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Do not understand when reading, cannot focus or concentrate, skin on head becomes tight and stretched backwards, obstruction in nose

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General & Family Physician
Practicing since : 1969
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My name is XXXXXXX. I am a male and 32 year old. Weight 70Kg and Height 167 cm.
My medical history starts way back from the year 1996-97.
When I was studying in 12th standard I got the problem of feeling depressed because of the reason of not giving best in school. When I was studying, I was the topper in my class. I used to study too much. I was taking the sleep of only 5 hours for long time. Then one guy joined my class and became superior to me. I got depressed and started to loose control on myself. Here control means I was not able to study/concentrate. Whenever I wanted to read class books, I got disturbed by the thought of that guy and sometimes whenever I want to concentrated on books, I used to get distractive by the things around the book like pen, pencil or any dark spot that can distract me. Somehow I cleared my 12th. When I joined Graduation, then the problem continued with me for getting distracted by the things around my books/ computer. One day the problem got so worst that my head (scalp) skin tightened so much that I was not able to think clearly. My vision was also got weird (everything like floating) and if I want to see something, I was not able to concentrate on that thing. I was not able to study anything. Here I mean I can read everything but can’t understand anything. I could read sentence but couldn’t understand what it means even if someone explains me I couldn’t understand. Even I asked one of my friends that ‘Is it possible that if you want to study and still you can’t study and he told me that no it’s not possible’. I asked this question because I thought that may be other people also have faced same problem but it was not. I was the unique case. Whenever I had to go for exam I feared too much, in exam time I had to call my brother to stay with me. The main problem was that I could not understand anything that I read, Even I was not able to make sentences properly to speak. I could not remember anything that I read and forgot immediately. I went to XXXXXXX a neuro (year 2001) and he told me to have EEG and it came normal. This was my emotional part.

Now my physical part was I felt too much stretched (tightness) in my head/scalp. This problem continued for years. Somehow I completed my Graduation (year 2001) and Post graduation (year 2005). Every time I am saying somehow because in my heart I knew that I can achieve a lot better than I actually achieved. (If I was asked how much you achieved of your potential I would say 20%). This feeling made me depressed always. This story continued on. I got the job (again somehow). I worked for 3 years in my job somehow and finally my patience lost. I left the job(year 2009) and met an ENT specialist. I met ENT specialist because I had the problem of breathing. I met him and told him about my problem and he checked my nose and gave me some medicines for 3 months but no improvement. Finally he told me that I have to undergo Septoplasty (as my nose was deviated to right) and FESS. But he also suggested me to XXXXXXX a neurologist before the surgery to clear other doubts related to neuro. Here first dramatic change happened in my life almost after 14 years. Neuro doctor suggested me to check my vitamin B12 and D3 level and also brain MRI. My MRI came absolutely normal but B12 was 39 which severely low and also D3 was 32 which was low too. He told me that it is a clear case of B12 deficiency that I am carrying for last 14 years. He suggested methylcobal injection for 3 days (1 everyday) and then one per week for 1 month and then one per month. When I got first injection I felt like my life was changed and came back to absolute normal. I would say that recovery was 85%. Now first week was full of life. But unfortunately this could not last long and I started to get back to the problem and now I am still taking injection per month but not showing any improvement. Now I went back to ENT and told him that I am not recovering from neuro side and so do the septoplasty operation. He did the operation but my problem is at the same stage as it was.
My feeling right now is that I feel tightness in my head (In the scalp region). Because of this I can’t concentrate on anything and also I can’t remember the things properly. Whenever I work on computer or read books I get distracted by the things around the monitor or book for example pen, coin etc. I even don’t want to go the public as I feel very bad (thinking what people think about me). Another feeling is that I feel no (or very less) blood circulation in my head and due to that my mind doesn’t work as it should be.
Sometimes when lying down my temple get pressed by pillow or my head back gets pressed by some object , I feel some sort of water getting cleared in the root of the nose and then I feel pretty good. But these types of things don’t last long. They are like come and go nature. I get the feeling of my nose pulsating (nose skin movement) and also when I hear a sudden loud sound from somewhere my ears (ear skin) vibrate physically. My head inner skin nerves remains tight most of the time. When I talk, laugh, smile, my head skin moves backward and gets tight and so I don’t like to talk too much with anyone. I take time to sleep. When I go to bed, I am not able to sleep within 10-15 minutes It takes around 2 hours for me to get sleep and sometimes more than that. I keep moving from one side to other until I get full sleep. Once I slept, I take my full sleep of around 7-8 hours without any disturbance. Sometime I don’t find words that I should speak.

So first of all I am confused that which specialist I should visit. ENT, Neurology or Psychology

So my basic problem is:-
When I study/read, I don’t understand the things. I can’t concentrate/focus on anything. My head skin becomes tight specially stretched backwards. Feels something obstructing in the root of the nose and not in the nostrils.

If you think that this case is not for the General Physician then which specialist should I consult first in your opinion? If you can give me some medicine that you think should work then that would be great. I need your right consultation.
Posted Wed, 27 Jun 2012 in Mental Health
Answered by Dr. Ramesh M.Vachharajani 9 hours later
Thanks for writing in.

From your long query it is very clear that up till now you have suffered a lot without any obvious reason. It seems that you have mild depression with an anxiety disorder. This is an easily treatable condition. The drugs of choice would be selective serotonin reuptake inhibitors like escitalopram. However, these are prescription drugs and can be given only after an in person examination.
It seems that your problem is purely psychological. I wonder why no body advised to consult psychiatrist earlier.
In short I advice to consult,
1. Psychiatrist.
2. Psychologist.
After a detailed history and examination, a psychiatrist would be able to prescribe the required treatment.
Counselling for few weeks with psychologist will help and your problem will be solved.
Remain in follow up with your psychiatrist and take medicine as per his instruction.
Do not worry, your future is very bright and you will be successful in your coming future life.
If you have any other concerns, I would be happy to address them.
Take care.
Above answer was peer-reviewed by
Follow-up: Do not understand when reading, cannot focus or concentrate, skin on head becomes tight and stretched backwards, obstruction in nose 5 hours later
Thanks for quick reply.

I want to know that why do I feel something wrong (obstructed) in my root of nose. I get the feeling of pressure in that region. When pressure get released I get very good feeling throughout my head and my problem get a lot of improvement (almost 80% improvement). I think there is some relation between root of nose and scalp region . Root of nose creates some problem that makes my head (scalp) tight and so mind don't response in a right manner.

Can you make any relationship between the things that I mentioned.

Another thing as you suggested that I should consult a Psychiatrist. I am already consulting a Psychiatrist and I mentioned the name of medicine that she is giving but I get no improvement. Do you still think that I should consult another one (here in XXXXXXX itself).

Answered by Dr. Ramesh M.Vachharajani 3 hours later

Thanks for query of clarification.

It seems that you had 2problems found out during investigations.

1, Deviated nasal septum for which you have been treated and your problem was due to this problem so you have undergone treatment.

Your problem still remains after this, you can consult your treating doctor and discuss about this.

2, you had somatic disease which can be treated with psychologist.

So it is good that you are taking treatment from psychiatrist and remain in follow up with her, with change of medicine or dosage adjustment you will feel better.

As I told you in my first reply, consult psychologist and go for his regular counselling.
Develop strong will power and forget about your present entity and avoid stress.

If you do not have any clarification or query you can close the discussion and rate this answer.

Wish you good health.
Above answer was peer-reviewed by
Follow-up: Do not understand when reading, cannot focus or concentrate, skin on head becomes tight and stretched backwards, obstruction in nose 23 hours later
Thanks for your reply.

Finally I want to know which specialist should I visit first . Since you have mentioned that I should visit psychiatrist and psychologist both. I don't understand the difference between these. Should I consult them simultaneously or give someone priority. Please let me know the difference between these two.

Once I get the answer I will close the discussion and will give you the rating.

Thanks for your help....
Answered by Dr. Ramesh M.Vachharajani 19 minutes later
Thanks for writing back.
Usually the psychiatrist examines and then he will send to psychologist by discussing your case with him.
Accordingly, psychologist proceeds with counselling.
If you have any more concerns, I will be happy to address them.
Above answer was peer-reviewed by
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