Shawn's Health Blog: Feb 3, 2009

2/03/2009

Alcohol allergy

You must have heard people saying that after drinking just one alcoholic beverage they get a rash all over the body. It is absolutely normal for these people to wonder whether or not they are allergic to alcohol. However, many of them do not believe it is possible they are allergic. This is definitely possible, although allergic reactions to alcoholic beverages are uncommon. By contrast, non-allergic adverse reactions to alcohol such as flushing, irritant reactions, toxic reactions and psychological effects are more common then allergic reactions.

What is alcohol allergy?

The first thing you need to know is that if you think you may suffer from an allergy or another disease that requires attention, you should discuss it with your family doctor. Next, you should know that alcohol can cause a variety of immediate adverse effects on the body. Studies show that some people are more sensitive to these effects than others are. However, this does not mean that they have an alcohol allergy. The truth is that allergic reaction involves the immune system, so alcohol can cause headaches, rapid heartbeat and nausea. Some people are especially sensitive to the stomach-irritating effects of alcohol. These people may develop heartburn, abdominal pain and even vomiting. Alcohol can also increase blood flow to parts of the body, such as the skin and the lining of the nose which may result in warm, red, sometimes itchy skin, as well as nasal congestion. Rarely, a person may develop sensitivity to the preservatives used in some wines and beers but this situation is really rare. Many people of Asian descent experience an unusual flushing reaction after drinking alcohol. That happens even if very small amounts of alcohol are consumed. This is caused by a genetic disorder in which the body is unable to break down alcohol completely, and research suggests that people who experience alcohol flush reaction may be at increased risk of alcohol-related conditions, such as cancer of the esophagus and liver disease.

The only solution to all of these problems is to avoid alcohol, which is recommended for everyone, whether there is an alcohol allergy or not.

Identifying your allergy

It is extremely important for you to identify your allergy if there is any. Maybe you know that there is something in wine and beer that produces an adverse reaction, but you are not exactly sure what. So what should you do? Some doctors suggest that you learn all the ingredients that are present in the beverage you are reacting to. Then you might undergo a skin-prick test. If anything shows up then you are allergic, but if nothing shows up then you are likely to have an intolerance. If you are intolerant, then you can undergo a food challenge, by using specific ingredients via a capsule to see what it is that you are reacting to. This is simply to eliminate the offending ingredient from your diet and prevent further allergic reactions.

More about alcohol

Alcohol, or ethanol, is a natural product, a normal byproduct of human and animal cell chemistry (metabolism). Cell processes result in normal physiological levels of 0.01 to 0.03 mg of alcohol/100 ml of blood and by contrast, a blood alcohol limit for driving of 0.05 per cent is equivalent to 50 mg of alcohol/100 ml of blood. It is also important to know that alcohol is broken down in the liver, by liver enzymes within minutes. Conversion of ethanol to acetaldehyde requires the enzyme alcohol dehydrogenase so acetaldehyde is then transformed to acetic acid or vinegar by the enzyme aldehyde dehydrogenase. If individuals cannot break down alcohol easily, problems may occur when alcohol is consumed.

Flushing is not an allergic reaction

Some patients will experience intense facial flushing after having even small amounts of alcohol and these symptoms are most common in those with an oriental or Asian background. Other side-effects of fluttering of the heart (palpitations or tachycardia), sensation of heat, headache, tummy discomfort or a drop in blood pressure (hypotension), are related to high blood acetaldehyde levels. Individuals with these problems appear to be partially deficient in aldehyde dehydrogenase. This results in high levels of accumulated acetaldehyde.
Other conditions may also trigger flushing, since not all flushing is due to alcohol. Flushing can occur in skin conditions such as rosacea, the menopause, low blood sugar levels, and sometimes as a response to some antibiotics or medicines used to treat diabetes or high blood fat levels. As you%26rsquo;ve already heard, the liver breaks down the alcohol or ethanol we drink and converts it to a chemical called acetaldehyde. Acetaldehyde is then transformed to acetic acid or vinegar, but problems occur if alcohol cannot be broken down. As well as ethanol, alcoholic beverages contain a complex mixture of grape, yeast, hop, barley or wheat-derived substances, natural food chemicals, wood and fruit-derived substances, added enzymes and preservatives. Severe allergic reactions have been described in people with allergies to proteins within grapes, yeast, hops, barley and wheat, which means these patients are not sensitive to alcohol itself.

Conditions related to alcohol reaction

Asthma can be triggered by sulfites; up to a third of asthma patients complain that wine will worsen their asthma, less often with beer or spirits. Beer, wine and champagne contain sulfites, used as a preservative since Roman times. Some people, particularly those with unstable or poorly controlled asthma, may wheeze when they drink and develop something like an allergic reaction. In general, there is more preservative in white wine than red wine, and more in cask wine than bottled wine, while the amount of metabisulfite also varies from brand to brand. There are some low-sulfite wines available, although those with extreme sensitivity may not be able to tolerate them. The reason is that some grape growers will dust sulfur powder over grapes in the weeks leading up to harvest. Other sources of sulfites include vinegar, pickled onions, dried fruit, and some restaurant salads or fruit salads; sometimes grapes are transported with bags of sulfite to keep them fresh.
Even when people complain that wine triggers asthma, sulfite may not be the only explanation for this problem. Asthma can also be due to enzyme deficiency where patients with aldehyde dehydrogenase deficiency accumulate high levels of acetaldehyde after consuming alcohol. Acetaldehyde has been blamed for asthmatic reactions to alcohol in up to half of Japanese asthma patients so sometimes histamine within alcoholic beverages was blamed for allergic reactions. Histamine and other substances may also cause problems because histamine can trigger sneezing, runny nose and sometimes wheeze, stomach upset and headache. There is more histamine in red than white wines but the amounts will vary from wine to wine. Some small studies have shown that antihistamines can help reduce the severity of symptoms. If the amount of wine challenge was equivalent to only one glass, it probably will not prevent hangovers. Some others substances within wine may also cause problems to some unlucky individuals, but these are not well defined.

Serious allergic reactions to beer or wine

Anaphylaxis has been described in patients with severe allergic reactions to proteins within grapes, yeast, hops, barley and wheat, but these patients are not sensitive to alcohol itself. Anaphylaxis to alcohol is as rare as allergic reactions to alcohol. Although these allergic reactions are rare, they are described in a few dozen published case reports.
As little as 1 ml of pure alcohol, equivalent to 10ml of wine or a mouthful of beer, is enough to provoke a reaction. This could be severe rashes, difficulty breathing, stomach cramps or collapse, a condition known as anaphylaxis. Given that the body itself constantly produces small amounts of alcohol, the reason that such reactions occur is poorly understood and allergy tests using alcohol are usually negative. However, these tests are sometimes positive to breakdown products of ethanol such as acetaldehyde or acetic acid. Provocation tests with alcohol are usually positive, but only when acetaldehyde or acetic acid is used, and finally, alcohol can sometimes act as a co-factor. This means alcohol is increasing the likelihood of anaphylaxis from other causes.

Management of alcohol allergy

Accidental exposure may lead to unexpected reactions, so patients with alcohol allergy should be managed in the same way as others with serious allergic reactions. The patient must identify and avoid the cause, wear a Medic Alert bracelet, and carry adrenaline or epinephrine as part of an emergency action plan. This is especially important if they are at risk of dangerous allergic reactions in the future. Moreover, alcohol can worsen symptoms in patients with hives called urticaria. Occasionally, alcohol can also trigger hives directly, where as with more serious allergic reactions, the mechanism is unclear. Less common reactions include localized contact hives and contact dermatitis, but you must remember that not all adverse reactions to alcohol are due to allergy. Other effects of alcohol toxicity are well known, including its effect on the liver, stomach, brain and mental functioning, especially in large amounts. Even though alcohol has a relaxant effect on the brain, some individuals will experience paradoxical agitation and anxiety, which is due to the drug-like activity of alcohol.

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Bipolar disorder

Bipolar disorder is one of the most severe forms of mental illness. It is characterized by recurrent episodes of mania and even more often depression. The condition has a high rate of recurrence and it is dangerous if it is left untreated. If untreated, it has an approximately 15% risk of death by suicide. It is the third leading cause of death among people aged 15-24 years, and is the 6th leading cause of disability or lost years of healthy life for people aged 15-44 years. This is especially the case in the developed world.

What is bipolar disorder?

This disorder was previously known as manic depression. It is a diagnostic category, describing a class of mood disorders where person experiences states or episodes of depression or mania, hypomania, and mixed states. Left untreated, it is a severely disabling and dangerous psychiatric condition. The difference between bipolar disorder and unipolar disorder, also called major depression for the purpose of this introduction, is that bipolar disorder involves energized or activated mood states in addition to depressed mood states. The duration and intensity of mood states varies widely among people. Fluctuating from one mood state to another is called cycling or simply having mood swings. Mood swings cause impairment not only in one%26rsquo;s mood, but also in one%26rsquo;s energy level. It could also affect sleep pattern, activity level, social rhythm, and thinking abilities. Many people become fully disabled for significant periods of time and during this time have great difficulty functioning.

Causation of bipolar disorder

Bipolar disorder is a life-long disease and runs in families but has a complex mode of inheritance, where family, twin, and adoption studies suggest genetic factors. The concordance rate for monozygotic or identical twins is 43%, whereas it is only 6% for dizygotic twins. About half of all patients with bipolar disorder have one parent who also has a mood disorder, usually a major depressive disorder.

If one parent has bipolar disorder, the child will have a 25% chance of developing a mood disorder and about half of these will have bipolar I or II disorder, while the other half will probably have major depressive disorder.

If both parents have bipolar disorder, the child has a 50%-75% chance of developing a mood disorder. The finding that the concordance rate for monozygotic twins is not 100% suggests that environmental or psychological factors likely play a role in causation of bipolar disorder. Certain environmental factors such as antidepressant medication, antipsychotic medication, electroconvulsive therapy, stimulants, or certain illnesses such as multiple sclerosis, brain tumor, or hyperthyroidism, can trigger mania. Mania can be triggered by giving birth, sleep deprivation, and sometimes by major stressful life events.

Symptoms of bipolar disorder

In adults, mania is usually episodic with an elevation of mood and increased energy and activity while in children, mania is commonly chronic rather than episodic. It is usually presented in mixed states with irritability, anxiety and depression. Both in adults and children, during depression there is lowering of mood and decreased energy and activity. During a mixed episode, mania and depression can both occur on the same day.

Co-morbidity of bipolar disorder

Co-morbidity is the rule, not the exception in this disorder. The most common mental disorders that co-occur with bipolar disorder are anxiety, substance abuse, and conduct disorders, as well as disorders of eating, sexual behavior, attention-deficit/hyperactivity, and impulse control. Autism spectrum disorders and Tourette's disorder, co-occur with bipolar disorder. The most common general medical co-morbidities are migraine, thyroid illness, obesity, type II diabetes, and cardiovascular diseases.

Mental disorders associated with bipolar and its diagnosis

Bipolar disorder is often associated with alcoholism, drug addiction, anorexia nervosa, bulimia nervosa, attention-deficit hyperactivity disorder, panic disorder, and social phobia. Unfortunately, there are no diagnostic laboratory tests for bipolar disorder. Thus diagnosis is arrived at by using standardized diagnostic criteria to rate the patient%26rsquo;s behavior. However, bipolar disorder must be distinguished from mood disorder due to a general medical condition, for example due to multiple sclerosis, stroke, hypothyroidism, or brain tumor. Bipolar disorder should also be distinguished from substance-induced mood disorder (for example due to drug abuse, antidepressant medication, or electroconvulsive therapy), and from other mood disorders such as major depressive disorder, dysthymia, bipolar disorder II, and cyclothymic disorder. It is even more important to see the difference between bipolar disorder and psychotic disorders such as schizoaffective disorder, schizophrenia, or delusional disorder. Since this disorder may be associated with hyperactivity, recklessness, impulsivity, and antisocial behavior, the diagnosis of bipolar disorder must be carefully differentiated from attention deficit hyperactivity disorder, conduct disorder, antisocial personality disorder, and borderline personality disorder.

Pathophysiology and prevalence of bipolar disorder

The pathophysiology of bipolar disorder is poorly understood, but a variety of imaging studies suggests the involvement of structural abnormalities in the amygdala, basal ganglia, and prefrontal cortex. Research is now showing that this disorder is associated with abnormal brain levels of serotonin, norepinephrine, and dopamine, which are very important substances in the brain.

Bipolar disorder affects both sexes equally in all age groups and its worldwide prevalence is approximately 3-5% and it can even present in preschoolers. There are no significant differences among racial groups in the prevalence of bipolar disorder. Moreover, the first episode may occur at any age from childhood to old age, although the average age at onset is 21. More than 90% of individuals who have a single manic episode go on to have future episodes, while untreated patients with bipolar disorder typically have 8 to 10 episodes of mania and depression in their lifetime. Often five years or more may elapse between the first and second episode. However, the episodes become more frequent and more severe thereafter. There is a significant symptom reduction between episodes, but 25% of patients continue to display mood instability or mild depression, as many as 60% of patients experience chronic interpersonal or occupational difficulties between acute episodes. Bipolar disorders may develop psychotic symptoms, while psychotic symptoms only occur during severe manic, mixed or depressive episodes. In contrast, the psychotic symptoms in schizophrenia can occur even when there is no mania or depression. The problem is, poor recovery is more common after psychosis. Manic episodes usually begin abruptly and last for between 2 weeks and 4-5 months with median duration of 4 months. Depressive episodes tend to last longer with median length about 6 months, though rarely for more than a year, except in the elderly.

Treatment and outcome of bipolar disorder

The usual treatment for bipolar disorder is lifelong therapy with a mood-stabilizer. It could be lithium, carbamazepine, or divalproex and valproic acid. These drugs work the best in combination with an antipsychotic medication. Usually treatment results in a dramatic decrease in suffering, and causes an eight-fold reduction in suicide risk. In mania, an antipsychotic medication or a benzodiazepine medication is often added to the mood-stabilizer, while in depression, an antidepressant medication or lamotrigine is often added to the mood-stabilizer.

Since antidepressant medication can trigger mania, this medication should always be combined with a mood-stabilizer or antipsychotic medication to prevent mania that is the common problem. Research has shown that the most effective treatment is a combination of supportive psychotherapy, psycho-education, and the use of a mood-stabilizer, which might be often combined with an antipsychotic medication. However, there is no research showing that any form of psychotherapy is an effective substitute for medication. Likewise there is no research showing that any health food store nutritional supplement such as vitamin or amino acid, is effective against bipolar disorders. Since a manic episode can quickly escalate and destroy a patient%26rsquo;s career or reputation, a therapist must be prepared to hospitalize out-of-control manic patients before they lose everything. Likewise, severely depressed, suicidal bipolar patients often require hospitalization. This is necessary to save their lives. Although the medication therapy for bipolar disorder usually must be lifelong, most bipolar patients are non-compliant and stop their medication after one year.

It is also important to point out that according to the US government%26rsquo;s National Institute of Mental Health there is no single cause of bipolar disorder, but rather, many factors act together to produce the illness. Probably that is why single medication cannot help these people. Modern evidence-based psychotherapies designed specifically for bipolar disorder, when used in combination with standard medication treatment, increase the time the individual stays well significantly longer than medications alone.

Blurred vision

When patients complain of blurred vision, it is first necessary to define exactly what they mean. It is also important to find the time frame and the extent to which the visual fields are affected. Patients can be very inexact in their terminology so blurred vision must be differentiated from gradual loss of vision and visual field defects. Cranial nerve lesions cause diplopia rather than blurred vision which is important what doctor must remember.

What is blurred vision?

There are many types of eye problems and visual disturbances that include blurred vision, halos, blind spots, floaters, and other symptoms. Blurred vision is the loss of sharpness of vision and the inability to see small details and blind spots called scotomas, which are dark holes in the visual field in which nothing can be seen. You must know that changes in vision, blurriness, blind spots, halos around lights, or dimness of vision should always be evaluated by a medical professional. Such changes may represent an eye disease, aging, eye injury, or a condition like diabetes that affects many organs in the body. Whatever the cause is, vision changes should never be ignored because they can get worse and significantly impact the quality of life, so professional help is always necessary.

As you determine which professional to see, you should know that opticians dispense glasses and do not diagnose eye problems. Optometrists perform eye exams and may diagnose eye problems, so they prescribe glasses and contact lenses while in some states they prescribe eye drops to treat diseases. Ophthalmologists are physicians who diagnose and treat diseases that affect the eyes, so these doctors may also provide routine vision care services, such as prescribing glasses and contact lenses. Sometimes an eye problem is part of a general health problem, when your primary care provider should also be involved.

Common causes of blurred vision

Vision changes and problems can be caused by many different conditions, such as presbyopia, or difficulty focusing on objects that are close, which is common in the elderly.

Cataracts are also a common cause, and this is cloudiness over the eye%26rsquo;s lens causing poor nighttime vision, halos around lights, and sensitivity to glare, until even daytime vision is eventually affected. This condition is also common in the elderly.

Glaucoma is the next cause of blurred vision, which is increased eye pressure, causing poor night vision, blind spots, and loss of vision to either side. Glaucoma is a major cause of blindness. It can happen gradually or suddenly but if it is sudden, it is a medical emergency.

Diabetic retinopathy is complication of diabetes that can lead to bleeding into the retina, and is another common cause of blindness.

Macular degeneration is loss of central vision, blurred vision, especially while reading, distorted vision, like seeing wavy lines, and colors appearing faded. This is the most common cause of blindness in people over age 60.

Further causes of blurred vision can be eye infections, inflammation, or injury. Floaters are tiny particles drifting across the eye and although often brief and harmless, they may be a sign of retinal detachment. Retinal detachment with symptoms that include floaters, flashes of light across your visual field, or a sensation of a shade or curtain hanging on one side of your visual field could also cause blurred vision. Optic neuritis is inflammation of the optic nerve from infection or multiple sclerosis, so you may experience pain when moving your eye or touching it through the eyelid.

Stroke or TIA, brain tumor and bleeding into the eye, are also causes of blurred vision.

Temporal arteritis is an important condition, an inflammation of an artery in the brain that supplies blood to the optic nerve. Migraine headaches occur as spots of light, halos, or zigzag patterns. These are common symptoms prior to the start of the headache. An ophthalmic migraine is when you have only visual symptoms without a headache at all.

Other potential causes of vision problems include fatigue, overexposure to the outdoors, temporary and reversible blurring of vision, and many medications. Medications that can affect vision include antihistamines, anticholinergics, digitalis derivatives, some high blood pressure pills, indomethacin, phenothiazines, medications for malaria, ethambutol, and many others.

Home care for blurred vision

Safety measures may be necessary if you have any vision problems, for example if you have trouble seeing at night, you should not drive after dusk. It may be helpful to increase the amount of light in a room or arrange a home to remove hazards, and specialist at a low-vision clinic may be able to help. If you experience partial or complete blindness in one or both eyes, even if it is only temporary you should immediately call your doctor. It is also important to call him if you experience double vision, even if it is temporary and if you have a sensation of a shade being pulled over your eyes or a curtain being drawn from the side. Blind spots, halos around lights, or areas of distorted vision appear suddenly are warning signs as well. If you have eye pain, especially if also red call the doctor, because a painful eye is a medical emergency. If you have trouble seeing objects to either side, difficulty seeing at night or when reading, gradual loss of the sharpness of your vision, difficulty distinguishing colors, blurred vision when trying to view objects near or far, or diabetes (or a family history of diabetes) you should definitely talk to your doctor. Your provider will check your vision, eye movements, pupils, the back of your eye and eye pressure when needed. An overall medical evaluation will be performed if necessary, but you should not be worried about it, just report your problem to a professional.

What should the doctor ask you?

It is very important that the doctor knows whether the blurred vision was sudden or gradual in its onset and, if gradual, over what period of time you experienced it. Exactly what part of the visual field is affected, is it unilateral, bilateral or homonymous, is there just blurring or actual loss of visual field, whether this has happened before, and if there is any history of trauma are details essential for an appropriate diagnosis. The doctor should also ask you if there is any pain, but it is important to differentiate between eye pain and headache. Are there any associated features like fortification spectra, and the personal and family history of eye disease are also very important issues the doctor should consider.

Diagnosing blurred vision

Medical history is very important as well as medication, because drugs may be toxic to the eye or precipitate glaucoma. Examination consists of looking at the eyes, comparing the size of the pupils, and looking for any abnormality of shape of the pupils or clarity of the eyes. It is also important to know if pupils respond equally and briskly to light and accommodation, and if the external ocular movements are full. The doctor will probably check visual acuity. Exact previous visual acuity will probably not be on record but note the strength of spectacles if worn. One of the steps is to use the ophthalmoscope to check the anterior segment for discharge, vascular injection, or swelling and make sure the corneal reflection is clear and free of irregularities.

For diagnosis it is extremely important to know if there is blood (hyphema) or pus (hypopyon) in the anterior chamber. In some cases doctor will suspect the cause of blurred vision is a cataract. To get exact diagnosis it is helpful to check the blood pressure and check urine for glucose, examine the pulse for atrial fibrillation, and listen for any carotid bruit.

If the fovea or macula is affected there will be a dramatic loss of vision. Investigation will depend upon what is suspected; it may require urgent (on the same day) referral to an ophthalmologist for slit lamp examination and a definitive diagnosis. Differential diagnosis means it is helpful to divide into unilateral and bilateral, including homonymous, sudden and gradual in onset, and painful and painless. In addition, glaucoma may affect both eyes but usually only one at a time has an acute attack. Giant cell arteritis may affect one eye initially and immediate starting of steroids is essential to protect the other eye, and chemicals or foreign bodies in the eye may be unilateral or bilateral. Unilateral, sudden and painful are often associated with a painful red eye, which could be corneal abrasion or infection, anterior uveitis, traumatic hyphema, or acute glaucoma. There may even be prostration and vomiting as well. Giant cell or temporal arteritis may be associated with a painful or tender head but the eye is not usually painful and there is usually a complete unilateral loss of vision rather than a complaint of blurred vision. Some people get a typical migraine prodrome without a following headache and it is usually unilateral but may progress to be homonymous. Blurred vision can be part of a toxic illness, which is apparent the patient that is pyrexial and unwell. There will probably be a history of welding a number of hours earlier with inadequate protection and often the patient will offer the diagnosis on its own. It is interesting that drugs like steroids and anticholinergics can also have similar effects. Cerebrovascular disease may lead to damage to the visual pathways and optic cortex. Because of that, there may or may not be macular sparing associated with visual disturbance that is often homonymous.

Male G-spot

For women, the G-spot lies directly behind the pubic bone within the front wall of the vagina. It is usually located about halfway between the back of the pubic bone and the front of the cervix, along the course of the urethra. It is also near the neck of the bladder, where it connects with the uret...
For women, the G-spot lies directly behind the pubic bone within the front wall of the vagina. It is usually located about halfway between the back of the pubic bone and the front of the cervix, along the course of the urethra. It is also near the neck of the bladder, where it connects with the urethra. The size and exact location vary from woman to woman. Imagine a small clock inside the vagina with 12 o%26rsquo;clock pointed towards the navel. The majority of women will have the G-spot located between 11 and 1 o%26rsquo;clock a few inches inside the vagina. Most people have heard about this, but we still wonder - is there a male G-spot.

Where is the male G-spot?

It is generally thought that the female G-spot and the male prostate are composed of the same tissue. The prostate is often referred to as the male G-spot. This might stretch the analogy a bit, as the area identified as the female G-spot is in-and-up behind the pubic bone. It also swells as the woman becomes aroused. The male prostate, on the other hand, is deeper and resides at the neck of the bladder and in fact, is a valve that decides if the man is going to ejaculate or urinate. It is interesting to know that men cannot come and go at the same time. A lot of men are goosey about getting a rectal prostate exam by their doctor. However, there is nothing erotic about this experience.
With sexual arousal and in the course of sexual stimulation, anal stimulation is pleasurable only for some men. Some men also enjoy stimulation of their prostate, which does contract some during ejaculation. Physicians often have to push in pretty hard and deep to reach the prostate, so some women with short fingers might not be able to get to it and reach the male G-spot.

If you wish to stimulate your partner%26rsquo;s G-spot, he should be on his back, and your palm should be up. You should be sure you do not have sharp fingernails, and be sure that you do not touch your own genitals with the finger you used to penetrate your partner%26rsquo;s anus because of bacteria that live there.
Remember that some men like prostate stimulation and others do not, just as some women love G-spot stimulation and others find it distracting. However, exploring and experimenting is fun. Unfortunately, there just aren%26rsquo;t any new and fantastic magical spots. Remember that human beings have been making love for millions of years so it is not likely that much has been missed during all that time until now.

The female G-spot

The female Grafenburg spot, or G-spot, is a region that, when stimulated, can produce intense pleasure and orgasmic response. It is found about one-third up the vagina, towards the front, and is often thought of as the urethra sponge. In men there really is no identical spot although in Men's Fitness US magazine, the authors allude to the male G-spot as the prostate gland. As you have already learned, the prostate is found by placing a well-lubricated finger inside the anus. Once you feel the sensation of pushing against a walnut-sized lump, you have reached the prostate or male G-spot. Pressing or rubbing it creates an intense pleasurable sensation for most men. However, most people still feel very negatively about touching the anus. If you wish to give your man extraordinary pleasure, stimulating his prostate is what you want to learn how to do. Because this gland is in an area where nerve endings are concentrated, it is easily aroused, often resulting in an intense orgasm. Obviously, this is something that many men find a relief and a delight of sexual experience. The female G-spot is an inch to inch and a half in size, but is the most sensitive and exciting area of the vagina. Therefore, you must know that size matters not; knowledge, tenderness, sharing and caring are the ingredients for wondrous loving and climax. The myth that size counts is a myth discounted by most who know and enjoy true sexual sharing. Unlike the clitoris, which protrudes from the surrounding tissue, it lies deep within the vaginal wall, and a firm pressure is often needed to contact the G-spot. Usually female G-spot is a lima-bean sized, spongy area which responds to stimulation by hardening and swelling as blood rushes to it.

How to find the G-spot

The Sybian machine and typical vibrators, as well as a man who knows how to use his hands, can provide the maximum stimulation often required to awaken the G-spot. Moreover, it is interesting that your own fingers can reach it. Techniques for stimulating G-spot are various. You could lie back with your knees pressed up to your chest. In this position, your vaginal depth will shorten and even small fingers should be able to reach the G-spot. With a partner, lie on your side with one leg drawn up to your chest as your partner enters you from the rear so he should be able to hit the spot. The G-spot responds to pressure rather than to touch, so gently stroking is not likely to get any results. It's more like massaging a pea under a mattress. One has to compress the flesh to find it. Try to insert fingers and bend them gently up. Do it around and behind the pubic bone. Beyond the rather rough-surfaced tissue immediately behind the pubic bone, fingertips will encounter a very soft, smooth area. You need to go very slowly and let her tell you what she feels as you explore the smooth area, which will feel to you like the inside of a very slippery mitten so when you straighten your fingers and reach further inside, you will encounter a hard, rubbery structure. This structure feels like an erect nipple pointing south. This is the cervix of the uterus, and the G-spot is somewhere just this side of the cervix, about an inch beyond the mitten. It is somewhere in the flesh immediately in the front of the vagina. It would be interesting if you could imagine that you are holding a tennis ball on those two or three inserted fingers. Then, an area about the size of a grape in the center of the tennis ball is what you are trying to reach. It can be anywhere along that two-or-three inch long area between the pubic bone and the cervix so explore it slowly. You must allow for feedback from the woman. It would be best to let her guide your fingers with her words if she can feel the stimulation. The G-spot responds to pressure rather than to touch and gentle stroking is not likely to find it, you must remember this. When you reach in from the front with the woman on her back, the heel of your hand is over her clitoris while your fingers hook around the pubic bone. Pull upwards, as if you are trying to lift her off the bed. Do this with the same sort of rhythm you would use with penetration, and keep your fingers hooked, so they press deep into the woman%26rsquo;s tissue. Once you know where it is you can try using your penis on it, but for a good G-spot orgasm, she may prefer your hand rather then the penis. In face-to-face intercourse, the penis may not stimulate the spot enough to do any good, although some positions, such as the one where the women draws her knees close to her chest, may increase the changes for a G-spot orgasm, a very pleasurable feeling a woman could experience.

Techniques for stimulating the G-spot

Men should learn the techniques outlines above very well if they wish to give pleasure to a woman. If the man wishes to explore his body and try something new, then the woman could give him something similar. However, most men are controversial and do not want to try it. The main reason is they think it is something that only homosexuals are doing. However, that is not true, because each male has that sensitive area deep inside the rectum, to be more precise, on the front side of the rectal wall. If a man relaxes enough with a woman he trusts, they could find his G-spot together. Sometimes, a woman%26rsquo;s fingers are too short to reach this area. Then you could try some accessories such as this one in the picture. A man could explore it alone or with his girlfriend or wife, or friend; regardless, it all brings the same result.

Important tips for anal sex

With anal sex, or stimulating the male G-spot, it is important to remember there are bacteria that live in the anus. These bacteria are different then the bacteria women have in their vagina. That is why you must be careful not to transmit these possibly harmful bacteria. You should use a lubricated condom during anal sex. If you are stimulating the male G-spot with a hand, you should wash your hands carefully before you put them in your vagina or mouth. Moreover, you must know that the anal area is not meant for sex, and the skin is very sensitive. That is why bleeding is a common problem, as is transmitting bacteria into the bloodstream.

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All about orgasm

Orgasm is the conclusion of the plateau phase of the sexual response cycle, shared by males and females. During orgasm, both males and females experience quick cycles of muscle contraction in the lower pelvic muscles. These pelvic muscles surround both the anus and the primary sexual organs. Orgasms in both men and women are often associated with other involuntary actions, including vocalizations and muscular spasms in other areas. Beside this, generally euphoric sensation is associated with orgasm.

More about orgasm

Afterwards orgasm occurs, it generally causes perceived tiredness, and both males and females often feel a need to rest. This has recently been attributed to the release of prolactin, which is a typical neuroendocrine response in depressed mood and irritation. Recent study indicated significant differences in brain activity during the female and male orgasm. Even scans showed that both the female and male orgasm shut down areas in the brain associated with anxiety and fear. It has been found that the male orgasm focused the brain on sensory input from the genitals a little bit more than a female orgasm.

Male orgasm

In a male orgasm, there are rapid, rhythmic contractions of the prostate, urethra and the muscles at the base of the penis. This process in the adult typically forces stored semen to be expelled through the penis%26rsquo; urethral opening, in a process known as peristalsis. This is referred to as ejaculation, and is a well-known situation. The process generally takes from 3 to 10 seconds and is usually extremely pleasurable for the male. Orgasm is generally induced by direct stimulation of the penis although some men experience heightened orgasm by direct stimulation of the prostate through the perineum or rectum. As a man ages, it is normal for the amount of ejaculate to diminish, and hence, the length of time the man sustains orgasm also could diminish somewhat. This does not affect the pleasurable feeling of orgasm at all; it merely shortens the duration of pleasure.

Following ejaculation, a refractory period usually occurs. This is a period during which a man cannot have another orgasm. This period can be anywhere from under a minute to over half a day, depending on age and other individual factors, although a few cases have been reported of men who appear to have no refractory period at all.

Male prostate orgasm

Some men are able to achieve ejaculation or orgasm through intra-anal stimulation of the prostate gland, where men reporting the sensation of prostate stimulation often give descriptions similar to women%26rsquo;s accounts of G-spot stimulation. Other men report finding anal stimulation or penetration of any kind to be painful. Others explain simply that they find no profound pleasure from it. With sufficient stimulation, the prostate can also be milked so providing that there is no simultaneous stimulation of the penis, prostate milking can cause ejaculation but without orgasm. When combined with penile stimulation, some men report that prostate stimulation increases the volume of their ejaculation, and provides an enhanced and more pleasurable version of the standard orgasm.

Male multiple orgasms

It is possible to have an orgasm without ejaculation, which is called dry orgasm. It is also possible to ejaculate without reaching orgasm. Some men report that the ability to consciously separate orgasm and ejaculation has allowed them to achieve multiple orgasms and men who have practiced this technique extensively report that they can sometimes experience a continuous wave of orgasm. This can last indefinitely, but in practice is limited by the man%26rsquo;s ability to concentrate, or %26ldquo;surf the wave%26rdquo;. Reaching between ten and twenty orgasms in one session is reportedly common for many of the practitioners.
During recent years, a number of books have described various techniques for achieving multiple orgasms. Most multi-orgasmic men and their partners report that refraining from ejaculation results in a far more energetic post-orgasm state. Additionally, some men who have become adept at this practice also report more powerful ejaculatory orgasms when they choose to have it. Some of the most basic techniques for achieving multiple orgasms require that the man hold on to the perineum to prevent ejaculation occurs. More advanced techniques are analogous to reports by multi-orgasmic women indicating that they must relax and let go to experience multiple orgasms. Some young men have enough stamina so that the penis, given sufficient stimulation, never goes flaccid during the refractory period. In such cases it is unnecessary to try yoga and meditation techniques that could help them gain control over their body. It is actually quite painful to try to interfere with the ejaculation response once it has been triggered and generally within 30-45 minutes of the onset of the first refractory period, men are able to have an orgasm again. Internet rumors and a few scientific studies have pointed to the hormone prolactin as the likely cause of the male refractory period. Because of this, there is currently an experimental interest in drugs which inhibit prolactin, such as Dostinex. Anecdotal reports on Dostinex suggest it may be capable of eliminating the refractory period altogether. Then it is possible for men to experience multiple ejaculatory orgasms in rapid succession. At least one scientific study supports these claims. Dostinex is a hormone-altering drug with many potential side effects, and has not been approved for treating sexual dysfunction. Another possible reason may be an increased infusion of the hormone oxytocin, and it is believed that the amount by which oxytocin is increased may affect the length of each refractory period. It can also be said that in some cases, the refractory period can be reduced or even eliminated through the course of puberty and adulthood.

Female orgasm

In a female, orgasm is preceded by moistening of the vaginal walls, and an enlargement of the clitoris. This is due to increased blood flow trapped in the clitoris%26rsquo;s spongy tissue. Some women exhibit a sex flush %26ndash; a reddening of the skin over much of the body due to increased blood flow to the skin. As a woman comes closer to having an orgasm, the clitoris moves inward under the clitoral hood, and the labia minora become darker. As orgasm becomes imminent, the vagina decreases in size by about 30%. Beside this, the vagina also becomes congested from engorged soft tissue. The uterus then experiences muscular contractions where the woman experiences full orgasm as her uterus, vagina and pelvic muscles undergo a series of rhythmic contractions. The majority of women consider these contractions to be very pleasurable. However, not all sexually active women experience this.

After the orgasm is over, the clitoris re-emerges from under the clitoral hood, and returns to its normal size. It happens in less than 10 minutes. Unlike men, women either do not have a refractory period or have a very short one, thus they can experience a second orgasm soon after the first. Some women can even follow this with additional consecutive orgasms. This is known as multiple orgasms. After the initial orgasm, subsequent climaxes may be stronger or more pleasurable as the stimulation accumulates and research shows that about 13% of women experience multiple orgasms. A larger number may be able to experience this with the proper stimulation, such as a vibrator and the right frame of mind. However, some women%26rsquo;s clitorises are very sensitive after orgasm, making additional stimulation initially painful, so it is possible to engage in deep, rapid breaths while continuing stimulation and making a conscious intention to release the pain and tension. Doing this can allow for the intense stimulation to be interpreted not as painful but as intensely pleasurable for woman.

Achieving multiple orgasms

Some women can achieve a series of orgasms, one after another with possibly increased intensity after the first. The great exertion involved can be blissfully debilitating for quite some time. This kind of orgasm would normally involve stimulation of the woman%26rsquo;s clitoris rather than the vagina. Some women can do this manually using their fingers and taking a pause of two or three seconds between each. When using their hands, women can insert fingers up the vagina, wriggling their fingers to stimulate the G-spot. Beside this, women may also massage the clitoris repeatedly. A vibrator applied directly to the clitoris can help women who are not practiced in using their fingertips; a vibrator used this way can be applied almost continuously to bring about orgasms that seem less separated. A battery-powered tooth brush that vibrates with an oscillatory rotational motion is preferred by some, for whom it is even more effective than a vibrator.

Vaginal versus clitoral orgasms

A distinction is sometimes made between clitoral and vaginal orgasms that occur in women. An orgasm that results from combined clitoral and vaginal stimulation is called a blended orgasm although many doctors have claimed that vaginal orgasms do not exist. They claim that female orgasms are obtained only from clitoral arousal. Recent discoveries about the size of the clitoris that extends inside the body, around the vagina would seem to support this theory. Other sources argue that vaginal orgasms are dominant or more mature, but these arguments are frequently criticized. This latter viewpoint was first promulgated by Sigmund Freud who argued that clitoral orgasm was an adolescent phenomenon, and upon reaching puberty the proper response of mature women changes to vaginal orgasms. While Freud did not provide any evidence supporting this basic assumption, the consequences of the theory were greatly elaborated thereafter.

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Nail Fungus Treatment

An infection of nail fungus is also called the onychomycosis and it usually occurs when fungi infect one or more nails. This condition is easily recognizable because it usually begins as a white or yellow spot under the tip of nail or nail. As the nail fungus spreads deeper into nail, it may cause the whole nail to loose its normal color, thicken and develop crumbling edges. Beside this esthetic damage, this condition can be extremely painful. Infections of nail fungus account for about half of all nail disorders. Fungal infections usually develop on nails when they are continually exposed to warm, moist environments, such as sweaty shoes or shower floors. Although many people believe that nail fungus is the same thing as athlete's foot it is not so. Athlete%26rsquo;s foot primarily affects the skin of the feet. Although these infections aren%26rsquo;t a life-threatening disorder, the treatment can turn out to be a big problem. Even after a complete recovery, infections often recur again and again.

Incidence

These infections are far more common on the toenails than the fingernails. It is estimated that they affects about 12% of all Americans. When it comes to age distribution, it occurs in approximately 25% of people at age 40, and 40% of older people. These infections tend to run in families but not everyone is susceptible.

Cause of nail fungal infection

Fungi are microscopic organisms that don't need sunlight to survive.
That%26rsquo;s why they live in moist and dark places. Several researches have proven that great majority of nail fungal infections are caused by a group of fungi called dermatophytes. Yeasts and molds can also be responsible for nail fungal infections.

They invade skin through tiny invisible cuts or through a small separation between your nail and nail bed. This infection is far more common in toenails than in fingernails because toenails are often confined in a dark, warm, moist environment inside the shoes.

Signs and symptoms of nail fungal infection

These infections are very easy to detect and diagnose. A patient may have a nail fungal infection if one or more of his or hers nails are:

%26bull; Thickened
%26bull; Brittle, crumbly or ragged
%26bull; Distorted in shape
%26bull; Flat or dull, having lost luster and shine
%26bull; Yellow, green, brown or black in color
%26bull; With debris building up under nail

Risk factors for developing nail fungal infection

%26bull; Age
It is proven that nail fungus is more common among older adults because nails grow more slowly and thicken with aging, making them more susceptible to infection.
%26bull; Sex
Nail fungus also tends to affect men more than women.
%26bull; Perspiring heavily
%26bull; Working in a humid or moist environment
%26bull; Wearing socks and shoes that lack of ventilation
%26bull; A minor skin or nail injury, a damaged nail or another infection
%26bull; Diabetes, circulation problems or a weakened immune system
%26bull; Other fungal skin infection
%26bull; After washing hands frequently, or have them in water a lot
%26bull; A nail that has recently been damaged is also more likely to become infected
%26bull; Nail infections are more common in people who live in hot or humid climates
%26bull; Smoking also increases the risk of developing a nail infection

Possible complications

Beside the fact that these nail fungal infections can be very painful, they may cause permanent damage to the nails. These infections may also lead to other serious infections that can spread beyond patient%26rsquo;s feet. They can pose a serious health risk for people with diabetes and for those with weakened immune systems. In such cases even a minor injury to the feet can lead to a more serious complication, such as an open sore that's difficult to heal.

Diagnosis of nail fungal infections

Examination of nails

The first step in beating nail fungus is getting a diagnosis. Your doctor will likely examine your nails first.
Sample testing and analysis
To test for fungi, your doctor may scrape some debris from under your nail for analysis. The debris can be examined under a microscope or cultured in a lab to identify what is causing the infection. Other microorganisms, including yeast and bacteria, also can infect nails.

Treatment of nail fungus infections

The treatment of fungal nail infections is expensive and long-term and it requires taking medicine for several months, sometimes even years. Unfortunately, topical preparations do not effectively treat fungal nail infections.

Oral Antifungal Medications

There are 3 effective oral antifungal medications - 2 that are FDA approved for fungal nail infections and one that is not FDA approved specifically for nail infections. All 3 medications have significant side effects and interact with many medications. Patients should know that these medications are incorporated into the nail and that%26rsquo;s why-they continue to work even after the medication is discontinued. It is important to remember that none of the oral antifungal medications can be taken during pregnancy.
%26bull; Terbinafine (Lamisil%26reg;, Apo-Terbinafine%26reg;)
This is an FDA approved medication for fungal nail infections treatment. Several researches have proven that it is 70% to 90% effective when used as prescribed. The dosage used is 250 mg once a day for 6 weeks for fingernail infections and 12 weeks for toenail infections.
%26bull; Itraconazole (Sporanox%26reg;)
Second FDA approved medicine for fungal nail infections is called Itraconazole. Studies have shown that it is 70% to 80% effective. This drug interacts with many medications and should always be taken with some kind of food. It can be taken daily or as pulse therapy with one but very large dose. The daily dose is 200 mg once a day for 6 weeks for fingernail infections and 12 weeks for toenail infections. The pulse dosing is 200 mg twice a day for one week per month repeated for 2 or 3 months.
%26bull; Fluconazole (Diflucan%26reg;)
This medication is not approved by the FDA to treat fungal nail infections. However, it is an effective oral antifungal medication. The advantage of fluconazole is that it stays in the body for a long time and only needs to be taken weekly.

Other treatment options

Doctor may also suggest these treatments:

%26bull; Antifungal lacquer
If patient has a mild to moderate infection of nail fungus, sometimes the doctor may prefer to prescribe some simple antifungal nail polish instead of any medication. FDA has approved a topical antifungal lacquer called ciclopirox (Penlac). This lacquer should be applied onto infected nails and surrounding skin once a day. Single treatment lasts for seven days after which the patient should wipe the piled-on layers clean with alcohol and begin fresh applications. Daily use of Penlac for up to one year or longer has been shown to help clear nail fungal infections.
%26bull; Topical medications
The doctor may also recommend some other topical antifungal medications, such as econazole-nitrate (Spectazole%26reg;). Topical medications usually don't provide a cure but may be used in conjunction with oral medications.
%26bull; Nail removal
If other treatments have failed, the infected nail can be removed by a small operation done under local anaesthetic. This is combined with treatment with antifungal medication.
%26bull; Not treating
If the infection is mild or causing no symptoms it can be left untreated. Some people may prefer not to take medication as, although rare, there is a small chance of serious side-effects from antifungal medication.

Some treatment tips

All the fungi that are killed with treatment remain in the nail until the nail grows out. When a fresh, healthy nail grows out from the base of the nail, it is a secure sign that the treatment is working. When this healthy nail reaches the end of the finger or toe, the nail will often look normal again. Most people already know that fingernails grow faster than toenails, so it may appear they are quicker to get back to normal.

Prevention tips

To help prevent nail fungus and reduce recurrent infections, practice good hand and foot hygiene by following these steps:

%26bull; Patient should keep nails short, dry and clean.
%26bull; Only appropriate socks should be wear. Synthetic socks that wick away moisture may keep feet dryer than cotton or wool socks
%26bull; Some antifungal spray or powder should be used on a daily basis.
%26bull; Patient should wear rubber gloves and give up nail polish and artificial nails. Although it may be tempting to hide nail fungal infections under a coat of pretty pink polish, this can trap unwanted moisture and worsen the infection.
%26bull; Hands should be washed after touching an infected nail.

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Passive Aggressive Personality Disorder

Passive-aggressive personality disorder is a chronic condition in which a person accepts the desires and needs of others, but actually passively resists them, becoming increasingly hostile and angry. This affects almost all interpersonal or occupational situations. It is a method of dealing with stress or frustration, but it results in the person attacking other people in indirect ways. This disorder can manifest itself as resentment, stubbornness, procrastination, sullenness, or intentional failure at doing requested tasks. However modern psychiatry no longer recognize this condition as an official diagnosis.

This behavior creates many problems in a person's work and social life. Unfortunately, passive-aggressive personality disorder lasts for life and the patient needs frequent monitoring by a healthcare professional. There are no established risk factors for passive-aggressive personality disorder, but genetics may play a role.

Symptoms and signs of passive-aggressive personality disorder

People diagnosed with this disorder resent responsibility passively rather than by open expression of their feelings. In most cases procrastination, inefficiency, and forgetfulness are behaviors commonly used to avoid doing what they need to do.
A person with this disorder may appear to comply with another's wishes, however the requested action is either performed too late or performed in a way that is useless.

There are certain behaviors that help identify passive-aggressive behavior.

%26bull; Obstructionism
%26bull; Procrastination
%26bull; Resentment
%26bull; Resisting suggestions from others
%26bull; Sullenness
%26bull; Ambiguity
%26bull; Avoiding responsibility by claiming forgetfulness
%26bull; Blaming others
%26bull; Chronic lateness and forgetfulness
%26bull; Complaining
%26bull; Not expressing hostility or anger openly
%26bull; Fear of competition
%26bull; Making excuses and lying
%26bull; Fear of dependency
%26bull; Fear of intimacy
%26bull; Fear of authority
%26bull; Fostering chaos
%26bull; Intentional inefficiency

Cause of passive-aggressive personality disorder

The exact cause is still unknown but like in most personality disorder it probably hails from a combination of genetic and environmental factors.

%26bull; parental over-control
According to most experts, behaviors of passive-aggressive personality disorder appear to have theorigin in unending power struggles with parents. Parental over-control, neglect, or favoring of a sibling can all contribute to the development of the silent protest and grudging obedience associated with this disorder.

%26bull; Five-factor modelThere is a hypothetical model of personality found in people who are suffering from Passive-Aggressive Personality Disorder.

%26bull; High Neuroticism

This line of character is accompanied with chronic negative affects, including anxiety, fearfulness, tension, irritability, anger, dejection, hopelessness, guilt, shame. Difficulty in inhibiting impulses is the predominant symptom as well as the irrational beliefs, unrealistic expectations, perfectionistic demands on self and unwarranted pessimism.

%26bull; High Extraversion

This line of character is characterized by excessive talking, leading to inappropriate self-disclosure and social friction and inability to spend time alone. All this is accompanied with dramatic expression of emotions; reckless excitement seeking; inappropriate attempts to dominate and control others.

%26bull; Low Openness
This is resulting in difficulties with adapting to social or personal change and low tolerance or understanding of different points of view or lifestyles.

%26bull; Low Agreeableness
This line of character is characterized by cynicism and paranoid thinking. The affected people are unable to trust even friends or family, too ready to pick fights, exploitive and manipulative, lying, rude and inconsiderate toward friends which may lead to alienation. They have a limited social support, lack the respect for social conventions which can lead to troubles with the law, inflated and grandiose sense of self and show arrogance.

%26bull; High Conscientiousness
These people are often recognizable by overachievement: workaholic absorption in job can cause the exclusion of family, social, and personal interests. They are often signs of compulsiveness, including excessive cleanliness, tidiness, and attention to detail.

Relationships

It is proven that individuals with passive-aggressive personality disorder are ambivalent within their relationships. They are sometimes very hard to understand because they are in doubt between expressing hostile defiance toward people they see and attempting to mollify these people by asking forgiveness. That%26rsquo;s why, they are sometimes very difficult to handle. These individuals are noted for the stormy nature of their interpersonal relationships and they are resentfully quarrelsome and irritable. They often feel like a victim. People in relationships with them are just waiting for the next struggle and round of volatility and carping criticism. In most cases, they engage in grumbling, moody complaints, and sour pessimism. These socially maladaptive behaviors result in inevitable interpersonal conflict and frustration. These individuals can control others by forcing them into an uncomfortable anticipatory stance. Passive-aggressive individuals are able to trap people into situations wherein whatever they do is wrong.

Long-term effects of the condition

A person with a passive-aggressive personality disorder will most probably have big problems at work and in relationships with others. The person's behavior makes him or her difficult to deal with.

Diagnosis of passive-aggressive personality disorder

The current criteria for the passive-aggressive personality disorder as proposed by the Personality Disorders Work Group for the DSM-IV includes:

%26bull; passive resistance to fulfilling social and occupational tasks through procrastination and inefficiency
%26bull; complaints of being misunderstood, unappreciated, and victimized by others
%26bull; sullenness, irritability, and argumentativeness in response to expectations
%26bull; angry and pessimistic attitudes toward a variety of events
%26bull; unreasonable criticism and scorn toward those in authority
%26bull; envy and resentment toward those who are more fortunate
%26bull; self-definition as luckless in life and an inclination to whine and grumble about being jinxed
%26bull; alternating behavior between hostile assertion of personal autonomy and dependent contrition

Treatment of passive-aggressive personality disorder

%26bull; Counseling and cognitive-behavioral therapy
Counseling may help a person with passive-aggressive personality disorder identify and change behaviors. Cognitive behavioral therapy, group therapy, or individual psychotherapy may be used. Treatment is aimed at helping the person better relate to others. Some experts say that counseling can just increase the person's irritability and anxiety. This happens when he or she is forced to look at the negative behavior.
%26bull; Group therapy
Group therapy can be extremely useful because it provides individuals with this personality disorder an opportunity to learn how to manage their hostility.
When their hostility emerges, group leaders can comment on hostile behavior and encourage other group members to respond. The group leader can assist these individuals to process what it is they want or need at that moment and to rehearse the appropriate behavior within the group context.
%26bull; Medications
Unfortunately, there is no cure for passive-aggressive personality disorder but there are medications which may help reduce some symptoms. Medications used to treat depression, called antidepressants, may reduce irritability. Fluoxetine or sertraline are commonly used. However they may cause sleep disorders, drowsiness, or stomach upset.

Treatment Techniques

When assessing individuals with PAPD, following areas should be noticed:

%26bull; survival skills and self-care
%26bull; use of OTC drugs
%26bull; psychosocial and AOD history
%26bull; mental status
%26bull; coexisting anxiety disorders
%26bull; medication evaluations for antidepressants
%26bull; identification of typical passive-aggressive mane

Incidence of Co-Occurring Substance-Abuse-Disorders

Unfortunately, the incidence of co-occurring substance abuse with PAPD is extremely high. These individuals are prone to use drugs to regulate mood states. They believe they are entitled to an external solution to problems and are likely to use their addictions to justify their angry or violent behavior or to provide a rationale for nonperformance, incapacitation, or inaccessibility. Prescribed pain killers and anti-anxiety agents, in combination with alcohol, are probably the most common pattern of abuse.

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