Center for Neurology & Psychiatry: Psychology of UAE teenagers”

2009 November, “German Center for Neurology & Psychiatry: Health Festival 2009, Dubai Healthcare City”

.

.

.

2009 November, “German Center for Neurology & Psychiatry: Children with Pica Disease”

2009 October, “German Center for Neurology & Psychiatry: interview about workspace related stress”

2009 October, “Dubai Metro: GNP explains the nature of rule breaking”

2009 September, “Epilepsy on the roads of Dubai”

2009 September, “Do we use only 100% of our brain?”

2009 September, “Parenting Solutions”

2009 August: “Medical Impressions in Dubai”

2009 July: “Stress and the Dubai Metro”

.

2009 June: “Expat Depression”

2009 May: “Deep Brain Stimulation”

.

2009 April: “Depression Awareness Week”

. .

2009 April: “In the throes of a thrisis”

. .

2009 March: “Credit Crunch”

. .

©

2009 March: “Locking Horns”

. .

2009 February: “Credit Crunch”

. .

2009 January: “Deep Brain Stimulation - Parkinson Disease”

2009 December; German Center for Neurology, Psychiatry, Psychology & Counseling: “Anger Management”

10 ways to harness your anger
The feeling of anger is like an unbridled horse galloping across the fields, with teeth bared to the wind and flames flashing in his eyes… powerful, uncontrollable and totally wild. Louisa Wilkins speaks to the experts (German Center for Neurology, Psychiatry, Psychology, Psychotherapy & Counseling, Dubai) about how to rein in your anger, get it under control and send it back to the paddock to graze.

1 UNLOAD THE STRAWS
An angry outburst is rarely the result of one incident. Usually, a long list of annoyances build up over a long time, and eventually send your calm millpond temperament bubbling like a Jacuzzi on super power. The best way to deal with this is to prevent it from happening in the first place by snuffing out frustrations as and when they arise.
Situation diffuser: If your mother wouldn’t listen on the phone when you tried to tell her you weren’t coming home for the holidays, send her an e -mail before you head into that board meeting. If your thermos tipped over in the car for the fourth time this week, maybe it’s time to start having coffee at work.

2 CHANNEL THE ENERGY
Dr Roghy McCarthy, clinical psychologist at Counseling and Development Clinic (04-3946122), says,
“If you don’t know how to express negative emotions, suppressed anger can easily turn into misplaced anger, meaning that you end up taking your work anger out on your husband, or your husband anger out on your children. Instead of throwing things, screaming, harming others or yourself, take responsibility for your anger; start going to the gym or hang a punchbag in your spare r00m. You can also g0 for a long walk or listen to favourite music.”
Situation diffuser: You’ve had a stressful morning sorting out home finances. Before you pick up the children from school, take time out to de-steam with a session on the cross train or, or to chill in the garden listening to your iPod.

3LOG IT
Keep an anger log to keep track of your anger.” suggests Dr McCarthy. “First rate your meet on a scale of o to ten. Then record what provoked your anger, how von expressed it, what coping strategies von used and it they worked, and how the situation ended. I will help you to control your anger and see your emotions in a healthy way.
Situation diffuser: You seem to have been tenser recently and have been flipping our more regularly than normal, but von cm t work out why. Stop and take stock of your anger patterns, and lift yourself out of your funk.

4 REALLY FEEL IT
Is there another emotion lurking beneath vont anger? Frustration at not being heard? Rejection at not being invited? Instead of denying these feelings until they fester into hot lava of rage, look at them, accept them and express them for what they really are.
Situation diffuser: Yon haven’t had an argument with your daughter, bur you can feel one brewing as she has been silent and moody for days, which frustrates you. Avoid the showdown by veiling her, “When you slam your door in my face when 1 am trying to talk to you, it makes me feel hurt and rejected.”

5 BUILD A ZONE
Choose a peaceful, secluded spot in your home and desígnale it your Anger-tree Zone. I his is a place where you can go and listen to music, read your hook, or just sit undisturbed. Dr McCarthy says,
“If you are starting to feel angry go to your Anger-tree Zone and tell yourself, ‘When I am here, there is no anger.”
Situation diffuser: You have had a long day at work arid have just got home, via .a hectic super market stop. Your husband is on the way home and has called three, times already ranting about his bad day. Instead of clashing in the kitchen again, whisk yourself off to your Anger-free Zone until you have both had a chance to calm down.

6 TENSE AND RELAX
When you feel your blood pressure rising, try Progressive Muscle Relaxation (PMR). Dr Brosig, medical director and senior consultant for neurology, psychiatry, psychotherapy and rehabilitation at the German Center for Neurology and Psychiatry, Dubai Healthcare City (04-4298578) says,
“By relaxing your muscles, you also relax your nervous system, thereby alleviating stress, anxiety, panic and anger.
Situation diffuser: You are in the car stuck in traffic and your children are squabbling in the back, Tense all the muscules in your arms and hands and then loosen them. Then move on to tensing arid relaxing the other muscle groups in your body. (German Center for Neurology, Psychiatry, Psychology, Psychotherapy & Counseling, Dubai)

7 MANAGE YOUR LANGUAGE
This is not about controlling the words that tumble out of your mouth in tiny, but the words that incite you to anger. Blame words, such as ’should’, can lead to you feeling frustrated and hard-done-by, which in turn can lead to anger. Dr Brosig also recommends avoiding the use or words like ‘never- and ‘always Situation diffuser: Avoid accusatory sentences such as, “You should have remembered that I like my eggs sunny side up.” Instead try, “It would be nice if next time you remember that I like my eggs sunny side up.” (German Center for Neurology, Psychiatry, Psychology, Psychotherapy & Counseling, Dubai)

8 LAUGH IT OFF

In the heat of an emotionally tense moment, it can be hard to find the sunny side. If you can train yourself to do this, you will be well on your way to controlling your anger demon Dr Brosig  (German Center for Neurology, Psychiatry, Psychology, Psychotherapy & Counseling, Dubai) says. “Try to use humour to realize how ridiculous the situation is and to release the tension in the situation. It tins seems hard, start with simple humour, such as imagining comical situations” Situation diffuser: You’re arguing with your husband and it seems to be spiraling out of control. Try picturing both of you dressed up as chickens, bur still arguing.

9 WALK AWAY
Removing yourself from the situation can be difficult when you want to voice your frustration, but it is crucial for releasing pressure. This doesn’t mean storming out for hours; it could simply mean locking yourself in the bathroom or study or better still taking yourself out to the garden for ten minutes.
Situation diffuser: Your boss is waiting for an important document, which you worked hard on yesterday. You can’t find it anywhere, even though you know it was on your desk when you left the office at 8pm last night. You turn your desk upside down and look up to find your colleague handing it to your relieved looking boss. Walk directly to the coffee machine, grab a hot drink and take a live-minute break to cool off outside.

10 APPLY THE RIGHT TECHNIQUE
Train yourself to trigger a practised calming routine when your blood starts to boil, such as; speak slowly in a calm voice; tense and relax your muscles, starting with your hands and arms, and then your jaw; take three slow, deep breaths: take a few steps away from the confrontation, close your eyes and imagine n peaceful scene; try to find humour in the situation; if these don’t work, head straight to your Anger- free Zone.
Situation diffuser: You are on the phone to an insurance company trying to get a simple letter of no claims bonus. They don t understand,: Nobody ever understands. Initiate calming routine step one.

2009 April; German Center for Neurology, Psychiatry, Psychology & Counseling: “In the throes of  thrisis”

Is it better to be halfway up a ladder you don’t want to climb or jump down and begin climbing anew?
Jola Chudy investigates the lifestyle reassessment some will undertake in their thirties

Have you ever woken up and realized you didn’t want to go to work? I have. Of course, there’s the odd occasion when an ill-advised late night or the gnawing fear of a big presentation transforms your willingness to work into an inescapable yearning to never be parted from your duvet again. But what about when you wake up, sometime in your thirties, and realize that the goals you have clung to throughout your twenties have left you hurtling down a life path that suddenly feels completely wrong?

Kasey Edwards, the author of the new book 30-Something end Over It, felt exactly that. “One morning, I woke up and realized I didn’t want to go to work anymore. This was really shocking to me because I’d always been very career-focused. T hoped it was a phase, but when months passed and I still greeted every day with a sense of pointlessness, I knew it was something that I had to address.” Edwards writes about her year in the throes of a “thrisis”, a crisis in your thirties that leaves you feeling disillusioned and disenfranchised with your life. The British-Australian says it typically afflicts those who spend their twenties following a prescribed pathway to success, ticking all the boxes of education, career, relationship and material success. After these goals have been achieved, or are clearly within reach, the realization of a life shaped by the expectations of parents and society sets in. Having switched careers myself after moving to the UAE, I know what it’s like to be painfully stuck in the wrong box. I spent a year feeling miserable in a job that I hated, wondering how I’d managed to turn a degree from one of the UK’s most prestigious universities into a menial job that involved little more than filling in spreadsheets.

It seemed my friends were living the high life in a city that promised everything with a giltedged twinkle, while I felt stuck in a void. Was it a mere coincidence that I was in my early thirties at the time? Is there any medical truth to the thrisis theory, or is it simply a buzzword? It’s both, says the senior consultant neurologist of the German Center of Neurology and Psychiatry in Dubai, Dr Michael Grundmann (German Center for Neurology, Psychiatry, Psychology, Psychotherapy & Counseling, Dubai). “The media subversively suggests ‘must haves’ that are absorbed none critically by most people,” he says. “Ambitious people arc burning out trying to comply with seemingly important demands, such as being attractive, having a good job, being a perfect parent, going on an exciting holiday, d riving a large ear and owning a house.”At the end of the day, it is quite impossible to live up to all these expectations. As a matter of fact, never before in the history of mankind, especially in the industrialized countries, are people living in materially or medically better circumstances, and yet, we observe a constant rise in discontent and depression worldwide.” (German Center for Neurology, Psychiatry, Psychology, Psychotherapy & Counseling, Dubai)

Linda Sakr, a counseling psychologist at the Dubai Community Health Centre, agrees we mistake material wealth for hap piness. Sakr sees men and women from all backgrounds complaining of thrisis symptoms and gives them this advice: “Draw a line between work and play. Take up a hobby and fulfill yourself personally. The physical, mental, social, emotional and spiritual need to be present in one’s life is not just through achieving professional and relationship success.” She discourages her adolescent clients from seeing the purpose of education as solely a launching pad for a career. “We are driven to achieve too much too soon. We start to believe that money will buy love, self-esteem and a better character. The result is anxiety, depression, low self-esteem and burnout.” To some critics, the idea of a thrisis is an indulgence that only the well-off can afford, and Edwards herself is the first to ad mil that she felt guilty for feeling bad about her outwardly perfect life. She was a successful management consult¬ant who regularly took home bonuses that would rival most people’s annual salaries. She had been conditioned to follow a successful path, which she says was part of the problem. “Initially I didn’t tell people how I was feeling because I felt ashamed and embarrassed to be unhappy and discontent with my life when I knew it was so privileged. I had achieved everything I always thought I wanted- the good job and the lifestyle and assets to match - so what did I have to complain about?”

Edwards says a painful or dramatic “thrisis point” is often a necessary catalyst for beginning a re-evaluation process.

Susan Soliman, a lecturer at Dubai’s Middlesex University, agrees. The 37-year-old from Lebanon speaks quickly, with infectious passion. She says she’s never been happier, but earlier in her thirties; she went through experiences that would floor most people. She lost her father to cancer. “I watched this wonderful man who had achieved so much die a little bit every day for three years. My fiancé, the love of my life, left me because he couldn’t deal with it. I was in the hospital with my dad when he died. It was the shock of my life. A month later, I resigned from my job and moved to Dubai, 1′hat was when the questioning began.” Susan, a high -achieving manager in a multinational firm, realized that she was going to have to reassess her Life from scratch. “Most of us don’t do it voluntarily. There has to be something imposed on us,” Soliman says. “But it wasn’t a quick fix. I worked my tail off to change things, It was interesting too, seeing the factors that were missing slowly being added to my life, I am in a good place now, I’ve accepted those experiences. I make the effort to take care of myself, surround myself with things and people that inspire me. I’m going to enjoy whatever life brings. I have a plan, hut if it doesn’t work out, I know something else will.” Stepping off the treadmill to reassess one’s life is hypothetically a good, brave thing to do, but it is also a luxury to have the time to do it. When I hit my low, I couldn’t let myself wallow financially or emotionally. I had to shake myself off and start making baby steps towards change. Like Soliman, I had to work hard at it. That meant building up a small portfolio of unpaid writing samples in order to approach magazine editors, I knew I’d have to start at the bottom, but it was better than being halfway up a ladder I no longer wan ted to climb. Edwards cautions against placing too much importance on a defining career. “Many people have a dysfunctional relationship with work. They invest so much of their time, energy and identity into their jobs, expecting things from it that it can’t possibly provide. A job will not meet all your relationship needs or your spiritual or creative needs, and it’s unlikely to connect you to your community. People need to accept that no matter how much they love their job, it will never love them back. “Men also suffer from thrisis,” Edwards says. “However, they are more reluctant to talk about it. It’s not masculine for them to op t out of the workforce or scale back to a less stressful job. Women don’t always have this pressure and they also have a socially acceptable reason to opt out having children.”

Daisy Omissi, a 30-somcthing inn m who now runs her own company, says having a baby put her life in perspective. “After I had my daughter, 3am deadlines weren’t as important as worrying about whether she had been inoculated.” Omissi says that while parenthood brings its own set of anxieties, working for herself gives her more satisfaction than a normal nine to five ever did. It’s something I can relate to. Having worked for employers all my life, I, like many others, got “credit crunched” and lost my job earlier this year. But rather than despairing, I decided that I would rather work for myself anyway long days in the garden, impromptu road trips and guilt-free late nights have failed to materialize. Instead, I find myself putting in longer hours than 1 did at the office. But it’s much more fulfilling and exciting. The duvet is far less insistent when you answer only to yourself. “Dubai is a great place to work things out, but at the same time it is highly competitive,” says Soliman. “You really have to work hard at life balance. It is easy to get absorbed in what you do at work and lose the purpose of your life. I realized it’s not about a goal right now; it’s about having a horizon. It’s the day-to-day experiences, the little things that make the difference.”

This is also the conclusion of Edwards, who says that while it’s the worst cliché she’s ever written, the answer is in the journey. “It wasn’t until I finished writing my own book that I realized the answer is not something you can read in a book, hear from a guru or swallow in a pill. The cure is to get to know yourself again, to rediscover what makes you happy and then take steps to readjust your life.”

Grundmann  (German Center for Neurology, Psychiatry, Psychology, Psychotherapy & Counseling, Dubai) says the best solution is to rediscover what is really important in life. “You must develop the magnitude to admit to not being perfect in all aspects. At first, this might seem to be a contradiction but it takes a certain maturity and selfesteem to say ‘no’ resolutely. This might be the most important word to relearn and apply: ‘no’ to such things and circumstances that one does not really want to endure.”

” I had achieved everything I always thought I wanted — the good job and the lifestyle and assets to match -so what did I have to complain about?
Kasey Edwards’s author

2009 August; German Center for Neurology, Psychiatry, Psychology & Counseling: “Medical Impressions in Dubai”

Life can hand you anything, especially when your job is taking care of people. Jola Chudy asks three UAE-based doctors to describe their most memorable patients and valuable lessons learnt.

Every day, doctors witness the extremes of human life. They are there as stories of tragedy, illness, death and defiance unfold in ways that many of us would find hard to cope with once in a lifetime. When your job involves telling patients their loved ones won’t be coming home or their child may never get better, keeping a bigger picture about life’s priorities suddenly doesn’t seem quite so hard. There might be a global recession to contend with, but having your health can be a sadly under-appreciated blessing.

Dr Ron McCulloch
General Practitioner, D r Mc Culloch’s Clinic, Abu Dhabi
I have been in the UAE since December, 1974. I started my clinic in Abu Dhabi in 1975.
One of the first things a doctor here may notice is the different experience of practicing medicine in a country where you may only know your patients for a few years. In the UK, you get to know your patients over decades but h ere expatriates tend to stay for around two to four years and few doctors have patients on their list beyond a decade. The saddest case I remember is a young couple who came to sec mc in 2002 or 2003. They were both so happy and chirpy and they were engaged to be married. I examined the man and a female colleague examined his fiancée. Everything seemed fine, as they both looked so healthy. Then I noticed a lump in his neck. Tests revealed that it was cancer and it was terminal. They had been about to embark on a happy life so it was a devastating blow. They had been due to travel hut decided to go straight home. They had a hospital wedding and he died the next day. People marry in tragic circumstances. Sometimes I see patients and they are obsessed with the idea that they might have cancer. They are focused on this even when the news is good. I always think: “How lucky you are to leave with a pat on the shoulder and not a death sentence.” None of us knows what is around the corner. Just because you have passed a physical doesn’t mean you are going to live longer; it just means that at that moment you are healthy. You could be the only non-smoker on a balcony and it collapses. I think doctors often have a kind of gallows humour about life and death. It helps us cope. What makes my career worthwhile is when I come across inspiring people. There was a patient who was diving in Khor Fakkan and he was involved in an accident. He came to t he surface too quickly and got the bends, a decompression sickness. A helicopter took him to Dubai and of course that made it worse because of the air pressure.
By the time he got to the hospital he was paralysed from the neck down and told he’d never walk again. Yet, 18 months later he was able to walk. That was a real case of mind over matter.
Then there was the case of a marathon runner who is paralysed and did a marathon in two weeks, it would take most people four hours. Reading about inspiring people is uplifting. A lot of people are depressed about the downturn yet there is something so uplifting about a story like that. It puts the little things in perspective.

Dr Moeena Zain
Infectious diseases specialist, American Hospital, Dubai
Of all the patients I have seen, there are a few that I remember more than others. There was one case in particular, a lady I saw in Texas about four years ago.
She was 44 years old and completely deaf and mute. She had been brought to the hospital because of persistent seizures and was diagnosed with a kind of viral encephalitis. Over the following weeks, she developed one complication after another and eventually slipped into a comatose state. By all normal medical standards, it looked as if she was not going to make it. At the time, her son had been overseas. He returned home and came to the hospital to see her. I had a long and difficult talk with him and explained gently that she would likely die, or be permanently afflicted with severe neurological disabilities. But rather than accepting this, her son looked straight at me and said: “No, mum will do as I say. Now that I am here, she will improve.”
I was naturally skeptical, as family members often see things like involuntary movements as a sign of cognitive function, so the next day I asked him to ask her to move her hand. To my surprise, she did. From that day on, she started making a rapid recovery. She eventually woke up and was able to communicate in sign language and even walk.
Medically speaking, this case is not that unusual. People often wake up after months in a coma. However, for me this case was a lesson because 1 was so sure of the out¬come; all the scientific evidence was on my side, yet I was proved wrong. It taught me to never take hope from a family and that having faith is a strong healing force. As they say in medicine, anything can happen. There have been several patients whom I have helped to face death-Some are so fearless; you wonder how they can be like that. They have been suffering for so long yet they maintain a cheerfulness that feels almost unreal. They face each day with enthusiasm. Almost all of these patients have had a strong faith, and I believe that has been a pillar of support to them during their suffering. I have learnt things from patients that I have incorporated in my life. The first is to remember to be grateful for being healthy. I never take my health for granted. I silently thank God for it as I walk in the corridors of the hospital or ride in the lift. Ours is an emotional field and sometimes you can go through a whole range of feelings in one day.
The second thing I have learnt is to do everything in my power for my patients. The reason that physicians can go to bed at night and sleep peacefully is not that we cure all our patients but that we know we do all that we can.

Dr Michael Grundmann (German Center for Neurology, Psychiatry, Psychology, Psychotherapy & Counseling, Dubai)
Senior consultant for neurology, German Center for Neurology and Psychiatry (GNP), Dubai Healthcare City. Many patient’s stand out, but there ís one case that I remember because it is so exceptionally tragic; it reminds me that we are sometimes helpless in the face of illness. The patient, a middle-aged lady, developed a very progressive dementia disorder that took hold within a matter of months. You can lose your vision or your limbs or even develop paralysis and spend the rest of your life in a wheelchair, but that is nothing compared to losing your memories, your feel¬ings and the experiences you have made in your life. Without memory, you lose your personality, Grundmann (German Center for Neurology, Psychiatry, Psychology, Psychotherapy & Counseling, Dubai) says. So, in my opinion, the most terrible illnesses are dementia disorders such as Alzheimer’s disease. The inspiring thing to take from a situation like this was that the family tried to get her all the help available. As a doctor, I always try to help a patient in the same way I would a member of my own family. It is important for doctors and patients to get on with each other, to have that authenticity and respect for each other, because human beings aren’t just machines that it is our job to “fix”. You have to remember the psychological aspects. In that respect, one patient who haunts me is a man who I treated in my first year as a doctor. He had a malignant brain tumor. Both he and I knew there was no cure for him in the long run, but I was able to offer him a month more of life if he would agree to take some cortisone to control the oedema (excess accumulation of water in the inner brain). Unfortunately, he refused to take this treatment. As the doctor responsible, I had a long discussion with him about his decision but be remained absolutely clear and sharp in his mind. I encouraged him to take the medicine, as otherwise the oedema would affect his brainstem and he would die within 36 hours. But he refused to do this. His son came and they also bad a long discussion. After three hours, the son came out of the patients room feeling beaten down and helpless. The next day the patient became sleepy and the day after that he died. His son was at his bedside the whole time. At the time, I felt helpless, but now I understand his intention; it is the quality, not the quantity of life that is important and I think he knew that. (German Center for Neurology, Psychiatry, Psychology, Psychotherapy & Counseling, Dubai)

Doctor must live with the fact that sometimes, despite their best efforts, they cannot save a patient. Dana Neel/Getty Images

Ours is an emotional field and sometimes you can go through a whole range of feelings in one day
Dr Moesna Zaift American Hospital Dubai

2009 September; German Center for Neurology, Psychiatry, Psychology & Counseling: “Epilepsy on the roads of Dubai”

A medical expert says the UAE authorities need to bring in guidelines tor licensing drivers with epilepsy, writes Ian Hainey

Authorities in the UAE need to provide clear guidelines and regulations for drivers who suffer from epilepsy, says awardwinning neurologist Dr Arne Brosig from the German Center for Neurology and Psychiatry in Dubai Healthcare City.

Many countries have controls in place to prevent epilepsy-related accidents. However, the UAE has no restrictions or public guidelines for people prone to epileptic seizures. Epilepsy is a serious and endangering condition that manifests itself in different ways, according to Brosig  (German Center for Neurology, Psychiatry, Psychology, Psychotherapy & Counseling, Dubai) :” Epilepsy often displays itself in the sudden occurrence of fits. “Very often this leads to a serious disturbance or even complete loss of consciousness. Even small epileptic fits whereby consciousness isn’t lost may severely impair the ability to drive. Such fits can cause vision disturbance or cramps, which can have dire consequences for driver, passengers and others.” The most recent UAE study came from the Department of Community Medicine and Family Medicine at United Arab Emirates University in Al Ain. It was carried out between October 1992 and June 1994. The aim of the paper was to investigate the risk and effect of eplepsy on ma d traffic accidents and casualties and identify possible risk factors for traffic accidents and violations among epileptic drivers. From these drivers, 34 per cent had at least one epileptic seizure per year and 26 per cent had at least one seizure per month.
The most common violations were careless driving (34 per cent) and traffic regulation violations (24 per cent). A significantly higher risk was observed from epilepsy sufferers with regard to property damage and traffic violations. Almost 50 per cent of the subjects bad a full licence to d rive private or commercial taxis.
The study concluded I hat patients with conditions such as epilepsy should feel obliged to inform the traffic authorities or the health authorities’ about their condition. It claimed incidents could be greatly reduced if appropriate action was taken concerning epileptic drivers and made these recommendations to UAE traffic and health authorities at the time.
Dr Brosig  (German Center for Neurology, Psychiatry, Psychology, Psychotherapy & Counseling, Dubai) said “People with epilepsy should be allowed to drive, but only under certain conditions, and the rules should be clear and strictly enforced . There should also be clear guidelines for UAE drivers diagnosed with the condition of epilepsy in the UAE.
For instance, in the UK you can apply or reapply for a licence as long as you have been completely free from epileptic seizures for on e year. This is only granted if the driving agency is satisfied that as a driver you are not likely to be a source of danger to the public.
Dr Brosig (German Center for Neurology, Psychiatry, Psychology, Psychotherapy & Counseling, Dubai)also added that, under certain conditions, an accident due to a known but concealed diagnosis of epilepsy might lead to the loss of insurance cove rage.
Dubai Road Transport Authority’s licensing director, All Al Jassim, explained that Dubai’s Licensing Agency has had discussion with Dubai Police as well as the Dubai Health Authority on this subject. “If the person with the illness epilepsy is detected during the training period before licensing, the issue is reported to the Dubai Licensing authorities. The licensing authority then refers the person to the Dubai health authorities for proper medical evaluation. Driving students will be required to submit a relevant medical report where appropriate actions will be taken based on the recommendations of the medical report. If epilepsy is detected after the licence has been issued, such as due to involvement in an accident, Dubai Police will refer the issue to the Dubai health authorities and the licensing authorities will be notified. The licensing authority may decide to take necessary and appropriate actions with regard to the person’s driver’s licence if the medical report shows evidence of such illness as epilepsy,” he said. When asked whether the Dubai Licensing Agency plans to make guidelines for epilepsy sufferers public, Al Jassim explained: “I believe this issue requires a comprehensive study and there is a plan to conduct a dedicated project, which will include the proper guidelines, among other things. Once this is completed, in form at inn will he made available on the web site.”

In the UK, anyone who suffers even a minor epileptic seizure has to inform the vehicle licensing authorities, who will suspend the licence for at least a year, ‘the patients can then reapply for their licence after twelve months provided they remain seizure-free over that period . The effects of this can he severe, especially if they have a job which requires driving. Therefore it is thought that many epileptics are prepared to run the risk of a subsequent epileptic seizure while driving, rather than inform the lincensing Authority.To obtain a driver’s license in most US states, a person with epilepsy must be free of seizures for a certain period of time, usually a year and may be required to submit a doctor’s statement that the person can drive safely. A recent US conference of epilepsy organizations recommended a seizure-free period of three months for driving privileges, since surveys had found that returning to driving after three months rather than a year did not greatly increase the rate of seizure-related crashes.

In Australia a, person with epilepsy cannot hold an unconditional license, but a conditional licence may be granted by the authorities for three or six months after seizure free periods set by experienced epilepsy consultants and are subject to at least an annual review. There is still some debate over whether a ban is medic Lilly required and the duration of such a ban.

Re-searchers from the Mayo Clinic in Maryland in the US were given the opportunity to test this question when the state of Arizona decided to reduce the length of the prohibition from a year to three months. The team looked at the number of seizure-related crashes before and after the change and found here was a small increase in such incidents with eleven more seizure-related crashes.
Dr Brosig said: “Those experiencing epilepsy should be treated as soon as possible with special anti-epileptic drugs combined with regular EEG checkups, thus saving many other connected problems. “Few traffic accidents turn out to be harmless. More often serious injuries are caused which may have lasting consequences or even have a deadly outcome. Therefore it is crucial UAE authorities monitor this correctly and epilepsy sufferers themselves seek professional advice when it comes to driving. ” (German Center for Neurology, Psychiatry, Psychology, Psychotherapy & Counseling, Dubai)

2009 September; German Center for Neurology, Psychiatry, Psychology & Counseling: “Parenting Solutions ”

This month we ask the experts about fussy eaters, childhood depression and homeopathic remedies.
Compiled by Louisa Wilkins.

My five-year-old is really fussy when it comes to eating fruit and vegetables. What is the minimum amount of fresh produce she needs to be eating?

Kathleen Farren, Nutritionist at Synergy Integrated Medical Centre (04-3485452) says:
“Children don’t starve themselves, most go through fussy phases, and their tastes change —so it is essential to re-introduce foods regularly until the age of eight. Also some children use food to wind up their parents or get attention, so don`t react to a food tantrum by insisting she eats and remember not to bargain with food.
The World Health Organization recommends five portions of fruit and vegetables daily a portion being as much as they can hold in their hand. Boost your child’s intake with freshly-squeezed juices; sliced banana on cereal: vegetable pizzas; fruit crumbles; and tomato-based pasta sauce, which counts as a portion Show them that food is fun by letting them help in the kitchen; planting veggies in the garden: being a vegetable-eating role model yourself; letting children serve themselves: removing all refined carbohydrates (biscuits, cakes, sugary juices) from their diet; and play with food, by arranging it in circles or faces and playing games.”

I have heard that the UAE has high rates of childhood depression. How will I know if my child is depressed?

Dr Michael Grundmann, senior consultant for neurology at the German Centre for Neurology and Psychiatry (04-4298578) says: “Children are receivers of their parents’ emotions and, as depression is high among adults here in the UAE, more children are depressed too. It can start as early as the age five — watch out for physical manifestations of depression, like stomach aches, headaches, changes in sleeping patterns or behaviour, aggression, or bed-wetting. “Children may become depressed if there is an absence of family support at home. Having high quality time with parents, like reading together at bedtime is important for the social and emotional development of children says Grundmann (German Center for Neurology, Psychiatry, Psychology, Psychotherapy & Counseling, Dubai). When you’re with your children, be present in the moment. Genetically, boys need more support than girls, but traditionally parents support girls more. Depression is toxic for health and for the development of the brain and intelligence.
“Remember, depression is a biological disorder — it doesn’t just happen to weak people. If you think your child is depressed, try to validate their feelings and book an appointment with a specialist”

Is there a homeopathic alternative to using antibiotics to fight off my sons recurring chest infections?

Dr Mukesh Batra, homeopathic doctor at Dr Batras Positive Health Clinic (04-4343981), says:
“Children with a strong immune system usually on y get infections in their upper respiratory tract  i.e. the nose and throat. So, the fact that your son gets recurring chest infections is a sign that his immunity is on the lower side. Homeopathic medicines can fight off infections and boost a patient’s natural immunity. Indiscriminate use of antibiotics can result in organism’s becoming resistant to them, can lower a patient’s immunity and, consequently, increase the chances of a recurrence, or another infection. “Antibiotics can cause adverse side-effects and can even produce drug-induced disease. Hence, good doctors always prescribe antibiotics with great caution. “Homeopathic remedies are prescribed based on the patient’s symptoms, personality, attitudes, temperament, behavioural patterns and more. For example, while Hepar Sulph is used to treat respiratory infections with yellow, thick phlegm or mucus. Antim Tart is useful for patients with rattling mucus in the chest and vomiting.”

2009 April; German Center for Neurology, Psychiatry, Psychology & Counseling: “Depression AwarenessWeek “

Dubai Experts Uplifting Advice for Depression Awareness Week

Free Depression tests offered at German specialist clinic in DHCC to help detect and reduce one of the most common health problems which often leads to death

As Depression Awareness Week, April 21-26, 2009, looms on the horizon; a Dubai-based specialist explains the condition and gives some insight into how to avoid developing this common condition and recognizing it as quickly as possible in friends, family and colleagues.

And to mark Depression Awareness Week, German Center for Neurology and Psychiatry (GNP) in Dubai Healthcare City is offering free Depression Tests for those wondering whether they might be suffering from symptoms. The doors of the German Center for Neurology and Psychiatry will be open all day on Thursday April 23, 2009, when a scientific test and short consultation with a German expert will be offered to anyone pre-registered for the day. According to the Depression Alliance, one in five people suffer from temporary depressive symptoms at some point in their lives. An estimated three out of ten members of the workforce suffer from genuine depression and studies show employees suffering from depression are off work for an average of 30 days with each bout of sickness. More than 2.9 million people are diagnosed as having depression at any one time but 70 per cent of all cases are neither recognized nor treated.

The World Health Organisation says that by the year 2020, depression will be second only to chronic heart disease as an international health burden. Depression affects around 120 million people worldwide and this number is projected to increase. Fewer than 25 per cent of those affected worldwide have access to adequate treatment and health care and the number of untreated depressions in the UAE is most likely even higher. Even though effective medical treatment can be provided by a psychiatrist, very often the patients don’t find their way to a specialist clinic. Depression is one of the main causes of death in developed countries. In Germany around 4,500 people are killed each year by road traffic accidents but around three times this number die of suicide, which is a result of depression in the majority of cases. The number of attempted suicides in Germany is estimated at over 10 times this figure.

The good news is that more than 80 per cent of people suffering from depression can be helped with appropriate treatment after a secured diagnosis. Depression specialist Doctor Michael Grundmann, who recently arrived from Germany as a resident senior neurological consultant at the GNP clinic, explains the problem of depression is also prevalent in the UAE, but often for different reasons than in other countries. “Depression often stems from work-related problems and the stressful work of expatriates in cities such as Dubai and Abu Dhabi in particular, is not dealt with in the same way as might be the case in their homelands. Often separated from family or friends, expatriates here commonly do not have the same social support network, which is essential for reducing stress levels and fending off the onset of chronic stress and depression.

“Depression is not a disease that happens to weak people. There is no shame to be attached as it is a biological condition. Tests have shown depressive symptoms in all kind of creatures, even as small as mice,” says Dr Grundmann (German Center for Neurology, Psychiatry, Psychology, Psychotherapy & Counseling, Dubai).

“Depression is most common between 20-35 years of age, during the prime earning years, as people tend to heap the most pressure upon themselves to make money and achieve success, often not realising the stresses this brings. Interestingly enough, there is a second high risk age between 60-65, when adults wind down their working life and again unexpected problems come along, such as a sense of worthlessness and unusual amounts of free time that have to be organized. Unexpected events such as the death of a dear person or the recent economic crisis can also lead to depression, which should be treated immediately in order to prevent a chronic development.

Dr Grundmann (German Center for Neurology, Psychiatry, Psychology, Psychotherapy & Counseling, Dubai) adds: “By raising awareness about depression in UAE we can help make employers more knowledgeable about this condition and more sympathetic towards employees who are affected. Changes in day-to-day behaviour such as not being able to cope with the workload any longer, loss of motivation, absenteeism or signs of distraction are all warning signals at the early stages of depression.”

Depression describes a range of moods from the low spirits we all experience from time to time, eventually growing to a severe problem, which interferes with everyday life if not treated. It can affect anyone of any culture, background or age. Around twice as many women as men seek help for depression, however, it is thought that this merely reflects a greater readiness in women to discuss their problems. Depression is brought about through the interaction between external and internal stresses, genetic factors and biochemical changes in the brain. Due to this complex mixture, it can be difficult for doctors to recognize and sort out the symptoms, since people suffering from depression often complain of physical problems, such as headaches, lethargy, stomach upsets or joint pain, rather than of a low mood for instance.

There are a few main treatment options and the most important is the use of selected drugs to reorganize the biochemical disturbances in the brain. These anti-depressant drugs act by increasing the activity of those brain chemicals which affect the way we feel. Optimally this medication is combined with talking or alternative therapy. ‘Talking treatment’ or cognitive behavioural therapy is based upon the fact that the way we feel is partly dependent on the way we think about ourselves and what is happening to us. Alternative remedies are often used in mild cases by applying herbal remedies such as St John’’s Wart. Dr Grundmann (German Center for Neurology, Psychiatry, Psychology, Psychotherapy & Counseling, Dubai UAE) adds: “Of course the workplace is not the only cause of depression but it is one very important factor for most people. By raising awareness at the workplace and by improving working conditions, we can help to reduce the instances of depression, helping those who are affected to recover more quickly but also helping employers and the economy by reducing sick leave dramatically.

“If you suspect that you or someone in your family or social surroundings might be depressed, you should seek expert advice to assist you in finding the right medical treatment as soon as possible and to help you change your lifestyle, which would be the most effective long-term solution. “You can contribute by exercising more, by avoiding alcohol and by trying relaxation techniques such as meditation. Under the guidance of your doctor you could consider giving some alternative therapies a chance and even look into attending a local self help group such as the one we at GNP intend to establish soon in DHCC.”

Anyone wishing for a free depression test is invited to call +971 04 429 8578 or visit www.gnp-dubai.com.

2009 October; German Center for Neurology, Psychiatry, Psychology & Counseling: “Interview about workspace stress”

Studies show that the ongoing recession has resulted in ill health, particularly anxiety, heart disease and stress

Dubai - One-third of mental and physical illnesses are caused by stress, either directly or indirectly, according to health experts.

Individual responses to stress may vary from person to person, depend¬ing on environmental, work-related and interpersonal factors, and from life events, said Dr Firdous Jahan, Con¬sultant Family Physician at Aga Khan University Hospital, who is in Dubai to present a series of lectures under the hospital’s Signs, Symptoms and Care programme to raise public awareness of health issues. An increasing number of international studies are linking the recession to ill health—particularly anxiety, heart disease and stress. Rising unemployment and falling property prices are cited as two key factors that can alter a person’s overall health. Pointing to the recent work-related suicides in France as a case study, experts say that the recession has increased workplace stress levels leading to different reactions in people. At a recent seminar, healthcare experts urged the UAE government to formulate a national strategy for addressing the mental health issues faced by the working age population and making counseling services in workplaces mandatory. Stress can also manifest into physical symptoms. “Symptoms range from a simple stomach ache, to major heart problems affecting the entire body, rather than just a single part. It also impairs the immune system, leading to greater vulnerability to infections,” she said.

Dr Arne Brosig from the German Centre for Neurology and Psychiatry at Dubai Healthcare City said it was really important to try and analyse the causes of high stress levels currently experienced by people. “When times are bad, it’s important to try and confront problems head-on,” he said. “Listing specific reasons for your stress can help one become aware and feel less overwhelmed.” He said it can also help one to identify areas of his or her life that make them feel secure and calm, allowing them to create time to focus upon these areas. (German Center for Neurology, Psychiatry, Psychology, Psychotherapy & Counseling, Dubai UAE)

Dr Jahan stressed on the benefits of physical activity which can help release stress.
“Deep breathing techniques and even imagining a warm, comfortable, safe and pleasant place as well as progressive muscle relaxation are also effective methods for relaxation,” she said.
asmalizain@khaleejtimes.ae

2009 July; German Center for Neurology, Psychiatry, Psychology & Counseling: “Stress and the Dubai Metro”

Metro to help reduce stress at work
COMMUTING BY TRAIN INSTEAD OF CAR-LIKELY TO BOOST PRODUCTIVITY AND WELL BE INC – PSYCHIATRIST

Dubai (WAM) For many Dubai residents, it will be an exciting new way of getting around the city, but, according to a Dubai-based psychiatrist, the Metro, opening on September 9,200, will also be an op¬portunity to reduce stress and improve the quality of life for thousands of commuters. The Dh15.5 billion driverless railway, which will cater to an average of 1.2 million passengers a day and deliver around 17 per cent of the public transport needs of the emirate, is on target for its September Red Line opening, which will see up to 40 trains every hour moving along 52km of track. The journey along Shaikh Zayed Road from Al Rashidiya to Jebel Ali will stop at 29 stations  including Burj Dubai and Dubai International Airport. The Green Line is expected to open in March 2010, when 18 more stations will serve an additional 22.5km of track.

Dr Arne Brosig of the German Centre for Neurology and Psychiatry (GNP) in Dubai’ Healthcare City explained how various benefits associated with Metro commuting as an alternative to using the car will boost individuals’ and the city’s productivity.

Better performance
“Many studies have shown a significant relationship between reduced stress and better professional performance. For instance, the US Transportation Research Board carried out a field study when a New York commuter rail line was improved and found increased work productivity and reduced commuter stress. Commuters who switched to the new train service also experienced a reduced level of job strain after the implementation of the line. “When driving the car during rush hour, commuters need to be continuously mindful of traffic rules, speed limits, traffic lights, jams, other drivers, accidents on the road, pressure of delays, being late for appointments and aggression of other drivers. The list is endless and all contribute to stress levels. Of course, there will also be other Stress factors encountered on the way to and from the Metro station, but overall it is likely to result in a sizeable reduction in daily stress levels for thousands every day” he said. Dr Brosig (German Center for Neurology, Psychiatry, Psychology, Psychotherapy & Counseling, Dubai UAE) maintained “Stress has a close relationship with work productivity. The higher the stress level when you start your working day, the smaller is the coping ability for the rest of the day.” For Instance, if you damage your car on the way to work, then you are unlikely to be as productive throughout the working day as you would have been arriving fully relaxed. This is not restricted to work productivity, but all other aspects of life and health can be influenced by stress. “There is a certain amount of stress which is good and actually helps to improve performance. We call this ‘Eustress. “However, after a certain point, when stress becomes too much it will reduce a person’s productivity. This is called ‘Distress’. However, it is impossible to predict individually which amount of stress is too much for someone, because the same stress factor, such as a traffic jam, can be dealt with totally different by two different people, depending upon the overall stress level of the individual and the coping mechanisms this person uses to deal with stressful situations.”
A study by the US Centre for Disease Control and Prevention (CDC), which recommends a basic daily fitness regime of walking 10,000 steps, discovered that train commuters walked an average of 30 per cent more steps every working day than car drivers. It also found more than 40 per cent walked at least 10,000 steps a day, compared with just over 14 per cent of car commuters. (German Center for Neurology, Psychiatry, Psychology, Psychotherapy & Counseling, Dubai UAE)

2009 November; German Center for Neurology, Psychiatry, Psychology & Counseling: “Children with Pica Disease”

This month we ask three experts for advice on good hygiene habits, excessive chewing and settling into a new school. Compiled by Louisa Wilkins.

My three-year-old son seems to have had a non-stop cold and cough since starting nursery in September. Is there anything I can do to prevent this?

Dr Alya Ahmed, specialist paediatrician at City Hospital (800THECITY) and spokesperson for the American Academy of Paedicatrics (AAP), UAE, says:
“Teach your child these simple hygiene rules, as recommended by the World Health Organisation and the AAP, to prevent the spread of infections:
>> Encourage your child to wash his hands regularly with soap and water, especially after he coughs or sneezes. Teach him to wash his hands for 20 seconds, which is about as long as it takes to sing the ‘Happy Birthday’ song twice. Alcohol-based hand cleansers are also useful.
>> Show him how to cough or sneeze into the crook of his arm. Or, how to cover his nose and mouth with a tissue before coughing or sneezing and then throw the tissue away.
>> Remind him not to touch his eyes, nose or mouth unnecessarily as germs spread that way.
>> Try to avoid seeing people who you know are sick.
>> When your child is unwell, keep him home from school to keep the illness from spreading.”

My eight-year-old daughter chews her clothes, her hair and anything else she can get her hands on. Is this just a bad habit? Is there any way I can help her to stop it?

Dr Hartmut Herbert Kollikowski, senior consultant for neurology, psychiatry, psychotherapy and rehabilitation, at the German Center for Neurology and Psychiatry, Dubai (04-4298578), says: “A professional consultation would be needed to determine the reason for this conduct, to find out whether she just chews objects or if she also swallows parts of them, and to determine how long this behaviour has been persistent. “If children put inedible objects into their mouths, chewing them or swallowing parts of them from time to time, this would not be abnormal and could be a behavioural issue. This happens usually out of curiosity and is quite common at a certain age. “However, if the child eats parts of the objects, this could be indicating a certain disease or syndrome, such as Pica Syndrome where children consume items including dirt, ice, glue, sand, chalk and hair. In this case, parents should see a psychiatrist as soon as possible. Also, if the child has a mineral deficiency, she may try to eat things which contain the missing mineral.” (German Center for Neurology, Psychiatry, Psychology, Psychotherapy & Counseling, Dubai UAE)

My 11-year-old son is starting a new school in January as he has been a victim of bullying at his present school. How can I help ease the transition?

Sue Bishop, inclusion co-coordinator at Uptown High School, Mirdif (04-2641818), says:
“Start preparing him for the new school as early as possible. Look through the prospectus and website regularly. Visit the school beforehand and take photos. Label these photos and put them up somewhere where he will see them. Refer to the photos often, and also to the teachers he will be having in class. “One good thing about starting half-way through the year is that you should be able to get hold of a copy of his timetable. Use this and a plan of the school to practise moving from one class to another. “Look at the curriculum he will be following and encourage him to do some background research on the topics he will be studying. “Ask the school to allocate him a ‘buddy’ student who can show him around and talk to him about what’s coming up during the rest of the year.”Remind him that lots of students find starting a new school challenging, but that soon he won’t be the new boy.”

2009 November; German Center for Neurology, Psychiatry, Psychology & Counseling: “Psychology of UAE teenagers”

Knowing what is a healthy life style is a lot more prevalent in the younger generation than in the older Dr Arne Brosig (German Center for Neurology, Psychiatry, Psychology, Psychotherapy & Counseling, Dubai UAE).

Knowing something and acting accordingly are different things.

Today’s teenagers live in a more complicated world than ever before. Generation Y, as they’ve become known, face many health issues in their years to come, thanks to a proliferation in the availability of fast food, a more sedentary lifestyle and a busier social life that leaves little time for organized meal times and home cooked food.

The United Arab Emirates (UAE) unfortunately has one of the worst rises in diabetes cases in its younger population. A whopping 20 per cent of the country’s residents will get diabetes, which is a phenomenally high rate. Obesity, too, is at an all time high (12 per cent of teenagers are obese according to World Health Organization statistics released in June this year) when conversely the internet, the TV and better education should mean that today’s teenagers are better informed about nutrition and exercise than any generation before them. To explore further the challenges facing Generation Y, Healthmarters has gathered a panel of expert health professionals.

Dr Magarida O’Neill is a dentist at Towerclinic, Dr Arne Brosig is a senior consultant at the German Center of Neurology and Psychiatry (German Center for Neurology, Psychiatry, Psychology, Psychotherapy & Counseling, Dubai UAE) , Kelly Lynch is a dietician and nutritionist at Dubai’s City Hospital and Dr Naeem Tareen, chief cardiologist at the American Heart Centre.

Healthmatters: What do you think are the major health issues facing Generation Y today in the UAE?

Kelly Lynch: The UAE’s Generation Y face the problem of, for many months of the year, not being able to go outside due to the climate. Children don’t play enough outdoors and hence are becoming couch potatoes’ or
video game addicts as teenagers. The malls are full of fast food restaurants and there’s a lack of education and concern about disease. Add this to a sedentary life and you have key reasons why diabetes, obesity and heart disease are so high.

Dr Brosig (German Center for Neurology, Psychiatry, Psychology, Psychotherapy & Counseling, Dubai UAE): Today’s teenagers in the UAE are facing some big challenges. There are all kinds of different influences which can include unprecedented access to new cultures, languages and ethics through thousands of TV channels, the internet and through friends. On the one hand, this makes life more open, more colorful and freer. But on the other hand, children or teenagers sometimes lose their mental stability by getting all mixed up and confused. This often leads to a lot of pressure which can be compensated by eating the wrong things or having an unhealthy lifestyle.

M O’Neill: In an overall point of view, the most important health issue affecting teenagers all over the world and in the UAE is obesity. It has been reported that in the United Arab Emirates, 21.4 per cent of children are overweight and 13.7 per cent are obese. In terms of oral health, oral diseases are a major public health concern in the Middle East.

2009 June; German Center for Neurology, Psychiatry, Psychology & Counseling: “Expat Depression”

Doctors warn of increasing depression among expatriates

By Mahmood Saberi, Senior Reporter Published: July 17, 2009, 23:30

Dubai: Doctors have called for better access to counseling for expatriates who are depressed as they are often isolated and have no family support. Doctors also warn that many cases remain untreated.

Expatriates have no close friends because their stay here is transitory, say the doctors, noting that the very early warning signs of depression are lack of energy, sleeplessness, isolation, complaints of headaches and pains.

“Even though effective medical treatment can be provided by a psychiatrist, very often patients do not find their way to a specialist clinic,” said Dr Michael Grundmann, senior neurological consultant at the German Centre for Neurology and Psychiatry.

According to the Depression Alliance, a leading British charity for people with depression, the top 10 sources of stress at work are lack of job fulfillment, feeling that your contribution is not valued, poor distribution of work and resulting overload, not knowing what is expected of you, and lack of autonomy and feeling of trust. Dr Carolyn Roseler of the Emirates Clinic, said recently the Rashid Hospital has taken steps to liaise with clinics and called for regular mental health awareness weeks, as in Australia, to help stop people hiding their depression, thinking that it is a “weakness” of sorts. She said depression is a major global problem as people lead stressful lives, not giving themselves enough rest time and not spending enough time with their families. There should be more avenues to people with depression where they can turn to for help.

Grundmann (German Center for Neurology, Psychiatry, Psychology, Psychotherapy & Counseling, Dubai UAE) said the workplace is not the only cause of depression, but it is an important factor for most people. “By raising awareness at the workplace and by improving work conditions, we can help to reduce the instances of depression, helping those who are affected to recover more quickly and also help the employers and the economy by reducing sick leave dramatically.” He said depression is most common between 20 to 35 years, “during the prime earnings years, as people tend to heap the most pressure on themselves to make money and achieve success”. Grundmann (German Center for Neurology, Psychiatry, Psychology, Psychotherapy & Counseling, Dubai UAE) said the second high-risk age group is 60 to 65, “when adults wind down their working life& and a sense of worthlessness [sets in] and unusual amounts of free time that has to be organized”.

Factoids: Treatment could help

80 per cent of people suffering from depression can be helped with appropriate treatment. Depression is brought about through interaction of external and internal stresses, genetic factors and biological changes in the brain. People suffering from depression often complain of physical problems such as headaches and stomach pains, rather than of a low mood. “Talking treatment” or cognitive behavioural therapy, is as important as anti-depressant medication. The therapy is based on the fact that the way we feel is partly dependent on the way we think about ourselves and what is happening to us.

Change your lifestyle. Exercise more, avoid alcohol, and try relaxation techniques like meditation.

2009 April; German Center for Neurology, Psychiatry, Psychology & Counseling: “Depression Awareness Week”

Accepting the depressing reality
By Carol Spiers, Special to Gulf News Published: April 27, 2009, 23:16

Perhaps you celebrated Depression Awareness Week by taking advantage of the free Depression Tests at the German Centre for Neurology and Psychiatry.

As a newly-arrived team, these specialists were able to take a sharply focused view of the Dubai factor in work-related depression. Resident senior neurological consultant, Dr Michael Grundmann, (German Center for Neurology, Psychiatry, Psychology, Psychotherapy & Counseling, Dubai UAE) explained that the large expatriate community suffered from being a long way from their family and friends, and lacked the social support network that is necessary for reducing stress levels and warding-off the onset of chronic depression. He says the condition is most common between 20 and 35 years of age, during the prime earning years, as people tend to heap the most pressure upon themselves to make money and achieve success, often not realising the stresses this brings. This tallies with other findings over the years that people in their early thirties in high-stress jobs run twice the risk of suffering serious depression or anxiety as those in lower-stress occupations. Top of the league are head chefs in top restaurants and construction workers under pressure to complete a building on time. They are found to be six times more likely to buckle under stress, because they are working to deadlines in an environment where failure is publicly visible, while facing hard physical labour in extremes of heat or cold, frequently without encouragement or support.

As an established local stress consultant (German Center for Neurology, Psychiatry, Psychology, Psychotherapy & Counseling, Dubai UAE), I can certainly confirm all of that. In Dubai, the stress levels have outstripped anything I’ve seen in other great capitals. The sheer pace of business in the Emirates the acutely competitive nature of the work, the exhausting heat, and now the credit crunch, applying huge extra pressures of uncertainty, financial disruption and the daunting prospect of idleness. A Depression Awareness Week for Dubai seemed timely indeed. But depression does not just come from overwork. I am always strongly aware of that other less-obvious stressor, idleness. The most memorable case of this in my experience was in Switzerland, where I once had to counsel an engineer installing a new ski-lift in one of the top resorts. His contract included a lucrative bonus for punctual completion, but heavy penalties in the event of lateness. Then at a crucial moment, they found that the biggest component of all, the huge wheel that controlled the lift, was faulty; an ultrasonic test showed that it had developed a structural fault and, until a replacement arrived, the team could do nothing but wait on the spot, poised for action. He said it was the longest three days of his life - simply forced to do nothing. Some people might have envied him, free to laze about on scenic slopes. But it is actually very hard to do nothing. And I hope that this does not become Dubai’s next challenge, as we confront the global downturn.

- The writer is a BBC broadcaster and motivational speaker, with 20 years experience as CEO of Carole Spiers Group, an international stress consultancy based in London.

Depression: Trigger factors
- Prolonged pressure turns to stress and then depression.
- Big bonuses and penalties raise the stakes - and the stress.
-Redundancy and idleness cause as much depression as overwork.

2009 September; German Center for Neurology, Psychiatry, Psychology & Counseling: “Do we use only 10% of our brain?”

A matter of fact

Myth has it that we only use a very small percentage of our brain’s full power. Eve Dugtiale delves deep inside the mind of an expert to find out if this is true.

The guy who cuts you up on the highway almost causing an accident - he probably doesn’t use his brain to its full capacity.The woman who uses three plastic bags to transport a packet of cigarettes, bottle of milk and a loaf of bread to her ridiculously sized SUV - her grey matter more than likely isn’t being used to its full extent either. But the truth is, none of us use our brain to its full capacity all of the time - and it’s actually a good thing believe it or not. Yes, even those of who hog the answer sheet at the pub quiz and think they’re far more intelligent than any scientist or doctor quoted on the TV, are probably not utilising 100 per cent of their mind’s actual power.
But experts from the German Centre for Neurology and Psychiatry in Healthcare City say if we did use all of our brain, all of the time, it would be seriously damaging to our health.
“We don’t use 100 per cent of the electrical activity in our brain all of the time and we should be very happy, because otherwise we would he seized by what neurologists call an epileptic attack!” explains the centre’s Doctor Arne Brosig, specialist in neurology, psychiatry, psychotherapy, rehabilitation. Myths are abundant about how much of our brains’ full power we actually use; with many citing that it’s less than ten per cent. However, scientists say there’s no evidence to suggest this is true. It’s believed a misquote by Albert Einstein about mental capabilities is to blame for the misconception. Doctor Brosig adds: “Thanks to evolution it is quite unlikely that us humans carry around an organ which is 30 per cent not working or useless.
There are people surviving with only one half of the brain, but this is only possible because of neuro-plasticity (the brain’s ability to reorganize itself by forming new neural connections.” Reading, enjoying electronic brain training games, tackling the daily crossword or even just enjoying a debate with a pal can all help keep your brain active, out sadly, there’s no way to make our brains work 100 per cent, all of the time.

20??; German Center for Neurology, Psychiatry, Psychology & Counseling: “??” Grundmann child depression

Depressed children at risk, say doctors

Condition often difficult to diagnose

Bad behaviour may be a sign that there is a problem, and experts warn that when a child talks suicide, it should be taken seriously

Mitya Underwood ABU DHABI // Children as young as nine are being diagnosed as depressed and are being prescribed anti-depressants, doctors say. They have issued a warning that factors like the economic down turn can affect children, and any signs of depression, such as a child talking about suicide, should be taken seriously.

Doctors in t he UAE said there had been a number of attempted suicides by children whose depres¬sion had not been detected or had not been treated properly.

The World Health Organization’s global figures state that one in 33 children under the age or 12 is depressed, but health experts in the UAE suggest the figure could be higher here and rising.

Dr Alif Saleh, a clinical psychologist at Rashid Hospital, said it was often difficult to diagnose and treat a child with depression. “It is sometimes seen as a taboo. And some parents want quick fixes which just is not possible. Having a child with a mental health probem is not always something a parent wants to admit. “We have to deal with the situation with great delicacy because usually we have some cases of attempted suicide. We have (children aged) nine and 10 years here in the hospital whose depression has failed to be detected.  Dr Saleh said it was important for health professionals to know what to look out for in children as the symptoms of depression were different from those in adults. Temper tantrums, anxiety, psychosomatic complaints and lack of enthusiasm about friends and school could all be signs. “A family may not have the support system and does not have time to come for 45 minutes a week so say ‘Give us medication for three months and it will fix it’.” Dr Saleh said he thought mental health services for children were improving but more could be done. “Families are learning that there is nothing to be ashamed of so will seek help; this shows there is a need for services. Tour years ago ii was very different,”

The WHO estimates that by 2020 depression will he second only to chronic heart disease as an international health burden. Depression Alliance, a UK-based charily that organizes Depression Awareness Week, which begins on April 21, estimates that as many as one in five will suffer from depression at some point in their lives. There are no epidemiological studies for the UAE, which makes it difficult for doctors to establish the true extent of the problem.

Dr Roghy McCarthy, a clinical psychologist who has practised in the Emirates for a decade, has noticed an increase in child patients. “Maybe five years ago in a class of .10 children there would be one who had a problem, now there are at least seven with a couple more masking it.” she said. “The rise in depression is a combination of family lives becoming more Stressful and children expressing themselves better.”
Dr McCarthy recalled a nine-year-old who tried to commit sui¬cide in school. “We have to take it very seriously when a child says they want to die. This is why it is so important for parents to look for signs, especially if there are difficulties in the home such as divorce.”

In March, the UN released fig¬ures showing the UAE had one of the highest rates of divorce in the Muslim world. The num b e r of broken marriages rose 13 percent to 12,974 a year from 2002 to 2004. The Tawasel Centre for Training and Family statistics show one in four marriages among the whole population is breaking down.

Dr McCarthy said this breakdown was a leading cause of childhood depression as children often fed off their parents’ emotions. She said parents often mistook depression for bad behaviour as it could manifest itself as aggression lo oilier children, particularly sib¬lings. “Slowly people are realising it is not just bad behaviour, there could be a serious problem.”

Dr. Kathrin Foehe, a paediatrician al Isis-The French Clinic, in Dubai Healthcare City, said epidemiological studies would greatly help in finding solutions. “The prevalence of depression is recently reported to be one in 33 in Dubai and a recent study in Al Ain showed a prevalence of 20 percent for overall psychiatric disorders with no child receiving any treatment. It is important to carry out an epidemiological study in the UAE.” Dr Foehe said parents should not only be aware of the symptoms of childhood depression but also needed to know how their own behaviour affected the child’s mental state. Times of stress, such as financial crisis, could have a great impact on all the family. “Children can be affected at any age,” she explained. “Even infants and toddlers. Of course the symptoms are different in different age groups. Children are sensible and perceptive, they easily capture the mood in the family, not only the problems but also suffering or stressed parents.”

The Ministry of Health, which has jurisdiction over the Northern Emirates, announced in September that it would carry out a comprehensive study of the physical an d mental state of children.

In the 2005 Global School-based student Health Survey, the WHO found 14.4 per cent of the UAE children felt so worried about something that they could not sleep at night. It also indicated that 13 per cent of children had seriously con¬sidered suicide and 9.8 per cent had planned how they would do it.

The WHO surveyed 15,790 pupils aged between 13 and 15, in 194 government and private schools across the Emirates. “Suicide occurs not only in adolescents but in children, Dr. Foehe said “Children under 10 years old are not aware the lethal implications so suicide attempts are most¬ly impulsive and not planned.”

A study of 321 households in Al Ain, in 2001, showed 16.4 percent had one child with psychiatric problems, including depression. The study, by Al Ain University, said the findings also showed “that while the prevalence and nature of mental health prob¬lems in children are similar to those reported from the West, the majority go unrecognized and un¬treated”.

It blamed ignorance, negative attitudes and social stigma for the failure to seek help, Dr Michael Grundmann, senior consultant of neurology at the German Centre for Neurology and Psychology in Dubai Healthcare City, said he would like to see more facilities just for children because treatment needs were “completely different” from those of adults.

20??; German Center for Neurology, Psychiatry, Psychology & Counseling: “??” Friday Magazine DBS

Deep Brain Stimulation is a highly complex yet revolutionary surgical procedure that offers relief to patients suffering from severe cases of Parkinson’s and certain movement disorders. Alex Westcott visits The German Centre for Neurology and Psychiatry in Dubai to find out more.

A ray of hope

The patient, who is suffering from Parkinson’s disease, is lying on the surgery table. He is wide awake while a neurosurgeon plants a mechanical device deep in his brain. The patient needs to be awake as his cooperation is necessary to map the precise location to place the pacemaker. This device can relieve him of the symptoms of Parkinson’s. The bright lights are focused on him and he can see nurses flitting about in the periphery. He is aware of electrodes being implanted in his brain and is cognisant of all that is happening around him. Having inserted the device into the brain target area successfully, the specialist sends a pulse of electric current to the brain through the implanted electrodes thus stimulating the current; he is keenly watching the patient’s hand which is trembling violently. The doctor manipulates the dials adjusting the current flow and, almost miraculously, the patient’s hand which was shaking begins to relax. In a few seconds, the trembling lessens until the hand is resting completely still by the patient’s side. This is perhaps the first time in over a decade that the patient has not experienced trembling in his limbs. Called Deep Brain Stimulation (DBS), this medical procedure is offering a spark of hope to many long-suffering patients of Parkinson’s as well as those affected by certain movement disorders. For patients in advanced stages of Parkinson’s, where drug therapy no is being hailed as a miracle alternative. The technical principle is similar to the better-known heart pacemaker where electric current (that can be controlled depending to the severity of the condition) is administered via implanted electrodes. Dr Arne Brosig, founder of the German Centre for Neurology and Psychiatry (GNP) at Dubai Healthcare City (DHCC), had much to say about the improvements in treatments for people with Parkinson’s and neurological and psychiatric movement disorders. Through a unique collaboration with the world-renowned neurosurgeon and DBS pioneer Professor Volker Sturm, chairman of the clinic for stereotactic (a minimally-invasive form of surgical neurosurgery of the University of Cologne - the biggest stereotactic department worldwide, Dr Brosig and his colleagues at DHCC are hopeful for the future possibilities DBS treatment will present for patients in the UAE.

The pioneer and expert of DBS
Fifteen years ago, Professor Volker Sturm, who holds the chair of the award-winning clinic of stereotactic neurosurgery at the University of Cologne, introduced Microinvasive Deep Brain Stimulation (DBS) in Germany. The procedure was designed to treat those with movement disorders such as Parkinson’s disease as well as patients suffering from certain psychiatric diseases. Initially, Professor Sturm successfully treated tremors in patients with advanced Parkinson’s. With more than 1,000 DBS procedures having been conducted for Parkinson’s disease, Professor Sturm has gained the most experience in DBS worldwide. He has performed numerous DBS operations in movement disorder patients at the International Institute of Neurosciences (INI) Hannover alongside founder and President Professor Madjid Samii, leading the unit of stereotactic neurosurgery. By transmitting electric current via electrodes, it’s possible to regulate the part of the brain that had malfunctioned, causing the condition in the first place.

How it works
In the early stages of Parkinson’s, a patient can be treated with medication. But after 10 to 15 years -after the disease has reached a critical stage - DBS can be administered. “Electrodes are planted in the brain which are connected [to an electric source] via cables. It works the same way as a heart pacemaker does and is worn under the skin,” explains Dr Brosig. After surgery, the doctor can manipulate the intensity of the electric current externally. The latest development is the Medtronic Restore Rechargeable “The treatment of this illness is complex and intricate,” says Dr Arne Brosig. After the electrodes have been implanted, Neurosurgeon Professor Sturm connects them to an electronic preamplifier, stimulating the brain tissue. Neurostimulation System, which is a pacemaker that can be recharged once a week for a few hours externally while the patient follows his/her daily life activities unrestricted. In October last year, the first generator of the new generation of pacemakers was implanted in a patient by Professor Sturm at his clinic in Cologne. “Previously, the pacemaker would have to be surgically removed and replaced every three to four years,” says Dr Brosig. “Now the patient does not have to undergo [repeat] surgery for at least ten years after the Medtronic pacemaker has been inserted.” What is remarkable about DBS in severe cases of Parkinson’s is that after the pacemaker is inserted, patients with a positive outcome can enjoy an almost normal quality of life. They can feed and bathe themselves.

WHAT IS PARKINSON’SDISEASE?
Parkinson’s is an extra pyram¬idal movement disorder. The brain controls and influences movement - it formulates the idea for movement and fine regulation instructs it. Parkinson’s involves a disrup¬tion in the extra pyramidal system resulting in muscle rigidity, tremors, a slowing of physical movement (bradykinesia) and, in extreme cases, a loss of physical movement (akinesia). The tremors are initially unilateral, affecting only one side of the body and will occur when the muscles are resting. But as the illness advances, the tremors come to dominate the entire body and become constant and uncontrollable. “Alongside motor distur¬bances, depression, psychosis, hallucinations and dementia are common in up to 50 per cent of cases,” says Dr Brosig. Parkinson’s is equally prevalent in men and women. When Parkinson’s occurs in men, it is common for their voice to become inaudible as it grows steadily hoarse and eventually becomes muted. World-famous ex-boxer Mohammad Ali as well as actor Michael J. Fox are two well-known men battling this debilitating disease. Dr Brosig explains that there is a genetic strain of Parkinson’s, particularly in the younger age group of sufferers, between 40 and 50.Parkinson’s is most likely to develop in patients who are in their fifties, but development in the thirties is not unheard of. “Severe sub¬stance abuse can also destroy this part of the brain and thus mimic the same symptoms as Parkinson’s,” explains Dr Brosig.”You can’t die from Parkinson’s, but you die from the complications that arise as a result of this condition. The lungs can become infect¬ed, and the tremors in an advanced stage can limit the activity of the patient to the point that he or she is bedrid¬den. Sometimes an orthopedic specialist may need to step in because intense pain develops in the lower back. Needless to say, the treatment of this illness is complex and intricate.”

Who is eligible for treatment?
Only patients suffering from a severe movement is no longer working will be considered for this procedure. “This is very much a last resort technique because it is a very complex neurosurgery [procedure],” emphasises Dr Brosig. “But it can be incredibly effective and, with new and improved techniques, results have been even more successful. As a result, I expect a huge demand for it in the UAE. “At the moment, we are conducting tests on patients to gauge who are suitable candidates for the procedure. We have to make certain that their heart is stable, take blood samples, conduct and do an EEG, which is a medical test to determine brain activity. We have already flown a few UAE patients to Germany for DBS treatment and the results have been impressive,” he says. This is where Dr Barnikol comes in. After visiting Dubai late last year to conduct research and investigate cases eligible for surgery and returning to Germany, she is now back in the emirate. Parkinson’s patients are not the only ones eligible for treatment as DBS has proven to be most successful in cases of Distonia and Tourette’s syndrome. Professor Sturm and his partner Professor Joachim Klosterkotter, director of the department of psychiatry, recently discovered that DBS also proved an effective treatment for patients suffering from Obsessive Compulsive Disorder.

DBS in the UAE
In the UAE, the population is on average younger than other population demographics, so the number of those affected by Parkinson’s is not as high as those in Europe. “It is estimated that over 150,000 patients are suffering from Parkinson’s disease in Germany alone,” research from the University of Cologne shows. While the numbers are not as staggering in the UAE when compared to Europe, Parkinson’s remains a disease that dominates many people’s lives in the UAE. Thanks to the region’s centrality, DHCC is becoming a hub for advancing medical procedures. “DHCC is a magnet for healthcare in the Middle East. We have patients from Bahrain, Qatar, India, Pakistan among other countries seeking medical opinion,” says Dr Brosig. This is a reason there is keen cooperation between Dr Brosig, Dr Volker Strum and Dr Utako Barnikol, who is part of the neuromodulation team at the University of Cologne. Dr Barnikol acts as the bridge between the German Centre for Neurology and Psychiatry and the University of Cologne channeling information and networking and connecting different disciplines of neurosurgery, psychiatry, neurology and neurophysiology to treat psychiatric and neurological disorders. The aim is to encourage this facility on a more permanent basis in the UAE with the extensive knowledge of Professor Sturm. Up till now, specialists have been flying in from Germany to treat patients in the UAE, as there has never been an established practice for treating sufferers here. Says Dr Barnikol: “Our first goal is to transfer concentrated knowledge about novel therapies to GNP in Dubai. In line with this cooperation strategy Professor Sturm has kindly agreed to transfer his professional competence to the UAE by operating personally in Dubai or operating on UAE patients in Germany. Professor Sturm has already established a close collaboration with Dr Abdul Karim Msaddi from the Neuro Spinal Hospital in Dubai, where he has performed several DBS operations on Parkinson’s patients. Besides the direct neurosurgical practical profession, advanced and proven presurgical planning is needed. Most important is the calculation of the best access to the target area in the brain without affecting blood vessels. This elaborate presurgical planning developed by Professor Sturm is pioneering and has less than one per cent side effects. The plan is to establish DBS treatment within a comparable high-quality elaborate UAE centre such as the unique stereotactic centre of Professor Sturm’s in Cologne. Dr Brosig adds: “I believe this clinical research cooperation between GNP and the team of DBS specialists, which has operated on thousands of patients and is led by a pioneer of stereotactic neurosurgery, is a major coup for the UAE and Middle East.”

Parkinson’s patients are not the only ones eligible for treatment as DBS has proven to be most successful in cases of Distonia and Tourette’s syndrome.

Looking to the future
“The future of healthcare in Dubai holds exciting possibilities. Many who expected to suffer with their condition until death now have access to some of the most advanced expertise in the world right here in Dubai. And that’s just fantastic,” says Dr Brosig.
For more information contact Professor Volker Sturm at volker.sturm@uk-koeln.de or Dr Arne Brosig at Brosig@GNP-Dubai.com

2009; German Center for Neurology, Psychiatry, Psychology & Counseling: “Depression in Dubai”

Down in Dubai
‘Depression is most common between 20 and 35 years of age’

The UAE’s expats are at high risk of developing depression right now. Neurological consultant Dr Michael Grundmann (German Center for Neurology, Psychiatry, Psychology, Psychotherapy & Counseling, Dubai) tells Laura Chubb why

Is depression a big problem here In Dubai?
Grundmann (German Center for Neurology, Psychiatry, Psychology, Psychotherapy & Counseling, Dubai) Depression is prevalent in the UAE, but for different reasons than in other countries. Depression often stems from work-related problems and stressful work of expats - in cities such as Dubai and Abu Dhabi in particular - is not dealt with in the same way as might be (lie case in expats’ homelands. Another point is, of course, the financial crisis. The reason this causes depression is the loss of control. When people are thinking about things they can’t influence, it induces masses of stress.

So expats an particularly at risk?
Grundmann (German Center for Neurology, Psychiatry, Psychology, Psychotherapy & Counseling, Dubai): Yes. Often separated from family or friends, expats here commonly do not have a social support network, which is essential to reducing stress levels and fending off the onset of chronic stress and depression. The human is a social animal, so when they have a hick of functional relationships, this will induce stress.

Any other risk factors?
Grundmann (German Center for Neurology, Psychiatry, Psychology, Psychotherapy & Counseling, Dubai): Depression is most common between 20and 35 years of age. It’s the rush hour of life, you have to establish yourself in your job, you have to start a family People heap pressure upon themselves to make money and achieve success, often not realising the stresses this brines. It causes a huge mixture of problems and challenges. Without support, there`s no relief from this stress. So there`s more risk at this age of getting depressed.

Is It true that depression comes with physical symptoms?
Grundmann (German Center for Neurology, Psychiatry, Psychology, Psychotherapy & Counseling, Dubai): Depression is a real, biological illness. The problem is that most people think, ‘Ah, I’m not depressed, that only happens to weak people,’ you know? Depression is not a disease that happens to weak people. An imbalance of hormones in neurotrans¬mitters is the biological reason for depression. Higher levels of Cortisol in the blood, caused by chronic stress, cause a decrease of serotonin in the brain.
You can even see it on a special MRI scan.

So what are the physical symptoms?
Grundmann (German Center for Neurology, Psychiatry, Psychology, Psychotherapy & Counseling, Dubai): Loss of concentration, lower back pain, aches in the shoulders and neck. Depression causes dysfunction of the muscles, so then those muscles develop a pain. It’s quite common to have lower back pain. The most striking symptom is change in sleeping pattern. Often, the patient wakes up in the early hours of the morning and they can’t get back to sleep, this is the first goal of treatment to improve sleep. Other symptoms could be a change in eating pattern, a loss of appetite or increased hunger. Sometimes people gain weight, sometimes people lose weight. It’s different.

What’s the best way to treat depression?
Grundmann (German Center for Neurology, Psychiatry, Psychology, Psychotherapy & Counseling, Dubai): First of all, you have to take it seriously. You have a right to feel depressed; it’s a real, biological illness. The treatment can contain many different solutions - social groups, self help groups, even anti-depressant medicines. Mainly, it’s a re-program¬ming of thinking. At CBT (cognitive behaviour therapy) you learn to change your attitude, to change your mind. With depression, you get caught in a cycle of negative thoughts and you have 10 breaks out of it.

If you think you might be depressed, con lad your local GP for advice. Alternatively, the German Centre for Neurology and Psychiatry in Healthcare City offers depression test.  Call 04 4298578 or visit www.gnp-dubai.com

Depression: The facts
• Depression affects 120 million people worldwide
• More than 2.9 million people are diagnosed with depression at any onetime
• Winston Churchill experienced bouts of depression

(German Center for Neurology, Psychiatry, Psychology, Psychotherapy & Counseling, Dubai)

2009; German Center for Neurology, Psychiatry, Psychology & Counseling: “Couple / Family Counselling”

SAME OLD STORY MADE NEW
If you are one of those people who overdoses an your new favorite song until you are sick of it, or who has the same thing for lunch for weeks at a time until you can’t stand it anymore, you might be a victim of variety amnesia. However, according to researchers at the University of Minnesota’s Carlson School of Management, over-satiated consumers can regain their love for a product simply by mentally recalling all the different songs, or lunches, they have previously enjoyed. In the study, participants listened to their favorite song 20 times in a row and, unsurprisingly, were not that keen on it by the end. Three weeks later, half the group were asked to recall all the songs they had heard in the three weeks while the other half were asked what TV programs they had watched. The TV group still did not like the song and were angry at the song being ruined for them, while the music group had almost totally recovered, liked the song and said that they had enjoyed the whole experience.

Simple steps to healthy relationships and emotional wellbeing By Louisa Wilkins

IS ANXIETY CONTAGIOUS?

l have suffered from anxiety attacks and Agoraphobia for years, but now I am worried that I might be passing it onto my eight-year-old son. Golda Ginsbung, child psychologist and associate professor of psychiatry at the Johns Hopkins School of Medicine, says that 65 per cent of children with anxious parents show symptoms of anxiety and that they are seven times more likely to develop full-blown anxiety disorders. A recent Study by Ginsburg suggests that the risk can be reduced by dealing with the situation early on. Ginsberg advises a course of eight, weekly Cognitive Behavioural Therapy (CBT) sessions for both the children and the parents, in which the children learn coping and problem-solving skills and the parents learn how to modify certain risk-related behaviours, such as overprotection. This program was found to reduce the children`s chances of developing anxiety in the following year down to zero and to reduce anxiety symptoms by 40 per cent. The German Centre for Neurology and Psychiatry (www.gnp-dubai.com) offers CBT (German Center for Neurology, Psychiatry, Psychology, Psychotherapy & Counseling, Dubai).

HO, HA OR HMMM?
A recent study published in the American journal, Emotion, highlights the emotional difference between a belly-rumbling guffaw and a snide snigger The study sought to differentiate between laughter types — joyful, tickling, taunting and Schadenfreude (taking pleasure from others misfortune) — and to rate them against emotional parameters. Researchers concluded that laughter is a social toot, used for establishing groups and for including or excluding individuals.

Not everything’s perfect — it is okay to say, ‘I need a bit of help today’,- Singer Myleene Klass

SHOW ME THE LOVE>> According to celebrated American family therapist and author Virginia Satir, we all need four hugs a day for survival, eight hugs a day for maintenance, and 12 hugs a day for growth.

2009; German Center for Neurology, Psychiatry, Psychology & Counseling: “Parenting Solutions”

Tough love

Being harsh with children is not the right way to discipline them. A firm yet loving approach is far more effective in driving home the message, says NEERJA SINGH
(German Center for Neurology, Psychiatry, Psychology, Psychotherapy & Counseling, Dubai)
Rania Hamdi Abdel Jawad, an Egyptian leather who recently moved to the UAE, is eagerly expecting her firstborn in a few months. Already, Rania has started to think about the sort of parenting that would work best for her child. “I think I will be like my mother; she was very clever and strict.”
Strict is not a word we could have use in a complimentary manner a couple of decades ago for a parent, but social altitudes are shifting, says Dr Arne Brosig of German Centre for Neurology Psychiatry. “In the 70s, we thought it was wrong to use any kind of harshness with children that their sensitive souls could be permanently damaged by too much discipline. Now, however, we are increasingly realising that the parent’s intent is paramount. A child instinctively knows when a strict parent comes from a place of love, and that can actually be better than handling children with kid gloves, “says Dr Brosig.
Wise words, but how can a parent conveys a harsh message in a loving manner? “Consistency is key. Children love their routine, and they need parents to set limits. But wavering boundaries confuse a child; a parent needs to — at least in the initial years—be firm about what acceptable behaviour is and what is not. And when the child goes off-limits, punishment should be immediate and in line with the seriousness of the action. Unfair punishment makes children bitter and rebellious. For example, if a child has not done her homework, I would ask her to stay back after school and finish it, or forego a play period to do her work. On the other hand, taking away a treat’ such as a class picnic would be unfair and counter-productive, “says Nandita Saxena, an Abu Dhabi based teacher.
Saxena actually goes a Step further and lets her students decide what rules should govern the class. They form four teams, come up with their ideas, and then choose the five most important ones. Letting them take ownership in this way removes a teacher’s burden of being the monster who keeps the class in control, and discipline is self-imposed. “What’s funny is they know what tin¬most important rules are,” says Saxena.
Unfortunately sometimes its parents who don’t appreciate the crucial role they play as role models. Be it work pressure, I lie lack of time or simply a lack of awareness, our lives are getting more robotic and superficial and the evidence is most visible in the food we cat and how we choose to spend the little free time we have. “We do not realize the extent to which processed food and TV impacts child behaviour.” says Latha Srikrishna, a mother of two, who now teaches six- to eight-year-olds the “Art of Living’ programme.
According to Latha, when children are taken off fast food, fizzy drinks and TV during the week-long programme, there is an immediate shift in their attention spans, academic performance and overall discipline, “Very often, just two weeks after tile programme, a child who could not sit still for half an hour U able to calmly participate in a two-hour long session without interruption.”
If families invested time in cooking fresh food, reading, painting and playing with their young ones instead of watching TV every evening, we might create a far more peaceful society for the next generation. “It is not easy,” says Maithily Desai, a Dubai-based chartered accountant who has placed her family before a career. “You have to be at it all the time, no matter how you feel but that is a responsibility we choose to take on when we become parents, and it has to lie done”
Loving parental interaction in the early years is also crucial in creating a warm, happy environment at home so that children want to be there. A tense, authoritarian parental attitude drives children away as they get older, with peers taking on a more influential role, which can sometimes scar a child for life. Of course, there are times when something more than parental attention and concern is required, and a child genuinely needs help. These include cases where children suffer from conditions such as attention deficit hyperactivity disorder and dyslexia. “In such cases, parents should not assume the child is being ‘naughty’. Instead of using harsh discipline, they should seek medical help.”‘ advises Dr Brosig (German Center for Neurology, Psychiatry, Psychology, Psychotherapy & Counseling, Dubai).

2009; German Center for Neurology, Psychiatry, Psychology & Counseling: “Employees Mental Health” 

Address Your Employees’ Mental Health Concerns
Dubai - Doctors are urging employers to address the mental health concerns of their employees in view of the heightened levels of depression and anxiety, thanks to the global economic meltdown. Experts, while speaking on the sidelines of a mental health conference organized by Harvard Medical School Dubai Centre Institute for Postgraduate Education and Research in Dubai, said it was high time organizations attended to stress-related conditions in the workplace. When an economy contracts, they said, it can cause huge pressure on individuals, and employees in the L’AE are not immune to these forces as there is a close association between economic problems and poor mental health.

Dr Sarah Peter, director of Prime Health Group at Dubai Health Care City, said job insecurity and financial worries were related to feelings of powerlessness, reduced Job satisfaction and lower levels of trust. This goes to the heart of what Freud believed we want from life the ability to work, and the ability to love.” she said. “We fear that if we lose our job, not only do we lose our status, but we may also be unable to provide for our famines.” She said employers can boost their own performance as well as that of staff if they stick to healthy management practices even when times are tough.
“Most of the research supports that investing in employees can have spin off effects on your staff. If you look at t he top 1o companies in the world, what differentiates them is their willingness to invest in their people.”

An increasing number of international studies are linking the recession to ill health  particularly anxiety; heart disease and stress. Rising unemployment and falling property prices are cited as two key factors that can alter a person’s overall health. Recent research by an American employment agency suggests that one in five US workers feels the recession is causing them mental health problems. Though there are no specific statistics available for the UAE, local media, including Khaleej Times, had earlier reported an increase in number of people seeking assistance to deal with depression and anxiety in the recent months.

Dr Arne Brosig from the German Centre for Neurology and Psychiatry at DHCC said it was really important to try and analyse the causes of high stress levels currently experienced by people.
“When times are bad, it’s important to try and confront problems head-on.” he said “Listing specific reasons for your stress can help one become aware and feel leas overwhelmed.”
Brosig (German Center for Neurology, Psychiatry, Psychology, Psychotherapy & Counseling, Dubai) said It can also help one to identify areas of his or her life that make them feel secure and calm, allowing them to create time to focus upon these areas.

Dr Prof. Shaikh Saoud Abdulla Al Mualla, who heads a network of mental health experts, said employers should raise awareness of mental health and stress related issues in the workplace.
“In this country, mental health issues are extremely common,” he said “We are not talking about something on the periphery; mental health affects everything and is affected by everything.”
sajila@kaleejtimes.com

Acknowledge their contribution

♦ Doctors said acknowledging the vital contribution made by stressed or depressed staff is one way that employers can boost their morale. This can also maximize business efficiency during the current economic downturn.
♦ Managing sickness absence effectively is another way advised for companies to address patterns of stress and ill health quickly.
• While urging companies to promote wellbeing at work, doctors said stressed out workers should realize the fact that these problems can affect anyone and, what they need to do is to bounce back by looking at positive aspects of life.
♦ Short, intense bursts of activity can boost both productivity and morale. They said creating a ritual of working for 120 minutes followed by a 15-minute break is one of the most effective ways to beat stress.

(German Center for Neurology, Psychiatry, Psychology, Psychotherapy & Counseling, Dubai)

2009; German Center for Neurology, Psychiatry, Psychology & Counseling: “Depression in Dubai”

Accepting the depressing reality

Perhaps you celebrated Depression Awareness Week by taking advantage of the free Depression Tests at the German Centre for Neurology and Psychiatry.

As a newly-arrived team, these specialists were able to take a sharply focused view of the Dubai factor in work-related depression. Resident senior neurological consultant, Dr Michael Grundmann (German Center for Neurology, Psychiatry, Psychology, Psychotherapy & Counseling, Dubai) explained that the large expatriate community suffered from being a long way from their family and friends, and lacked the social support network that is necessary for reducing stress levels and warding-off the onset of chronic depression. He says the condition is most common between 20 and 35 years of age, during the prime earning years, as people tend to heap the most pressure upon themselves to make money and achieve success, often not realising the stresses this brings. These tallies with other findings over the years that people in their early thirties in high-stress fobs run twice the risk of suffering serious depression or anxiety as those in lower-stress occupations. Hardest hit Top of the league are head chefs in top restaurants and construction workers under pressure to complete a building on time. They are found to be six times more likely to buckle under stress, because they are working to deadlines in an environment where failure is publicly visible, while facing hard physical labour in extremes of heat or cold frequently without encouragement or support.

As an established local Stress consultant, I can certainly confirm all of that. In Dubai, the stress levels have outstripped anything I’ve seen in other great capitals. The sheer pace of business in the Emirates, the acutely competitive nature of the work, the exhausting heat, and now the credit crunch, applying huge extra pressures of uncertainty, financial disruption and the daunting prospect of idleness. A Depression Awareness Week for Dubai seemed timely indeed. But depression does not just come from overwork. I am always strongly aware of that other less-obvious stressor, idleness. The most memorable case of this in my experience was in Switzerland, where I once had to counsel an engineer installing a new ski-lift in one of the top resorts. His contract included a lucrative bonus for punctual completion, but heavy penalties in the event of lateness. Then at a crucial moment, they found that the biggest component of all, the huge wheel that controlled the lift, was fault; an ultrasonic test showed that it had developed a structural fault and. until a replacement arrived, the team could do nothing but wait on the spot, poised for action.

Dr. Grundmann (German Center for Neurology, Psychiatry, Psychology, Psychotherapy & Counseling, Dubai)said it was the longest three days of his life  simply forced to do nothing. Some people might have envied him, free to laze about on scenic slopes. But it is actually very hard to do nothing. And I hope that this does not become Dubai’s next challenge, as we confront the global downturn.

DEPRESSION TRIGGER FACTORS:
• Prolonged pressure turns to stress an i then depression.
• Big bonuses and penalties raise the stakes — and the stress.
• Redundancy and idleness cause as much depression as overwork

2009; German Center for Neurology, Psychiatry, Psychology & Counseling: “Headache Awareness Week”

After nearly 20 years of prescribing the same medications to severe headache sufferers and hearing the same, seemingly incurable complaints of pain, throbbing and nausea, doctors finally have good news for patients. A slew of drug breakthroughs and advances in other treatments, from magnetic stimulation to yoga breathing, mean the options now on offer can vastly improve the quality of life of those affected.

Speaking on the first day of Headache Awareness Week (June 7-13, 2009) Dr Arne Brosig of German Center for Neurology and Psychiatry (GNP) in Dubai Healthcare City, explains how headaches are a common problem in the UAE.

“After depression, headache is the most common complaint from patients at our clinic, and it is a vast area of study  with over 30 identified types of identified headache. Undoubtedly, the hot climate in countries such as the UAE exacerbates the problem in many people explains Brosig (German Center for Neurology, Psychiatry, Psychology, Psychotherapy & Counseling, Dubai UAE). Add to this the stresses of living in a hectic city with daily commuting and long working hours and headaches are often the consequence. Interestingly, patients often claim that the problem is relieved when they go abroad, or even after a relaxing weekend in Oman and Fujeirah, when their tension levels drop. “It may sound trivial to some, but headaches can greatly reduce quality of life and even alter personality and affect relationships over time. For sever or prolonged headache cases, specialists can prescribe medication, which will relieve the problem and this should be complemented with preventive treatments and steps,” he said (German Center for Neurology, Psychiatry, Psychology, Psychotherapy & Counseling, Dubai UAE).
The goal of Headache Awareness Week is to educate the public about the impact and severity of headaches, support sufferers of one of the most common pain-related health problems in both children and adults and encourage sufferers to see a physician for proper diagnosis and treatment, where they will learn the new treatments available.
As long as humans have endured headaches, which affect all but one per cent of women and seven per cent of men, the prevailing remedies have included painkillers, ice packs of a dark, quiet room. For your garden-variety headache, a dose of an over-the-counter brand of painkiller usually works. But for more sever or frequent headaches, there has been a dearth of effective cures. Now there is a growing understanding of headaches and how to treat them, which has the medical community paying more attention. One of the most exciting developments is a new group of drugs called calcitonin gene-related peptide (CGRP) antagonists. Those work as “abortive” medications, which stop a headache attack, especially migraines. It has been almost two decades since a new headache medication has been developed and these new drugs are still in clinical trials but may be on the market as early as 2011. As effective as the current leading medication, known as triptans, the difference is that CGRP-antagonists do not cause the blood vessels to constrict. This means patients who couldn’t take triptans because they have risk factors for heart disease or who have suffered a stroke or heart attack may soon have access to a powerful headache remedy. Experts are predicting CGRP-antagonists could be a major breakthrough and huge number of patients stands to benefit from the new drugs. “The new headache treatments couldn’t come at a better time,” says Dr Brosig (German Center for Neurology, Psychiatry, Psychology, Psychotherapy & Counseling, Dubai UAE). “However, our specialists at GNP are also committed to non-medicinal treatments. For instance, tension headaches, such as sore neck and shoulder muscles, are by far the most common type of headache during one course of headache treatment we will measure stress levels and treat the cause in order to get to the root of the problem. Often this can be best dealt with through our physiotherapy specialist, who will give a program of muscle and breathing exercises.” Another concern among physicians is medication overuse headaches, or MOH. This happens when patients take any type of painkiller for more than 10-15 consecutive days in an effort to alleviate headaches resulting in provoking more headaches as the brain chemistry changes. Brosig (German Center for Neurology, Psychiatry, Psychology, Psychotherapy & Counseling, Dubai UAE) likens it to the carreine withdrawal that coffee drinkers experience when they curb their consumption. Many medications actually contain caffeine. The bottom line, he says, is for patients to talk to their doctor about their headaches. “Most patients suffer from a lot of headaches and they go on for years living with this condition unless they speak to a specialist and find out how to stop it,” says Brosig.

To mark the Headache Awareness Week, German Center for Neurology and Psychiatry (GNP) in Dubai Healthcare City will be hosting a day’s open clinic on Tuesday June 9, 2009, to discuss headache causes and treatments.
www.gnp-dubai.com
10 common causes of headaches:
* Muscle strain in the neck, upper back or shoulders.
* Emotional stress.
* Medications (especially when used regularly).
* Alcohol, caffeine, other drug use or withdrawal.
* Dehydration
* Eye strain.
* Exposure to smoke or fumes from chemicals.
* Dental problems or procedures.
* Upper respiratory infections.
* High altitude and lower oxygen levels.
3 most common types of headache
* Tension headaches are the most common type of headache and are often caused by stress and emotional strain. Most adults have tension headaches from time to time. They can cause pain in your upper back, neck, jaw, above the eyes and other areas.
* Cluster headaches case deep, stabbing pain, usually around the temple of eye.
* Migraine headaches Around one-third of sufferers began having them as teenagers.
(German Center for Neurology, Psychiatry, Psychology, Psychotherapy & Counseling, Dubai UAE)

2009; German Center for Neurology, Psychiatry, Psychology & Counseling: “Childhood Depression”

Number of Depression Cases in UAE Alarming
(German Center for Neurology, Psychiatry, Psychology, Psychotherapy & Counseling, Dubai UAE)

Dubai — While urbanisation has brought economic growth to Dubai, it has also brought health concerns such as diabetes, allergies and depression that are common in developed cities. These health problems can affect children as well as adults, according to physicians at Dubai Healthcare City (German Center for Neurology, Psychiatry, Psychology, Psychotherapy & Counseling, Dubai UAE) .

Dr Michael Grundmann, a neurologist who recently moved from Germany, said the number of depression cases he has seen surprised him, and is particularly worrisome given the difficulty children can have explaining themselves.

“Children cannot explain themselves,” Grundmann (German Center for Neurology, Psychiatry, Psychology, Psychotherapy & Counseling, Dubai UAE) said. “They often exhibit physical symptoms like stomachaches and headaches, loss of concentration or a major change of eating and sleeping patters.” Since a large number of Dubai’s residents are expatriates, families sometimes lack the social network that helps give children solid grounding. To help prevent depression and other chronic diseases in Dubai’s children, parents should: Perform blood screenings to reduce the chances of inherited genetic blood disorders prevalent in the UAE.

Keep track of checkups and vaccinations. Routine check-ups help identify ways to stay healthy and find problems early says Grundmann (German Center for Neurology, Psychiatry, Psychology, Psychotherapy & Counseling, Dubai UAE. Traffic accidents and accidental poisoning are the most common causes of trauma for children. Use car seats and seatbelts and keep harmful substances out of reach. Diet is crucial in providing the nutrients and energy necessary to fight diseases such as diabetes. Help children choose healthy meals and pay attention to how much they eat. One in 33 children under 12 suffers from significant depression. Dr. Grundmann (German Center for Neurology, Psychiatry, Psychology, Psychotherapy & Counseling, Dubai UAE): Reduce stress, provide a stable environment and eat meals together. Preventable tooth decay affects more than 80 per cent of the UAE population. Aim for no more than 1 to 2 hours of video games each day, and choose games with an educational content. To build strong bones, have children younger than 9 years old drink two cups of fresh milk each day. Vision problems and eye diseases can be treated early. One in five children in the UAE suffers from asthma, which can be controlled by recognising and limiting exposure to allergens and irritants such as smoke, dust and cold air.

2009 May; German Center for Neurology, Psychiatry, Psychology & Counseling: “World Hypertension Day Gulf News”

High blood pressure is a growing problem

Dubai: Hypertension, a condition more commonly known as persistent high blood pressure, is an increasingly common problem throughout the UAE and a major cause of strokes and heart attacks, according to a Dubai-based specialist speaking on World Hypertension Day (WHD) on Sunday.

This year’s WHD theme is ’salt and high blood pressure’ and, according to Dr Michael Grundmann of the German Centre for Neurology and Psychiatry (GNP) in Dubai Healthcare City, the UAE takeaway and dining out culture puts a large proportion of residents at risk of stroke and other deadly diseases.(German Center for Neurology, Psychiatry, Psychology, Psychotherapy & Counseling, Dubai UAE)

In particular, the appetite for high salt and fat-based fast food and lack of exercise has, according to the most recent Obesity Review, accounted for 60 per cent of Emiratis being clinically obese. And World Hypertension Day highlights that high blood pressure is the biggest single cause of death through strokes, heart attacks and kidney disease.

With salt being the major factor behind increased blood pressure, it is estimated if salt intake was halved worldwide it would save around 2.5 million people.

Dr Grundmann (German Center for Neurology, Psychiatry, Psychology, Psychotherapy & Counseling, Dubai UAE) said: “A plethora of studies have been conducted and all support the concept that salt intake is the major factor increasing population blood pressure… Hypertension does not ache, you can’t feel it, but in the long run it is the most effective killer because it can spoil small vessels throughout the body without symptoms until it induces a stroke or heart attack.”

2009; German Center for Neurology, Psychiatry, Psychology & Counseling: “Parenting solutions, counselling”

PARENTING SOLUTIONS (German Center for Neurology, Psychiatry, Psychology, Psychotherapy & Counseling, Dubai UAE)

This month we speak to three different practitioners for expert advice on childhood depression, thumb-sucking and raising responsible teens.

My five-year-old son has not been himself since my husband and I divorced earlier this year. He has started wetting the bed and seems to have frequent aches and pains.

Dr Arne Brosig, neurologist and psychiatrist at the German Centre for Neurology and Psychiatry (04-4298578. www.gnp-dubai.com) (German Center for Neurology, Psychiatry, Psychology, Psychotherapy & Counseling, Dubai UAE) says: “Children are receivers of their parent’s emotions -when parents are stressed, so are their children. Adult depression is high in Dubai, so childhood depression is too. “Children as young as five can become depressed. However, it can be hard to assess because of their behavioural patterns. They do not express it the same way adults do - instead, they often show physical manifestations, such as headaches or bed-wetting. “Parents separation is the most stressful thing that can happen to a child. Watch out for the following signs of depression - apathy and changes in sleeping pattern or behaviour, such as lowered motivation or becoming aggressive. “If he is depressed, validate his feelings rather than dismiss them, and book an appointment with a psychiatrist, as depression can be toxic for health and brain development.”(German Center for Neurology, Psychiatry, Psychology, Psychotherapy & Counseling, Dubai UAE)

My seven-year-old son still sucks his thumb at night. Will this damage his teeth? What can I do to break his habit?

Dima Zein. business leader at IM Unitek orthodontic solutions (www.SMUnitek.com) says: “If your child only sucks his thumb at night, it probably falls out of his mouth when he goes to sleep and is unlikely to displace his teeth or deform growing bone. On the other hand, thumb and finger sucking can affect jaw development if practiced forcefully for extended periods of time. “Watch out for gaps between the front teeth, upper front teeth being pushed outwards, lower front teeth being pushed inwards, or a narrow, high-arched palate - these symptoms will need an appointment with an orthodontist. “There are orthodontic options to help prevent thumb-sucking, such as a simple retainer made specifically for children aged three and up. Don’t nag or forcibly remove his thumb from his mouth. Try distracting him with an activity that requires both hands, and painting something unpleasant, like vinegar, on his thumb. Supportive comments from a doctor, dentist or orthodontist can be helpful to reinforce the idea that your child has given up the habit on his own.”

My 18-year-old daughter will be heading off to university in the UK next summer. How can I prepare her for living on her own and taking care of herself?

Therese Sequeira. parent educator at Australian Family Care (German Center for Neurology, Psychiatry, Psychology, Psychotherapy & Counseling, Dubai UAE) , says: “Follow these tips to prepare your daughter for independent living, which means looking after herself, leading a healthy lifestyle, being assertive and reliable, making decisions, solving problems, choosing supportive friends and planning ahead:
>> Encourage her to take an active role in helping out with family chores at home.
>> Encourage her to make her own decisions and resist making her decisions for her.
>> Coach her to problem-solve and evaluate what to do if things don’t go the preferred way.
>> Help her develop self-discipline by setting goals for the future and talking about how she needs to rely on herself to make things happen.
>> Model being assertive and praise her for attempts at assertiveness. » Show an interest in others and talk about interesting things. Give and receive compliments and listen to others points of view.
>> Talk about how to handle risky situations. » Most importantly, keep communication alive.