Q: My sister has a psychiatric problem. The problem started when she was 15 years old. She had just cleared her 10th class examination in flying colours and got admission into Kasturba Gandhi College for Women for pursuing her 10+2 education. During her first days in college, she underwent ragging from her seniors in college. She came home crying and her condition only got worse in the next couple of days. We went to the college authorities and complained but to no avail. She started exhibiting violent behaviour for a few days. We took her to a nearby hospital the doctors gave her shock treatment without my parents' knowledge. That aggravated the matter. Since then she has not been normal. We have taken her to psychiatrists but to no avail. She has been under strong anti-depressants and her violent behaviour stopped with her taking these medicines. She is not mad in that sense. However, one cannot term her as normal either. She is still in a state of depression and has not come out of it. She responds to what one asks her. She reads a few lines from the newspapers when asked but she stops abruptly. Her daily routine has been to do her daily chores, watch TV, sit the whole day and sleep. This has practically been her routine for the past 18 years. My parents have also been partly responsible for her current state, which I shall describe later. They have pampered her by showing mercy on her and have in a way caused her current state of affairs. My parents are simple people and are worried. If she cries on being made to walk, they do not force her further. Their being sympathetic has aggravated the matters. Being the sole earning member in the family, I stay away from home and have not been able to pay attention to my sister to the extent that I could have. My sister finds it difficult to get up, finds it very difficult to walk. She holds her hips and struggles to walk. She keeps crying often. Her hands keep shaking. The medicines I guess have taken a toll on her nerves. What is the best course of action? Do I take her to NIMHANS Bangalore or is there an equivalent hospital in Mumbai or Hyderabad, where can she get proper treatment? Is there hope?

A:I will try and respond to each of the points you have mentioned or asked about. The diagnosis you seem to mention is one of depression. I don't find convincing evidence of that diagnosis in your description but indeed find a strong suggestion of one of the long term mental illnesses like schizophrenia. Please do understand that I am mentioning this diagnostic possibility only on the information provided by you in your email, and without having had the opportunity to clarify many issues with you or examining your sister. Her state of health not having been very good is apparent from your description and it seems to me that it is so because of the inadequately treated mental illness and the side effects of the medicines. It is not, as you suggest, the effect of the medicines on the nerves, as in any permanent damage. There are some side effects of all medicines, as also for the medicines used for mental illnesses but most of them are easily treatable and not permanent. The good news is also that the newer medicines for all mental illnesses including schizophrenia are available with lesser side effects and most patients can be managed well and effectively. The opinion you have about the role of your parents in her condition also seems misplaced and exaggerated. The overall condition in such cases is mainly due to the illness. There is certainly quite a role of the family members and the nature of support available but it seems to me from your description that you seem to overestimate the contribution from that in your sister's case. You feeling responsible for not being with your family in such circumstances is understandable but then all of us have to make choices in life, which have their pluses and minuses, right? You can provide adequate help to your family for your sister's illness even from a distance. If you can be with them at home, it can be good but if you cannot be there, you can provide helpful guidance and other help for her treatment and rehabilitation. The quality of treatment and the competence of the clinicians is comparable across cities these days and so there may not be a need in most cases for travelling across cities for treatment. It is also important that the treatment takes place in the place where the patient and the family are likely to be living so that follow up care is ensured. In some instances, it may be helpful to obtain treatment at centres like NIMHANS, Bangalore or IHBAS, Delhi. You may consider that after speaking with the treating clinician. There are many competent clinicians and teams in Hyderabad who should be able to help you.