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My grandmother is a 65-year-old retired teacher. Lately, she has been experiencing memory problems, such as forgetting appointments, misplacing keys, and struggling to recall the names of familiar people. What could it be and is there anything that could be done

Answered by Rishav Koirala, psychiatrist and researcher

Age-related cognitive changes are common, and some degree of forgetfulness is considered a normal part of aging. Chronic stress can lead to cognitive difficulties, and addressing stress management techniques may help improve memory. Sleep disturbances, such as sleep apnea or insomnia, can also impair cognitive function, and optimizing sleep quality can have a positive impact. 

If your grandmother is on some medication regimen, there are some drugs that may be affecting her memory. So a review of her medication is essential. Additionally, addressing any underlying medical conditions and ensuring proper nutrition can play a crucial role in memory improvement.

With the aging population in Nepal, the prevalence of cognitive disorders, including dementia, has been on the rise. In the context of dementia, individuals may experience a distorted sense of temporal orientation, emphasizing past memories while struggling to remember or anticipate the future. This temporal disorientation can lead to a sense of ‘wandering’ through time, where past experiences become more accessible, while future events and plans become increasingly elusive. 

As a result of this temporal disorientation, individuals experiencing memory problems may also find it challenging to remember tasks or work that was in progress, which can be disruptive and disorienting. This issue can further compound the difficulties associated with dementia, as individuals may ‘lose track’ of their ongoing tasks, adding to their sense of temporal disorientation and causing frustration and confusion. Understanding and addressing these challenges are essential in providing appropriate care and support to individuals with dementia.

Moreover, it’s crucial to recognize that the person looking after the patient, such as family members or caregivers, may experience significant emotional and psychological challenges. The constant adjustments and uncertainties brought about by dementia can lead to caregiver anxiety, stress, and burnout. Caregivers often grapple with the demanding responsibilities of ensuring the patient’s safety, providing emotional support, and managing the daily care routine, all while witnessing the progressive decline of their loved one's cognitive function. Recognizing and addressing the caregiver’s well-being is a vital aspect of holistic care for individuals with dementia, as it helps ensure the patient receives the best possible support while also maintaining the caregiver’s own mental and emotional health.

To determine the exact cause and appropriate interventions, it is crucial for your grandmother to seek a comprehensive evaluation from a healthcare professional, be it a psychiatrist, neurologist, or geriatrician, who can provide a tailored assessment and guidance for her specific situation. Early intervention and support can significantly affect the management of memory issues, irrespective of their underlying cause, and may involve addressing temporal disorientation and providing a supportive environment for individuals with dementia.

I’m a 27-year-old woman and I have an issue with self-esteem. I say that because I am always worried about what people will think of me and go to extreme lengths to seem kind and polite in group settings. I hardly ever say no, and I’m always compromising even when I feel really bad about it. People tend to take me for granted and I allow it to happen. How do I change myself and become more confident about who I am? 

Answered by Rishav Koirala, psychiatrist and researcher

As a 27-year-old woman grappling with self-esteem issues, your tendency to excessively concern yourself with others' opinions and consistently prioritize their needs at your own could be indicative of underlying self-esteem challenges. These behaviors, including an inability to say no and a propensity to over compromise, may stem from a fear of rejection or a desire for approval. Recognizing these patterns is an important first step towards personal growth and self-confidence. Exploring potential root causes, such as past experiences or influences, including past relationships that may have impacted your sense of self-worth, can help you gain insight into your behavior. Embracing the concept of abundance, where you believe in your inherent worth and the availability of positive opportunities and relationships, can also be transformative in your journey towards building confidence. It’s important to remember that seeking to change and build confidence is a gradual process, and it can be valuable to seek professional support, such as therapy or counseling.

Individuals with personality disorders, like Borderline Personality Disorder (BPD) or Avoidant Personality Disorder (AvPD), often grapple with low self-esteem and difficulties in assertiveness. Building self-esteem and learning to say no assertively are critical skills for them. Assertive responses can take various forms, such as direct refusal, empathetic declines, or offering alternatives. It’s vital to respect one's needs and feelings while considering the feelings of others. Seeking professional guidance and practicing assertive communication can help individuals with personality disorders enhance their self-esteem and navigate social interactions more effectively, ultimately fostering healthier relationships.

Consulting a therapist or counselor is a valuable step to consider, as they can provide you with professional guidance, support, and tailored strategies to navigate these challenges and foster a more assertive and self-assured self. It’s important to note that sometimes these symptoms of low self-esteem, excessive worrying about what others think, and people-pleasing may occur alongside other symptoms of anxiety, potentially indicative of Generalized Anxiety Disorder (GAD).

I’m a 45-year-old woman who has a teenage daughter. She is 14. I’m finding it difficult to relate to and understand her. I have told her to share her problems with me and she seems to trust me enough to confide her secrets. But I find myself getting angry. I realize that’s not the right response but her ‘boy troubles’ and peer pressure issues make me want to punish her. How do I discipline my child and make sure she doesn’t become rebellious and pick up bad habits?  

Answered by Kapil Sharma, counseling psychologist, Nepal Institute of Mental Health 

Every mother wants nothing but the best for her child. It’s natural to feel frustrated with children for their recklessness at times, but punishing them might not be the most effective approach, as you seem to be aware. Yet the way you are feeling now might be due to anger issues with your daughter’s transition, disciplinary concerns, expectations you have for your daughter or your own personal struggle.

When things don’t go as planned, parents-adolescent conflict is fairly common, creating emotional irritation, rage, and concern. Also, because your daughter is just 14, she is in the process of transitioning from childhood to adolescence. You can start by educating yourself on adolescent issues so that you can help your child deal with them.

You’ve stated that you want your daughter to confide in you, and it’s wonderful that she does. It’s great that you want an open relationship for a safe and secure environment for her. But the main issue is that you lose your temper easily. Rather than interrupting, consider active listening. You can try to wait until she finishes her narrative before speaking. If you feel dissatisfied after hearing what she has to say, try asking open-ended questions to convince her to reflect on her thoughts and actions. She might have her own conclusion or way out about the issue. Also you can reflect on what you would expect from your mother if you were in your daughter’s place. This may change your perspective as well.

Try empathetic communication as that might help you deal with her rebellion. Instead of  restricting your daughter from doing things, try to make her feel at ease by validating her feelings. Also, learn to resolve your own anger issues first. To begin with, reflect on your personal life including your expectations and stress.  Try fixing them  through conflict resolution and problem solving skills. But even after this, if you still feel confused, I recommend you attend a therapy session.

I’m a 70-year-old woman who’s not happy in her marriage. My husband is indifferent and insensitive. I’ve been hurt a lot. He is always saying mean things that make me upset and angry. I have even stopped talking to him. But I don’t want a divorce and neither does my husband. But our relationship is suffocating and sad. What should I do?

Answered by Rishav Koirala, psychiatrist and researcher

In the context of long-term relationships, it’s not uncommon to encounter difficulties and hurdles that test the bond between two people. It’s a positive sign that neither you nor your husband is inclined towards divorce, as this indicates a willingness to work on the relationship. To address these complex issues, it’s important to adopt a holistic approach that takes into account both your perspectives, mental health, personality issues, and various potential strategies.

Begin with self-reflection, examining your own feelings and expectations within the marriage. This introspection can help you clarify what you want from the relationship and what you are willing to contribute towards its improvement. At the same time, try to cultivate empathy towards your husband. Understand his feelings, motivation, and past experiences, as this can be instrumental in fostering mutual understanding and empathy.

Perhaps underlying mental health issues could be the reason behind your husband’s indifference and insensitivity. Long-standing emotional struggles can manifest in these ways, and seeking professional help may provide valuable insights and strategies for managing your emotions and interactions. Additionally, mental disorders like anxiety can exacerbate these issues, as they often manifest as heightened negativity, irritability, and increased emotional sensitivity. These illnesses may remain hidden for years, disguised as behavioral quirks. So, it’s always advisable to visit a mental health expert for a thorough evaluation and professional management, which can play a crucial role in maintaining a healthy and harmonious partnership.

Effective communication is the cornerstone of any successful relationship. Initiate open and honest conversations with your husband, choosing a time when both of you are calm and willing to engage constructively. Express your feelings, but also actively listen to your husband’s concerns without judgment. If direct communication proves to be challenging and unproductive, it may be beneficial to seek the assistance of a couples’ therapist or counselor. A neutral third party can facilitate constructive conversations and offer practical tools to improve your relationship.

In some cases, taking some time apart to reflect on your feelings and goals independently can be beneficial. This separation doesn’t necessarily imply a permanent split but can provide both of you some valuable perspective. Establishing clear boundaries is also essential. Let your husband know what specific behaviors or comments you find hurtful, and request that he respect these boundaries. Similarly, be open to acknowledging and addressing any behaviors or comments from your side that he finds problematic.

To rebuild emotional connections, spend quality time together engaging in activities that you both enjoy. This can help create positive memories and strengthen your bond. Rely on your friends and family for emotional support. They can provide valuable insights and a listening ear during this challenging time.

Above all, be patient and persistent in your efforts to make the marriage better. Understand that improving a long-standing relationship takes time and effort from both parties. The ultimate goal should be to achieve a healthier and happier life for both you and your husband, whether that means remaining together and working through these issues or pursuing separate paths while maintaining respect and understanding.