Tuesday, May 27, 2008


Write short notes on anger management


Anger is a completely normal, usually healthy, human emotion. But when it gets out of control and turns destructive, it can lead to problems—problems at work, in your personal relationships, and in the overall quality of your life.
The Nature of Anger
Anger is "an emotional state that varies in intensity from mild irritation to intense fury and rage," which accompanied by physiological and biological changes; when you get angry, your heart rate and blood pressure go up, as do the levels of your energy hormones, adrenaline, and noradrenaline.

Anger can be caused by both external and internal events. You could be angry at a specific person (Such as a coworker or supervisor) or event (a traffic jam, a canceled flight), or your anger could be caused by worrying or brooding about your personal problems. Memories of traumatic or enraging events can also trigger angry feelings.

Expressing Anger
The instinctive, natural way to express anger is to respond aggressively.
Anger is a natural, adaptive response to threats; it inspires powerful, often aggressive, feelings and behaviors, which allow us to fight and to defend ourselves when we are attacked. A certain amount of anger, therefore, is necessary to our survival.

On the other hand, we can't physically lash out at every person or object that irritates or annoys us; laws, social norms, and common sense place limits on how far our anger can take us.

People use a variety of both conscious and unconscious processes to deal with their angry feelings. The three main approaches are expressing, suppressing, and calming:
1) Expressing your angry feelings in an assertive—not aggressive—manner is the healthiest way to express anger. To do this, you have to learn how to make clear what your needs are, and how to get them met, without hurting others. Being assertive doesn't mean being pushy or demanding; it means being respectful of yourself and others.
2) Anger can be suppressed, and then converted or redirected. This happens when you hold in your anger, stop thinking about it, and focus on something positive. The aim is to inhibit or suppress your anger and convert it into more constructive behavior. The danger in this type of response is that if it isn't allowed outward expression, your anger can turn inward—on yourself. Anger turned inward may cause hypertension, high blood pressure, or depression.

Unexpressed anger can create other problems. It can lead to pathological expressions of anger, such as passive-aggressive behavior (getting back at people indirectly, without telling them why, rather than confronting them head-on) or a personality that seems perpetually cynical and hostile. People who are constantly putting others down, criticizing everything, and making cynical comments haven't learned how to constructively express their anger. Not surprisingly, they aren't likely to have many successful relationships.

3) Finally, you can calm down inside. This means not just controlling your outward behavior, but also controlling your internal responses, taking steps to lower your heart rate, calm yourself down, and let the feelings subside.

Anger Management
The goal of anger management is to reduce both your emotional feelings and the physiological arousal that anger causes. You can't get rid of, or avoid, the things or the people that enrage you, nor can you change them, but you can learn to control your reactions.

Simple relaxation tools, such as deep breathing and relaxing imagery, can help calm down angry feelings. ( refer progressive relaxation by Jacobson )
Some simple steps you can try:

1) Breathe deeply, from your diaphragm; breathing from your chest won't relax you. Picture your breath coming up from your "gut."
Slowly repeat a calm word or phrase such as "relax," "take it easy." Repeat it to yourself while breathing deeply.

2) Use imagery; visualize a relaxing experience, from either your memory or your imagination.

3)Nonstrenuous, slow yoga-like exercises can relax your muscles and make you feel much calmer.
Practice these techniques daily. Learn to use them automatically when you're in a tense situation.

Cognitive Restructuring

This means changing the way you think.
Angry people tend to curse, swear, or speak in highly colorful terms that reflect their inner thoughts. When you're angry, your thinking can get very exaggerated and overly dramatic.
Try replacing these thoughts with more rational ones. For instance, instead of telling yourself, "oh, it's awful, it's terrible, everything's ruined," tell yourself, "it's frustrating, and it's understandable that I'm upset about it, but it's not the end of the world and getting angry is not going to fix it anyhow."

Keep reminding yourself that getting angry is not going to fix anything, that it won't make you feel better (and may actually make you feel worse).

Problem Solving
Sometimes, our anger and frustration are caused by very real and inescapable problems in our lives. The best attitude to bring to such a situation, then, is not only to focus on finding the solution, but rather on how you handle and face the problem.
(refer :problem solving technique for more information)

Better Communication
Angry people tend to jump to—and act on—conclusions, and some of those conclusions can be very inaccurate. The first thing to do if you're in a heated discussion is listen, slow down and think through your responses.
Don't say the first thing that comes into your head, but slow down and think carefully about what you want to say. At the same time, listen carefully to what the other person is saying and take your time before answering.

Using Humor
"Silly humor" can help defuse rage in a number of ways. For one thing, it can help you get a more balanced perspective.

Changing Your Environment
Sometimes it's our immediate surroundings that give us cause for irritation and fury. Problems and responsibilities can weigh on you and make you feel angry at the "trap" you seem to have fallen into and all the people and things that form that trap.

Give yourself a break. Make sure you have some "personal time" scheduled for times of the day that you know are particularly stressful. One example is the working mother who has a standing rule that when she comes home from work, for the first 15 minutes "nobody talks to Mom unless the house is on fire." After this brief quiet time, she feels better prepared to handle demands from her kids without blowing up at them.
If you feel that your anger is really out of control, if it is having an impact on your relationships and on important parts of your life, you might consider counseling to learn how to handle it better.

Assertiveness Training
It's true that angry people need to learn to become assertive (rather than aggressive)
Non assertive persons are more passive and acquiescent than the average person; they tend to let others walk all over them but they still can't eliminate anger. careful with passive aggressive coping . learn more on assertiveness training

Some Other Tips for Easing Up on Yourself
Timing: If you and your spouse tend to fight when you discuss things at night—perhaps you're tired, or distracted, or maybe it's just habit—try changing the times when you talk about important matters so these talks don't turn into arguments.

Avoidance: If your child's chaotic room makes you furious every time you walk by it, shut the door. Don't make yourself look at what infuriates you. Don't say, "well, my child should clean up the room so I won't have to be angry!" That's not the point. The point is to keep yourself calm.

Finding alternatives: If your daily commute through traffic leaves you in a state of rage and frustration, give yourself a project—learn or map out a different route, one that's less congested or more scenic. Or find another alternative, such as a bus or commuter train.

Friday, April 25, 2008

Question 1: Write short notes on Minimal Cognitive Impairment.


initial study related to :
  • benign senescent forgetfulness BSF - Karl
  • age associated memory impairment- AAMI- Crook 1986
  • ageing associated cognitive decline-
definitional criteria:
  • complaint of memory problem
  • normal ADL
  • normal general cognitive function
  • abnormal memory function for age and education (1- 2 SD)

Tools used

  • Global Deterioration Scale (GDS)
  • Cognitive Dementia Rating Scale (CDRS)
  • Cambridge Mental disorder & Elderly Examination CAMDEX
  • Comprehensive Assessment and referral Evaluation ( CARE)

Prevalence of MCI ( problem : different criteria use)

Incidence of MCI:

  • increase with age
  • higher in man
  • > 65 y.o: 12-15 per 1000 - year
  • >75 y.o: 54 per 1000-year

The course of MCI:

  • rate conversion varies
  • 10-15% MCI develops dementia/ year.

Predictors of conversion to AD

1) Using neuropsychological test:

  • decline memory:
  • verbal episodic memory:
  • problem solving impairment
  • judgement impairment
  • language deficit
  • reduced visuospatial abilities

2) Histology/ biological changes

  • ApoE genotype
  • atrophy of medial temporal lobes
  • EEG changes
  • olfactory deficit

3) Sociodemographic

  • age & education but controversial


  • To detect & treat early
  • To prevent dementia


  • longer duration study
  • standardize definition
  • standardize tools


Bischkopf J, Busse Angermeyer MC. Mild Cognitive Impairment . A Review of prevalence, incidence and outcome according to current approaches: Acta Psychiatr Scand 2002: 106:403-414