Hashimoto's Disease & Hyperthyroidism

Hashimoto's is a disease, while hypothyroidism is a condition. Hypothyroidism is most commonly caused by Hashimoto's disease, but the two terms are not interchangeable. Hashimoto’s disease is a problem with the thyroid gland located in the neck. The thyroid gland makes hormones that control ho...
Hashimoto's is a disease, while hypothyroidism is a condition. Hypothyroidism is most commonly caused by Hashimoto's disease, but the two terms are not interchangeable. Hashimoto%26rsquo;s disease is a problem with the thyroid gland located in the neck. The thyroid gland makes hormones that control how the body uses energy. When someone has Hashimoto%26rsquo;s disease, their immune system begins to attack its own thyroid gland. This causes the thyroid gland to become swollen and irritated. When this happens, the thyroid cannot make hormones as it should. Hyperthyroidism is a condition when the thyroid gland produces more of its hormones then it should.

What is Hashimoto%26rsquo;s disease?

Hashimoto's disease is sometimes known as Hashimoto%26rsquo;s thyroiditis, autoimmune thyroiditis, or chronic lymphocytic thyroiditis. This is an autoimmune disease.
In Hashimoto's, antibodies react against the proteins in the thyroid, causing gradual destruction of the gland itself. It also affects its ability to produce the thyroid hormones the body needs. The thyroid gland is found low in the neck and is shaped like a butterfly. It produces two hormones, thyroxine (T4) and triiodothyronine (T3).
These hormones are released into the bloodstream, controlling the speed of all the body%26rsquo;s functions or metabolism. In hypothyroidism the output of these hormones is reduced, resulting in a decrease of metabolism. This causes various symptoms.
General muscle slow-down leads to tiredness, while reduced body metabolism causes dry skin, hair loss, constipation and weight gain. Joints commonly swell up, while shortage of breath may develop due to effects on the heart. In women, periods may become heavy and slower brain activity might result in memory loss or poor concentration. Youngsters may fail to grow and may not do well at school, although some people have no symptoms at all. However, the doctor may notice only a slow pulse or another minor change in appearance.







If the thyroid gland is enlarged, the doctor may identify the condition as Hashimoto%26rsquo;s disease, named after the Japanese physician who first described this combination of abnormalities.

How does Hashimoto%26rsquo;s disease occur?

The body sometimes produces substances called antibodies which are defense chemicals. Antibodies are usually made only to deal with foreign substances such as viruses, other germs, and things like pollen. In hypothyroidism, the antibodies and the cells that make them are directed against the bodies own cells, in this case the thyroid cells. This is called auto-immune destruction, and is almost impossible to prevent or reverse, so once thyroid cell damage occurs in this way, it is usually permanent.

Symptoms of Hashimoto%26rsquo;s disease

Symptoms that those afflicted with Hashimoto%26rsquo;s disease may have are varied. Because the thyroid gland may swell due to Hashimoto%26rsquo;s disease, patient may have a feeling of fullness or tightness in the throat. Trouble swallowing food or liquids is also common. A patient might notice a swelling or bump (goiter) in the front of the neck. Tiredness, forgetfulness, depression, coarse dry skin, slow heartbeat, weight gain, constipation and intolerance to cold are also symptoms of Hashimoto%26rsquo;s disease. Many people with this disease have no symptoms at all, where ordinary blood test may just show that the thyroid hormones are out of balance.

Who gets Hashimoto%26rsquo;s disease?

Although Hashimoto%26rsquo;s disease can affect people of all ages, it is most common in women between 30 and 50 years of age. If someone in your family has had thyroid disease, you may have an increased risk for Hashimoto%26rsquo;s disease, but no one is entirely sure why people get this disease.

Treatment of Hashimoto%26rsquo;s disease

There is no known cure for Hashimoto%26rsquo;s disease, but the doctor can treat low thyroid function, which is why a patient probably will not suffer any long-term effects. Thyroid medicine can replace the hormones that the thyroid gland usually makes. How long a patient needs to take the medicine will depend on the blood test results.
For most people, thyroid hormone medicine causes no problems at all. Taking thyroid medicine and having regular blood tests to see how the thyroid gland is working can help prevent symptoms like tiredness, weight gain, and constipation. Tablets of synthetic thyroxine (T4) are the usual treatment for Hashimoto%26rsquo;s disease, taken once daily. If you forget a dose once in a while no harm should follow. It is interesting that the body can make all the triiodothyronine (T3) which it needs from this T4, and it does not need to be given separately in most cases. However, because T3 works more rapidly, in some situations your doctor may decide to commence T3 out of preference. Moreover, thyroid extract is no longer recommended. Although it contains a mixture of T4 and T3, the content is not very consistent and giving mixtures of T4 and T3 at the same time has also not been shown to have any advantages. Thyroxine is often started in doses as low as 25 micrograms a day, and the dose is gradually built up every month or two to give the body a chance to adjust.

The doctor will use a regular examination, a blood test, and perhaps a heart examination to decide about the final thyroxine dose. Final dose is usually between 50 to 200 micrograms a day. You should always check the strength of thyroid tablets each time they are dispensed, since mistakes can happen. Some improvement usually occurs within 2 weeks of starting treatment but it takes 4 to 6 weeks of daily tablets to get the full benefit of a particular dose.
The older you are, the longer the doctor will take to build up the dose of thyroid hormones. Most symptoms will improve, but occasionally chest pain or shortness of breath develops. If this happens, the doctor needs to be told straight away. If your under-active thyroid was picked up by chance in a screening test, you may not feel much better after this treatment. If the thyroid gland was enlarged before treatment, it may get much smaller after the treatment of Hashimoto%26rsquo;s disease.
If too much thyroxine is taken, palpitations, trembling and sweating may appear. Even without these symptoms, mild over-dosage over several years may weaken the bones, making them more likely to be painful and to fracture. With the sensitive tests now available, it is possible for the doctor to be absolutely certain whether the dose being taken for treating this condition is correct or not.

Hashimoto%26rsquo;s disease and hyperthyroidism

A tendency to develop auto-immune thyroid disorders is commonly inherited. Some people develop an under-active thyroid following an overactive thyroid condition earlier in life. Overactive thyroid condition is called hyperthyroidism. About one person in l00 develops this quite common condition caused by hyperthyroidism. Both thyroid operations and the use of radioactive iodine for an overactive thyroid often result in an under-active thyroid state. That is why we could see the connection between Hashimoto%26rsquo;s disease and hyperthyroidism. In fact, sometimes certain foods and medicines (especially those containing iodine) can cause it. A particular type of under-active thyroid occurs 4 to 6 months after childbirth, approximately once in 15 pregnancies. This so-called post-partum thyroiditis may cause temporary or permanent thyroid under-activity, which is sometime preceded by a temporary overactive state. In many cases the onset of Hashimoto%26rsquo;s and the elevation of antibodies will be accompanied by a variety of symptoms. These symptoms are fatigue, weight changes, depression, hair loss, muscle/joint aches and pains, infertility, and recurrent miscarriages, among others.

Many conventional endocrinologists will not treat Hashimoto%26rsquo;s disease if the thyroid function tests are in the normal range, despite these symptoms. However, in some cases Hashimoto%26rsquo;s involves a slow but steady destruction of the gland that eventually results in the thyroid%26rsquo;s inability to produce sufficient thyroid hormone. This is the condition known as hypothyroidism. Along the way there can be periods where the thyroid sputters back to life, even causing temporary hyperthyroidism, and then a return to hypothyroidism. This cycling back and forth between hypothyroidism and hyperthyroidism is characteristic of Hashimoto%26rsquo;s disease. That is why we cannot say that Hashimoto%26rsquo;s disease is just refers to hypothyroidism. Ultimately, the thyroid slowly becomes less able to function, and when hypothyroidism itself can be measured by blood tests, many practitioners will finally treat it exclusively with thyroid hormone replacement drugs.

However, there are some endocrinologists, osteopaths and other practitioners, who believe that Hashimoto%26rsquo;s disease, as confirmed by the presence of thyroid antibodies, along with its symptoms, is enough to warrant treatment with small amounts of thyroid hormone. The practice of treating patients who have Hashimoto%26rsquo;s thyroiditis but a normal range of thyroid function tests is supported by study. In that study, German researchers reportedly used levothyroxine treatment for cases of Hashimoto%26rsquo;s autoimmune thyroiditis where TSH had not yet elevated beyond normal range. The researchers concluded that preventative treatment of normal TSH range patients with Hashimoto%26rsquo;s disease reduced the various markers of autoimmune thyroiditis. They speculated that such treatment might even be able to stop the progression of Hashimoto%26rsquo;s disease, or perhaps even prevent the development of hypothyroidism.

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Smoking and lung cancer

Lung cancer is characterized by presence of malignant tumor cells which are destroying the healthy lung tissue. There are several types of lung cancer but the most common is bronchogenic carcinoma which accounts for about 90% of all lung cancers. A recent research indicated that inhaling carcinogen ...
Lung cancer is characterized by presence of malignant tumor cells which are destroying the healthy lung tissue. There are several types of lung cancer but the most common is bronchogenic carcinoma which accounts for about 90% of all lung cancers. A recent research indicated that inhaling carcinogen substances poses the biggest risk for lung cancer development and the most common mean of exposure to such substances is tobacco smoking. The risk of developing lung cancer increases sharply the more you smoke and the longer you smoke.

Incidence

Lung cancer is one of the most lethal of cancers worldwide, causing up to 3 million deaths annually. Only one in ten patients diagnosed with this disease will survive the next five years. Although lung cancer was previously an illness that mostly affected men, the lung cancer rate for women has been increasing in the last few decades, which has been attributed to the rising number of female smokers. Lung cancer is the number one cause of cancer deaths in both men and women in the United States. More than 154,000 Americans died from lung cancer in 2002. Still, more than 90% of lung cancers are preventable.

Signs and symptoms of lung cancer

Symptoms that suggest lung cancer include:

* dyspnea (shortness of breath)
* hemoptysis (coughing up blood)
* chronic cough or change in regular coughing pattern
* wheezing
* chest pain or pain in the abdomen
* cachexia (weight loss), fatigue and loss of appetite
* dysphonia (hoarse voice)
* clubbing of the fingernails (uncommon)
* difficulty swallowing

Possible causes of lung cancer

There are four major causes of lung cancer (and cancer in general):

* Carcinogens such as those in cigarette smoke

* Radiation exposure

* Genetic susceptibility

* Viral infection

Cigarette smoking

Lung cancer is directly related to smoking.







It is proven that there are over 40 carcinogens in the cigarette smoke including radioisotopes from the radon decay sequence, nitrosamine, and benzopyrene. Additionally, nicotine appears to depress the immune response to malignant growths in exposed tissue.

Unfortunately, the risk of getting cancer is not removed immediately after you stop smoking. In fact up to 40% of newly diagnosed lung cancer occurs in former smokers. In the United States, smoking is estimated to account for 87% of lung cancer cases.

Exposure to asbestos and certain chemicals

* Asbestos has been known to increase the risk of getting lung cancer.
* Uranium, chromium and nickel can all cause lung cancer too.

Exposure to radon gas

Radon gas is a naturally occurring radioactive gas that can seep out of the soil into buildings. It is thought that radon gas in very high concentrations may cause lung cancer.

Air pollution

Air pollution may cause lung cancer, although this has only been proven in people exposed to large amounts of diesel exhaust fumes for many years through their work. This type of long term occupational exposure may increase lung cancer risk by up to 47%.

Genetic susceptibility

Experts are still looking into the impact of family history on lung cancer. There is some evidence that there is at least one lung cancer gene because family history of lung cancer does have an impact on the risk. Families of smokers will all be exposed to cigarette smoke and so have an increased risk of lung cancer whether they carry the gene or not.

Passive smoking

Passive smoking refers to inhalation of the smoke coming from someone else%26rsquo;s cigarette. It has recently been identified as a much more possible cause of lung cancer in non-smokers than previously believed. Several researches have been conducted on this subject and they all came to the same conclusion- passive smoking causes lung cancer in non-smokers.

The study found that there was an estimated 16% increased risk of lung cancer among the non-smoking spouses of smokers. It is estimated that workplace exposure increases the risk for 17%.

Histological types of lung cancer

There are two major types of lung cancer:

* Non-small cell lung cancer %26ndash; This type of cancer is much more common. It usually spreads to different parts of the body more slowly than small cell lung cancer.
o squamous cell carcinoma
o adenocarcinoma,
o large cell carcinoma

* Small cell lung cancer- small cell lung cancer also called oat cell cancer, accounts for about 20% of all lung cancers.

Diagnosis of lung cancer

Unfortunately, lung cancer is usually diagnosed too late for treatment to be possible. In over half of people with lung cancer the disease has already spread at the time of the diagnosis.

Early diagnosis is difficult because many of the common symptoms of lung cancer are similar to those of chronic obstructive pulmonary disease.

* X-ray examination

The first investigation of lung cancer should be a chest X-ray. However, this method can't detect all tumors because it needs to be at least a centimeter in diameter to be detectable by an ordinary X-ray.

* Blood tests

Some simple blood tests and further examinations may also be carried out.

* Bronchoscopy

This is a very good diagnostic tool and it represents a direct inspection of the inside of the breathing tubes with a thin instrument called bronchoscope. It is all done using local anaesthetic and is the best method for the diagnosis of tumors in the bronchi in the centre of the chest.

* Biopsy

Depending on the site of the cancer, a biopsy will be obtained either by a bronchoscopy or a needle biopsy.

* Sample of sputum

A sample of sputum, the material coughed up from the respiratory tract, will also be examined for cancer cells.

* CT-scan

A CT scan provides more information about how much the tumor may have spread.

Metastatic lung cancer

The lung is a common place for metastasis from tumors in other parts of the body. These cancers, however, are identified by the site of origin, i.e., a breast cancer metastasis to the lung is still known as breast cancer. The adrenal glands, liver, brain, and bone are the most common sites of metastasis from primary lung cancer itself.

Treatment of lung cancer

Treatment of lung cancer can depend on the size, location and extent of the tumor, and general health of the patient. There are many treatments, which may be used alone or in combination. These include:

SURGERY

Surgery may cure lung cancer but it is used in limited stages of the disease. The type of surgery depends on where the tumor is located in the lung.

RADIATION THERAPY

Radiation therapy is a form of high energy X-ray that kills cancer cells. It is used:

* In combination with chemotherapy and sometimes with surgery.
* To offer relief from pain or blockage of the airways.

CHEMOTHERAPY

Chemotherapy is the use of drugs that are effective against cancer cells. Chemotherapy may be injected directly into a vein or given through a catheter, which is a thin tube that is placed into a large vein and kept there until it is no longer needed.

Chemotherapy may be used:

* In conjunction with surgery.
* In more advanced stages of the disease to relieve symptoms.
* In all stages of small cell cancer.

How come some smokers don%26rsquo;t develop lung cancer?

The fact is that not all smokers develop cancer but it is still not known why. Different people react differently to the 4,000 chemicals contained in cigarette smoke depending on their genetic and biological make-up. However, the fact is that the risk of developing lung cancer increases sharply the more you smoke and the longer you smoke. According to some researches, 1 in 11 men and 1 in 17 women will develop lung cancer in their lifetime.

Tobacco and other types of cancers

* Cancers of the mouth and throat

Several researches have tried to prove that smoking cigarettes is a risk factor for all cancers associated with the larynx, oral cavity and esophagus. It is proven that over 90% of patients with oral cancer use tobacco by either smoking or chewing it. The risk for these cancers increases with the number of cigarettes smoked and those who smoke pipes or cigars experience a risk similar to that of cigarette smokers.

* Bladder cancer

Tobacco smoking is the principal risk factor for bladder cancer in both men and women. It is estimated that current smokers are 2-5 time more likely to develop bladder cancer than non-smokers.

* Breast cancer

Some studies have proven that there is a link between smoking and breast cancer. Most epidemiological studies have found no association between active smoking and breast cancer but a new study found that among women who have smoked for 40 years or longer the risk of breast cancer was 60% higher that that of women who have never smoked.

* Cervical cancer

Cancer of the cervix has been found to be associated with cigarette smoking in many case-control studies. Smoking is the second most significant environmental factor after human papilloma virus.



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Hallucinations

Hallucinations are medically defined as apparent perception of an external object while the fact is that no such object is present. They are false or distorted sensory experiences that appear to be real perceptions to the person which is hallucinating. What is important about these sensory impressio...

Hallucinations are medically defined as apparent perception of an external object while the fact is that no such object is present. They are false or distorted sensory experiences that appear to be real perceptions to the person which is hallucinating. What is important about these sensory impressions? It is important to know that they are generated by the mind rather than by any external stimuli. Hallucinations could be seen, heard, felt, and even smelled or tasted by the person who is hallucinating. People may experience hallucinations as part of their normal developmental stages, especially during the preschool years, in the 2-5 year old range.

Possible causes of hallucinations

It is proven that the hallucinatory experience has a wide range of etiologies like:

%26middot; neurological insult,

%26middot; seizure and sleep disorders,

%26middot; substance abuse,

%26middot; grief,

%26middot; stress- It is proven that prolonged or extreme stress can impede thought processes and trigger hallucinations

%26middot; metabolic, endocrine and infectious diseases

%26middot; Electrical or neuro-chemical activity in the brain- It is proven that a hallucinatory sensation, often appears before, and gives warning of, a migraine. They are also reported as hallucinations!

%26middot; Mental illness- several researches done in the past have came to the conclusion that there is up to 75% of schizophrenic patients admitted for treatment which reported hallucinations.

%26middot; Brain damage or disease. Lesions or injuries to the brain may alter brain function and produce hallucinations.

The fact is that patients suffering from dementia and psychotic disorders such as schizophrenia frequently mostly experience hallucinations, but there is no rule because, hallucinations can also occur in patients who are not mentally.





In most cases we are talking about a result of stress overload, hypertension or exhaustion. It is also proven that sleep deprivation for a longer period can also lead to hallucinations.

Drug reactions %26ndash; Several researches done in the past have came to the conclusion that the use of psychotomimetics and many medication's side-effects could trigger hallucinations: ecstasy, LSD, mescaline, and psilocybin trigger hallucinations.

Top 10 drugs or classes associated with hallucinations.

• SSRIs



• tramadol



• bupropion



• venlafaxine



• quinolones



• proton pump inhibitors



• clarithromycin



• zopliclone



• ropinirole



• %26beta;-adrenoreceptor antagonists

Other drugs such as marijuana and PCP have hallucinatory effects. Hallucinogens can be classified by:

%26middot; quality of action,

%26middot; mechanisms of action,

%26middot; by chemical structure

Almost all hallucinogens contain nitrogen and are classified as alkaloids. THC and Salvinorin A are exceptions. Many hallucinogens often have chemical structures similar to those of human neurotransmitters, such as serotonin, and temporarily interfere with the action of neurotransmitters and/or receptor sites.

Beside these pathological causes- there are also some medical and psychiatric causes of hallucinations. Common causes include:

• Fever, which can occur with almost any infection,



• Intoxication or withdrawal from drugs



• Delirium or dementia



• Sensory deprivation such as blindness or deafness



• Severe medical illness including liver failure, kidney failure, and brain cancer



• Some psychiatric disorders, particularly schizophrenia, psychotic depression, and post-traumatic stress disorder

The mechanism of hallucination

Various theories have tried to explain the occurrence of hallucinations. Hallucinations were first seen as a projection of unconscious wishes and desires, but biological theories have claimed that hallucinations are more often thought of as being caused by functional deficits in the brain. Important thing to know is that the function of the neurotransmitter dopamine is thought to be particularly important. Hallucinations may result from biases in meta-cognitive abilities. These are abilities that allow us to monitor or draw inferences from our own internal psychological states.

Types of hallucinations

Hallucinations occur while a person is awake and conscious and some of the common hallucinations include:

• Hearing voices when no one has spoken (auditory-hallucinations)



• Seeing patterns, lights, beings or objects that aren't there (visual-hallucinations)



• Feeling a crawling sensation on the skin (tactile-hallucinations)



• Hallucinations related to smell or taste are rare, but possible

Visual Hallucination

• Hypnagogic Hallucination

These hallucinations occur just before falling asleep and can last from seconds to minutes; all the while the subject usually remains aware of the true nature of the images.

• Peduncular Hallucinosis

These hallucinations occur most often in the evenings but unlike the previous type-the subject is usually fully conscious.

• Delerium Tremens

The subject which suffers from delirium tremens is usually agitated and confused, especially in the later stages of this disease. It is also accompanied with sleep disorders!

• Parkinson's Disease and Lewy body Dementia

Parkinson disease is associated with Lewy body dementia because they produce similar hallucinatory symptoms. These hallucinations start with illusions and they typically last for several minutes. What is the cause? Well, it is a known fact that Parkinson's disease is usually associated with a degraded substantia nigra pars compacta.

• Migraine Coma

This type of hallucination is usually experienced during the recovery from a comatose state. Some researches have proven that these hallucinations occur during states of full consciousness.

• Charles Bonnet Syndrome

Symptoms characteristic to this syndrome are being felt by blind patients who experience visual hallucinations. The hallucinations usually occur during the morning or evening, but are not dependent on low light conditions.

• Focal Epilepsy

It is well known that some focal epilepsy could produce hallucinations which are characterized by being brief, and stereotyped.

Auditory Hallucinations

The definition is simple- they occur when people hear voices or other noises although nothing is there. It is also very important to rule out possible causes such as physical illness and the side-effects of medication. How to recognize? One sign that the person may be having hallucinations involving voices is when they talk to themselves although there are no rules!

Several researches has been conducted and the results are:

• 38% percent of subjects described the sound as stereophonic,



• 6% said it came from the right side,



• 4% said left.



• 10% ascribed the origin of sound as coming from behind them



• 9% percent said from the front



• 52% percent of subjects could not ascribe a gender to the voice, and considered it to be a mix,



• 24% considered the voice to be male and 5% female.

Auditory hallucinations are more common in psychotic conditions such as schizophrenia, although they may sometimes be associated with high doses of cocaine, amphetamine or other stimulants.

Hallucinations- a symptom of dementia

It is a proven fact that people with dementia often have hallucinations. It's still not clear if this is an indication that the dementia is getting worse, but the fact is that most dementia does worsen over time. When a person with dementia has hallucinations, it's important to rule out delirium as a cause.

Causes of delirium include:

• heart or lung disease,



• infections,



• poor nutrition,



• drug interactions



• hormone disorders

Hallucinations due to delirium usually go away with treatment of the underlying cause. When hallucinations occur as a symptom of dementia, treatment may include several medications.

Diagnosis

There is no doubt that every person should seek evaluation, if experienced hallucinations more then once and in unusual occasion!

Differential diagnosis

A general physician, psychologist, or psychiatrist will try to rule out possible organic, environmental, or psychological causes through a detailed medical examination and social history. If a psychological cause such as schizophrenia is suspected, a psychologist will typically conduct an interview with the patient and his family and administer one of several clinical inventories, or tests, to evaluate the mental status of the patient.

Occasionally, people who are in good mental health will experience a hallucination. If hallucinations are infrequent and transitory, and can be accounted for by short-term environmental factors such as sleep deprivation or meditation, no treatment may be necessary. However, if hallucinations are hampering an individual's ability to function, a general physician, psychologist, or psychiatrist should be consulted to pinpoint their source and recommend a treatment plan.

Treatment and prognosis

Every patient should know that hallucinations which are symptoms of a mental illness such as schizophrenia should be treated by a psychologist or psychiatrist.

• Medications

Antipsychotic medication such as thioridazine (Mellaril), haloperidol (Haldol), chlorpromazine (Thorazine), clozapine (Clozaril), or risperidone (Risperdal) may be prescribed.

• Psychosocial therapy

If hallucinations persist, psychosocial therapy can be helpful in teaching the patient the coping skills to deal with them. Hallucinations due to sleep deprivation or extreme stress generally stop after the cause is removed.

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Morton's Neuroma

A Morton's neuroma, also called an interdigital neuroma, intermetatarsal neuroma or a forefoot neuroma, is a benign swelling along a nerve in the foot that carries sensations from the toes. It is important to know that this isn't some cancerous growth and that the reason the nerve starts to swell i...

A Morton's neuroma, also called an interdigital neuroma, intermetatarsal neuroma or a forefoot neuroma, is a benign swelling along a nerve in the foot that carries sensations from the toes. It is important to know that this isn't some cancerous growth and that the reason the nerve starts to swell is unknown. Problem is that, once swelling begins, the nearby bones and ligaments put extra pressure on the nerve, causing more irritation and inflammation which is causing burning pain, numbness, tingling and other abnormal sensations in the toes. This swelling usually develops between the third and fourth toes and other locations are rare. Important thing to know is also that it is rare for a Morton's neuroma to develop in both feet at the same time.

Incidence of the condition

Several researches done in the past have came to the conclusion that the condition is much more common in women than men, probably as a result of wearing high-heeled and narrow-toed shoes. It is also much more common in obese people because being overweight also increases the risk of a Morton's neuroma. Highest prevalence of Morton's neuroma is found in patients aged 15-50 years, but the condition may occur at any age.

Symptoms of a Morton's Neuroma

When someone has a Morton%26rsquo;s neuroma, he or she will probably have one or more of these symptoms where the nerve damage in occurring:

• Tingling, burning, or numbness



• Pain



• A feeling that something is inside the ball of the foot, or that there's a rise in the shoe or a sock is bunched up.

The progression of a Morton's neuroma often follows this pattern:

• The symptoms begin gradually and at first- they occur only occasionally, when wearing narrow-toed shoes or performing certain aggravating activities.



• The symptoms may go away temporarily by massaging the foot or by avoiding aggravating shoes or activities.



• Over time the symptoms progressively worsen and may persist for several days or weeks.
  
  
  
  
  
  



• The symptoms become more intense as the neuroma enlarges and the temporary changes in the nerve become permanent.

Typically, the pain is relieved temporarily by taking off shoes, flexing toes and rubbing feet. Symptoms may be aggravated by standing for prolonged periods.

Possible causes of Morton%26rsquo;s neuroma

The fact is that experts don't understand exactly what causes Morton's neuroma. However- there are some theories that tried to explain the cause of the condition and most of them are considering injury to be the direct cause! The condition seems to occur in response to irritation, pressure or injury to one of the digital nerves that lead to toes. The growth of thickened nerve tissue is part of body's response to the irritation or injury. It is proven also that, in some cases, Morton's neuroma may result from abnormal mechanics of the foot. This includes the presence of different bunions, hammertoes, flatfeet or excessive flexibility. Certain activities carry increased risk of excessive toe deformities, such as prolonged walking, running, squatting, and ballet%26hellip;

Factors that appear to contribute to Morton's neuroma include:

• Wearing high-heeled shoes or shoes that are tight or ill-fitting, including those that box in feet and place pressure on toes



• High-impact athletic activities, such as jogging, that subject your feet to repetitive trauma



• Injury to your foot

Diagnosis of Morton%26rsquo;s neuroma

• Detailed patient%26rsquo;s history

Every doctor should suspect that a patient has a Morton's neuroma based on the nature and location of her or his foot pain. That%26rsquo;s why- doctor should ask questions about shoes %26mdash; what type of shoes a patient usually wears and whether these shoes have narrow toes or high heels. Differential diagnosis is easy! To rule out other causes of foot pain, doctor should ask questions about medical history, especially any history of arthritis, nerve and muscle problems or previous foot or leg injury.

• Physical examination

To confirm the diagnosis, every doctor should examine patient%26rsquo;s feet. He should look for areas of tenderness, swelling, calluses, numbness, muscle weakness and limited motion. It is very easy to confirm the diagnosis by squeezing the sides of patient%26rsquo;s foot. Squeezing should compress the neuroma and trigger patient%26rsquo;s typical pain. In some cases, doctor will find numbness in the area between the affected toes. It is also important to know one thing- pain in two or more locations on one foot more likely indicates that the toe joints are inflamed rather than a Morton' neuroma.

• X-ray and MRI imaging

Sometimes, a foot X-ray may be ordered to make sure that there isn't a stress fracture, but it will not show the actual neuroma. If the diagnosis is in doubt, doctor should request magnetic resonance imaging (MRI) of the foot.

Differential diagnosis

There are some condition that should be mixed with this Morton%26rsquo;s neuroma and these may include:

• Stress fracture of the neck of the metatarsal



• Rheumatoid arthritis and other systemic arthritis conditions



• Hammer toe



• Metatarsalgia



• Neoplasm



• Metatarsal head osteonecrosis



• Freiburg osteochondrosis



• Ganglion cysts



• Intermetatarsal bursal fluid collections



• True neuromas

Treatment of Morton%26rsquo;s neuroma

Every patient should know that in developing a treatment plan- foot and ankle surgeon will first determine how long does the condition last and evaluate its stage of development.

For mild to moderate cases of neuroma, treatment options include:

• Padding

It is proven that padding techniques provide support for the metatarsal arch, because it involves lessening the pressure on the nerve and decreasing the compression when walking. It could be very beneficial method!

• Icing

Placing an icepack on the affected area helps reduce swelling. Ice is also beneficial to decrease the associated inflammation.

• Orthotic devices

All patients will confirm- custom orthotic devices provided by foot and ankle surgeon provide the support needed to reduce pressure and compression on the nerve and sometimes %26ndash;relieve pain completely!

• Activity modifications

Activities that put repetitive pressure on the neuroma should be avoided until the condition improves. These include prolonged walking, running, squatting%26hellip;

• Changes in shoewear

It's important to wear shoes with a wide toe box and avoid narrow-toed shoes or shoes with high heels. This will significantly relieve pain and reduce risk for complications!

• Medications

Several patients have reported that some nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, help reduce the pain and inflammation.

• Injection therapy

If there is no significant improvement after initial treatment, injection therapy may be tried. Some simple analgesics or nonsteroidal anti-inflammatory medications may be used to relieve pain and inflammation! However, overuse of injected steroids can lead to a number of side effects, including weight gain and high blood pressure, so people usually receive only a limited number of injections.

Physical therapy

The physical therapist can help the physician in decisions regarding the modification of footwear, which is the first step to treatment. Every therapist should recommend soft-soled shoes with a wide toe box and low heel. High-heeled narrow non-padded shoes should not be worn; because it is proven that they aggravate the condition. A plantar pad is used most often for elevation. Other possible physical therapy treatment ideas for patients with Morton neuroma include:

• cryotherapy,



• ultrasound,



• deep tissue massage,



• stretching exercises

Surgical solutions

Most patients are confused because they don%26rsquo;t know when exactly is surgery needed? Well, it is simple- surgery may be considered in patients who have not received adequate relief from other treatments. Generally, there are two surgical approaches to treating a neuroma:

%26middot; removing of the affected nerve

%26middot; releasing of the affected nerve

Recovery period

Every patient should know that the length of the recovery period will vary, depending on the procedure or procedures performed. Regardless the type of treatment, every foot and ankle surgeon should recommend long-term measures to help keep your symptoms from returning.

Possible surgical Complications

The surgical area contains very small blood vessels, nerves, and muscles and complications can occur.

• Haematoma

Once the neuroma is removed, the empty space may fill with blood, resulting in a painful haematoma.

• Infection

There is a risk for infection, necessitating careful monitoring by the podiatrist and patient. If the incision site becomes warm or red within a day or two after surgery, or if the patient runs a fever, the surgeon must be contacted immediately.

• Recurrence of the pain

Every patient should know that the recurrence is another very common possibility. Problem is that the stump of nerve remaining after resection can begin to grow again. If this occurs, the nerve grows in width and length, creating a burning pain that can be treated by injection or further surgery.

Some useful tips for the patients

• Take anti-inflammatory medications.



• Try ice massage.



• Change your footwear and avoid high heels or tight shoes.



• Wear supports or pads



• Take a break for a few weeks and reduce activities such as jogging, aerobic exercise or dancing.

About 25% of patients will experience complete resolution of their symptoms by taking these steps.

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What is GHB?

Gamma hydroxybutyrate, or simply GHB, is a very powerful, rapidly acting central nervous system depressant. It was first synthesized in the 1920s and was used as a pain reliever. Some researches have proven that GHB is produced naturally by the body in small amounts but its physiological function is...
Gamma hydroxybutyrate, or simply GHB, is a very powerful, rapidly acting central nervous system depressant. It was first synthesized in the 1920s and was used as a pain reliever. Some researches have proven that GHB is produced naturally by the body in small amounts but its physiological function is unclear.

The law and abuse

GHB was sold in health food stores as a performance enhancing booster until the Food and Drug Administration banned it in 1990. It is currently marketed in some European countries as an adjunct to anesthesia.
GHB is abused for its ability to produce euphoric and hallucinogenic states and for its alleged function as a growth hormone that releases agents to stimulate muscle growth.

Common street-names of GHB

Blue nitro
Cherry fX bombs
Cherry meth
Easy lay
Everclear
Firewater
Gamma G
Georgia homeboy
GHB
G.H. revitalizer
Gib
Goops
Great hormones at bedtime
Grievous bodily harm
G-riffick
Growth hormone booster
Insom-X
Invigorate
Lemon fX drops
Liquid ecstasy
Liquid E
Liquid X
Longevity
Natural sleep-500
Nature's quaalude
Orange fX rush
Organic quaalude
Oxy-sleep
Poor man's heroin
Remforce
Revivarant
Salty water
Scoop
Soap
Somatomax PM
Somsanit
Vita-G
Water
Wolfies
Zonked

Incidence

GHB is often ingested with alcohol by young adults and teens at nightclubs and parties. It is used as a pleasure enhancer that depresses the central nervous system and induces intoxication.
Several researches have shown that annual GHB use by secondary school students in 2000 ranged from

%26bull; 1.1% among 10th graders
%26bull; 1.2% among 8th graders
%26bull; 1.9% among 12th graders

In 2001, estimates of annual GHB use ranged from 1.0% among 10th graders to 1.1% among 8th graders and 1.6% among 12th graders.

Production of GHB

GHB can be easily manufactured. In the United States, GHB is produced in laboratories with no guarantee of quality or purity, making its effects less predictable and more difficult to diagnose.






Abusers have figured out that this drug can be manufactured with inexpensive ingredients and using recipes on the Internet. There are some substances such as Gamma butyrolactone (GBL) and 1,4-butanediol which represent the analogs of GHB and can be substituted for it. Once ingested, these analogs convert to GHB and produce the identical effects. The FDA has issued warnings for both GBL and 1,4-butanediol, stating that the drugs have a potential for abuse and are a public health danger.

Medical used of GHB

From the date it was synthesized it has been used as a general anesthetic, and a hypnotic in the treatment of insomnia. GHB has also been used to treat clinical depression, and improve athletic performance. Food and Drug Administration have permitted the use of GHB under the trade name Xyrem in patients with narcolepsy, a form of sleep disorder. GHB is also used in the treatment of alcoholism. It is used to treat both, acute alcohol withdrawal and medium to long term detoxification.

The use and effects of GHB

%26bull; The appearance
GHB is usually taken orally, and in most cases it is sold as a light-colored powder that easily dissolves in liquids. It can also be found as a pure liquid packaged in vials or small bottles. In liquid form, it is clear, odorless, tasteless, and almost undetectable when mixed in a drink.

%26bull; The costs
GHB is typically consumed by the capful or teaspoonful at a cost of $5 to $10 per dose.

%26bull; The effects
Several studies have shown that the average dose is 1 to 5 grams. In most cases it produces effects in 15 to 30 minutes and the effects last from 3 to 6 hours. It is proven that consumption of:

o Less than 1 gram of this drug produce relaxing effects, causing a loss of muscle tone and reduced inhibitions.
o 1 to 2 grams causes a strong feeling of relaxation and slows the heart rate and respiration.
o 2 to 4 grams, pronounced interference with motor and speech control occurs. A coma-like sleep may be induced, requiring intubation to wake the user.

When mixed with alcohol, the depressant effects of GHB are enhanced. This can lead to respiratory depression, unconsciousness, coma, and overdose.

%26bull; Side effects

Side effects associated with GHB may include:

o nausea,
o vomiting,
o delusions,
o depression,
o vertigo,
o hallucinations,
o seizures,
o respiratory distress,
o loss of consciousness,
o slowed heart rate,
o lowered blood pressure,
o amnesia,
o coma

Mechanism of GHB action

Experts are still researching the exact mechanism of GHB effects because they are still not fully understood. GHB clearly has at least two sites of action, stimulating the:

%26bull; GHB receptor
%26bull; The GABAB.

Some researches tried to prove that GHB is nothing more then a neurotransmitter, which in high concentrations can also reach to the GABAB receptor causing the sedative effects.

GHB and cases of rape

The drug-facilitated rape is defined as a sexual assault made easier by the offender's use of an anesthetic-type drug that renders the victim physically incapacitated or helpless and unable to consent to sexual activity.

According to several researches, GHB is the most common substance used in drug-facilitated sexual assaults because it can mentally and physically paralyze an individual. Victims may not seek help until days after the assault, in part because the drug impairs their memory and in part because they may not identify signs of sexual assault. Even when they do seek help, GHB is only detectable in the system for a limited amount of time and the opportunity to detect the drug can quickly pass.

Dangers of usage

%26bull; Mixing GHB with alcohol is extremely dangerous and has caused many deaths due to respiratory failure.
%26bull; Passing out on GHB by itself is also dangerous and potentially life-threatening.
%26bull; Driving a car while on GHB could be extremely dangerous! It is proven that only one dose can impair motor coordination by as much as six drinks of alcohol.
%26bull; Regular, daily use of GHB can cause physical dependency with harsh withdrawal symptoms.
%26bull; GHB is illegal and possession can result in long prison terms.

Withdrawal from GHB

Patients with a history of around-the-clock use of GHB (every 2 to 4 hours) exhibit withdrawal symptoms including:

%26bull; anxiety,
%26bull; insomnia,
%26bull; tremors,
%26bull; episodes of tachycardia
%26bull; delirium
%26bull; agitation

Because GHB has a short duration of action and quickly leaves the user's system, withdrawal symptoms may occur within 1 to 6 hours of the last dose. These symptoms may last for many months.

Other signs and symptoms of acute GHB abstinence syndrome may include

%26bull; Anorexia, abdominal cramps
%26bull; Nightmares
%26bull; Impaired concentration, memory, and judgment
%26bull; Increased sensitivity to sounds and tactile sensations
%26bull; Delusions
%26bull; Tonic-clonic activity (it is unclear if actual seizures occur during GHB withdrawal)
%26bull; Elevated temperature
%26bull; Dehydration

Therapy of GHB dependence

Benzodiazepines
Benzodiazepines such as Lorazepam (Ativan%26reg;, Temesta%26reg;), chlordiazepoxide (Librium%26reg;, Mitran%26reg;, Poxi%26reg;), and diazepam (Valium%26reg;, T-Quil%26reg;), are useful in relieving some of the signs and symptoms of GHB withdrawal.
Big doses of oral or intravenous benzodiazepines do not decrease the likelihood of withdrawal delirium, but are important for controlling psychotic agitation. The big problem is that most patients in GHB withdrawal have an extremely high tolerance to the sedating effects of benzodiazepines and require large frequent doses similar to those required for the treatment of severe alcohol withdrawal. Such large benzodiazepine doses require close medical attention and the application of continuous pulse oximetry to monitor for oxygen desaturation.

Barbiturates
Barbiturates in combination with benzodiazepines have been used successfully to improve withdrawal symptoms. Pentobarbital, a short acting barbiturate, can be titrated intravenously in 100-200 mg increments to symptoms.

Sedating Agents
Propofol is an anesthetic agent used for sedation which has been reported to provide relief for the psychotic agitation in patients with severe GHB withdrawal symptoms.

Antihypertensive Medications
It is not uncommon for patients to request medications such as beta-blockers for the treatment of minor autonomic hyperactivity such as elevated heart rate, elevation of blood pressure, sweating, tremor, or panic attacks. Beta-blockers used to control vital sign abnormalities via peripheral beta-blockade, without central nervous system sedation, may be detrimental.

Haloperidol and Other Antipsychotic medications
Clinicians have reported using large doses of antipsychotic medication in an attempt to control GHB withdrawal psychosis and they provided limited control of symptoms. Neuroleptics may also increase the risk of neuroleptics malignant syndrome and malignant hyperthermia.


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Obsessive jealousy

It is very difficult to explain what jealousy is. The most common definition would be that jealousy is an emotion by one who perceives that another person is giving something that he or she feels is due to them to an alternate. The examples of jealousy are everywhere around us. Children may become j...
It is very difficult to explain what jealousy is. The most common definition would be that jealousy is an emotion by one who perceives that another person is giving something that he or she feels is due to them to an alternate. The examples of jealousy are everywhere around us. Children may become jealous when their siblings get something that they haven%26rsquo;t. An adult may become jealous if their lover is flirting with someone else. Although a small amount of jealousy is not considered to be pathological, this emotion, when seriously expressed, can invade every relationship, whether it be with husbands, wives, boyfriends, girlfriends, brothers, sisters, mothers or fathers. A form of jealousy called Delusional jealousy or Othello syndrome is a psychiatric disorder in which a person thinks that their spouse or sexual partner is being unfaithful. In some cases this type of behaviour is acquired through past experiences - people who have already been cheated on tend to be more possessive and controlling for fear of repetition. In most cases however, jealousy is a byproduct of one's own issues with self-confidence and self-esteem.

Fear and lack of trust

Fear is the number one cause of unfounded jealousy. The person who is jealous may not be willing to admit it at first, but at the core of almost all jealousy is a fear that they may lose their partner and their needs for love, friendship and affection will no longer be met. The second ingredient that is almost always present when someone is jealous is a lack of trust in a relationship. This can either be a lack of trust in their partner because of past actions or a lack of trust in their partner's ability to make conscious choices and decisions about their conduct when they are with other people.

Jealousy and envy

Some experts strictly distinguish between jealousy and envy on the ground that jealousy involves the wish to keep what one has while envy involves the wish to get what one does not have.







To oversimplify, jealousy causes anger, envy causes wistfulness. Jealousy is destructive, but envy rarely is. Envy is the desire for something in general, whereas jealousy is the desire to have something in particular.

Some even claim a distinction between jealousy and envy insofar as while envy is the carnal desire to possess something that is not yours, jealousy is the righteous feeling that one has towards that which is rightly his.. For this reason, some have suggested that jealousy mostly concerns one's perception of oneself.

Jealousy and self-esteem

Scientific research has not clearly established a link between jealousy and self-esteem although some experts claim that there is a strong link between thess two.

Is jealousy insecurity?

Several psychiatric studies have come to the conclusion that feelings of jealousy always appear to stem from one's sense that something about their life is not secure. In some cases, the insecurity is not founded on realistic dangers to the relationship and if that is the case, the jealous partner may wish to consider where the insecurities are coming from. Of course, solving these sorts of insecurities isn't easy, but until a person does it there is no chance for a healthy relationship without the excessive jealousy.

Totally non-jealous!

By the late 1960s and the 1970s, jealousy, particularly sexual jealousy, had come to be seen as irrational and shameful among the proponents of free love. People who practiced those non-exclusive sexual relationships believed that they ought not to be jealous and sought to banish or deny jealous reactions to their partners' sexual involvement with others. Many found this unexpectedly difficult. For some, conscious blocking of the jealous reaction is relatively easy from the start, and over time the reaction can be effectively extinguished.

Multiple intimate relationships

Several studies suggest that jealousy may be reduced in multilateral relationships. Contemporary practitioners of what is now called multiple intimate relationships for the most part treat jealousy as an inevitable problem, best handled by accommodation and communication.

Delusional jealousy

Delusional jealousy is a psychiatric disorder in which a person holds a delusional belief that their spouse or sexual partner is being unfaithful. Delusional jealousy is also known as the Othello syndrome, erotic jealousy syndrome, morbid jealousy, Othello psychosis, or sexual jealousy. This syndrome may appear alone or in the course of paranoid schizophrenia, alcoholism, or cocaine addiction.

The most common symptoms of Othello syndrome:

%26bull; recurrent accusations of infidelity,
%26bull; searches for evidence,
%26bull; repeated interrogation of the partner,
%26bull; tests of partner's fidelity,
%26bull; stalking


The affected person typically makes these accusations based on insignificant or minimal evidence. They may also frequently monitor their partner%26rsquo;s behavior and movements. This may be taken to extremes. This type of behaviour is more often found in males than females and it has a strong association with violence.
Some studies have also found that the constant accusations and suspicion from the delusional partner have driven some partners to actually have an affair.

Treatment of jealousy

The first step is that the person stops denying jealousy and starts dealing with it. There are several ways in which jealousy can be treated.

%26bull; Self-treatment

It is proven that one of the biggest mistakes that jealous person can make is to try and hide it. It is important to figure out that jealousy is usually a signal that something in the life of this person needs to be fixed. Ignoring usually only makes things worse. Jealous persons should ask themselves the following questions:

%26bull; What do I feel insecure about?
%26bull; Do I feel unattractive or uninteresting myself?
%26bull; Do I doubt the other persons love for me?
%26bull; Do I doubt that I can have the type of relationship I want?

Once a person figures out what the reason of discomfort is, they should ask themselves if these fears are well-founded. If the person is really sure that fears are unwarranted, but they feel insecure anyhow, they should try to change in order to avoid the situations which cause their insecurity in the future!

Sometimes jealous feelings can be triggered because we have unspoken expectations from our partner that aren't met. In such cases it may be helpful to ask the partner how they feel about it and, by clarifying the partners intentions, ending up feeling disappointed and hurt will be less likely. There is a lot of hope in being able to change ourselves, whether we are working on our personal defects of character, or we just need to change our attitude.

Some useful tips are:


%26bull; Learn from past experiences.
It is important to look at how your behavior affected the past relationships. You may soon discover that these frequent suspicions are the cause of your troubled love life.
You should realize that getting upset with your partner for no reason won't help your situation.
%26bull; Deal with reality
Focusing on what is really happening, not what you perceive to be happening is crucial. This is because with time, person may end up having difficulty distinguishing fact from fiction.
%26bull; Respect yourself
The partner chose you for a reason and there is no need for them to be so easily tempted elsewhere.
%26bull; Get a third party's opinion
It might be useful to ask a good friend to take note of your behavior around your partner. It may help you to fully understand the extent of your actions. Neutral perspective is the most objective criteria.

%26bull; Psychiatric therapy
Therapy can be another good way of dealing with unfounded internal fears. Unfortunately, there is often a stigma attached to therapy but you need to know that visiting a therapist doesn%26rsquo;t mean that you are crazy.

%26bull; Medications

Some patients with pathological jealousy have a predominant obsessional component to their jealous thoughts. Since obsessions and compulsions often respond to medications called serotonin reuptake blockers, these drugs may also be useful for obsessional jealousy. It is proven that obsessional jealousy has phenomenological similarities to other obsessions and compulsions, and therefore jealousy may respond to standard anti-obsessional medications.

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Antisocial Personality Disorder

Antisocial personality disorder is a specific psychiatric disorder characterized by antisocial and impulsive behaviors. This is a pathological disorder which means that modern psychiatry defines no potential benefits of positive antisocial behavior. Professional psychiatry generally compares Antisoc...
Antisocial personality disorder is a specific psychiatric disorder characterized by antisocial and impulsive behaviors. This is a pathological disorder which means that modern psychiatry defines no potential benefits of positive antisocial behavior. Professional psychiatry generally compares Antisocial Personality Disorder to sociopathy. That%26rsquo;s why the term %26ldquo;sociopath%26rdquo; is sometimes used to describe an individual with anti-social personality disorder. People with anti-social personality disorder show a chronic lack of concern for the rules and expectations of society, and repeatedly violate the rights of others. Anti-social personality disorders are difficult to treat. Group counseling and treatment of coexisting conditions may help some people.

Personality disorders

A personality disorder is a severe disturbance in the logical constitution and behavioral tendencies of an individual, usually involving several areas of the personality, and nearly always associated with considerable personal and social disruption. Personality disorder tends to appear in late childhood or adolescence and continues to manifest into adulthood.

Currently, there are 10 distinct personality disorders identified in the DSM-IV:

1. Antisocial Personality Disorder
2. Avoidant Personality Disorder
3. Borderline Personality Disorder
4. Dependent Personality Disorder
5. Histrionic Personality Disorder
6. Narcissistic Personality Disorder
7. Obsessive-Compulsive Personality Disorder
8. Paranoid Personality Disorder
9. Schizoid Personality Disorder
10. Schizotypal Personality Disorder

Incidence

Approximately 3% of men and 1% of women are thought to have some form of antisocial personality disorder according to DSM-IV.





The incidence of antisocial personality is higher in people who have antisocial biological parents.

The cause of Antisocial Personality Disorder

The cause of this disorder is unknown, although most experts believe that the biological or genetic factors may play a role.

%26bull; Genetic factors
The incidence of antisocial personality is higher in people who have antisocial biological parents. There is almost always a history of similar behaviors before age 15, such as repetitive lying, truancy, delinquency, and substance abuse. Several researches have confirmed the genetic factors of antisocial behavior in adults and shown that genetic factors are more important in adults than in antisocial children. Antisocial Personality Disorder in the biological parents predicted antisocial disorder in the adopted away children.

Symptoms of the condition

%26bull; Antisocial behavior
People with this disorder appear to be charming at times, and make relationships, but to them, these relationships are not filled with true emotions. The relationships of the persons with this disorder including marriages, are shallow and meaningles and are ended whenever it suits them. They have the ability to find the weakness in people, and are ready to use these weaknesses to their own ends through manipulation.
%26bull; Lack of true emotions
These people appear to be incapable of any true emotion. They are quick to get angry, but just as quick to let go, without holding grudges.
%26bull; Living for the moment
The are rarely able to have a steady job. They live for the moment, forgetting the past, and not planning the future, not thinking ahead what consequences their actions will have. They want immediate rewards and gratification.

Most commonly, the sociopath:

%26bull; Repeatedly breaks the law
%26bull; Displays reckless or impulsive behavior
%26bull; Exhibits persistent irritability and aggressive behavior
%26bull; Repeatedly lies to and manipulates others
%26bull; Is unable to sustain long-term relationships
%26bull; Shows consistent irresponsibility, such as failing to pay bills or hold a steady job
%26bull; Abuses alcohol or drugs
%26bull; Shows little or no remorse for their actions

Five-factor model of personality

1. High Neuroticism

Some of the common symptoms are:

%26bull; chronic negative affects, including anxiety, fearfulness, tension, irritability, anger, dejection, hopelessness, guilt, shame;
%26bull; difficulty in inhibiting impulses: to eat, drink, or spend money;
%26bull; irrational beliefs: for example, unrealistic expectations, perfectionistic demands on self,
%26bull; unwarranted pessimism;
%26bull; unfounded somatic concerns;
%26bull; helplessness and dependence on others

2. Low Extraversion

This is characterized by social isolation, interpersonal detachment, and lack of support networks, flattened affect, lack of joy for life, social inhibition and shyness.

3. Low Openness

It is characterized by low tolerance or understanding of different points of lifestyles, emotional blandness and inability to understand and verbalize own feelings.

4. Low Agreeableness

The most common symptoms are cynicism, paranoid thinking and inability to trust even friends or family.

5. Low Conscientiousness

It is characterized by poor academic performance relative to ability.

The person with APD is hardly fulfilling their intellectual or artistic potential.

Aggressive sociopaths

These people derive strong gratification from harming others. It is proven that they like to hurt, frighten, tyrannize, bully, and manipulate. They do it for a sense of power and control, and will often only drop subtle hints about what they are up to. They seek out positions of power, such as parent, teacher, bureaucrat, supervisor, or police officer.

Diagnosis of APD

Most of the manuals for diagnosing mental and behavioral disorders, define antisocial personality disorder as a pervasive pattern of three (or more) of the following:

%26bull; failure to conform to social norms with respect to lawful behaviors
%26bull; deceitfulness, repeated lying, use of aliases,
%26bull; impulsivity or failure to plan ahead
%26bull; irritability and aggressiveness, as indicated by repeated physical fights or assaults
%26bull; reckless disregard for safety of self or others
%26bull; lack of remorse
%26bull; The individual is at least age 18 years.
%26bull; There is evidence of conduct disorder with onset before age 15 years.

Differential Diagnosis

Some disorders have similar symptoms. That is why the clinician has to differentiate against the following disorders to establish a precise diagnosis.

These conditions are:

%26bull; Substance-Related Disorder;
%26bull; Schizophrenia
%26bull; Manic Episode
%26bull; Narcissistic Personality Disorder
%26bull; Histrionic Personality Disorder
%26bull; Borderline Personality Disorders
%26bull; Paranoid Personality Disorder
%26bull; Adult Antisocial Behavior.

Treatment of Antisocial personality disorder

Treatment Goals

Experts are saying that the treatment for all individuals with personality disorders should include:

%26bull; preventing further deterioration,
%26bull; establishing or regaining an adaptive equilibrium,
%26bull; alleviating symptoms,
%26bull; restoring lost skills,
%26bull; fostering improved adaptive capacity

Another treatment goal is to assist family members and significant others to set limits.

Counseling and Psychotherapy

The effective treatment of antisocial behavior and personality is limited but it is proven that group psychotherapy can be helpful.
The main goal of the psychotherapy is for the patient to develop a sense of trust. Only then the individual psychotherapy or cognitive behavioral therapy can be beneficial. It is likely, that intensive, psychoanalytic approaches are inappropriate for this population.

Pharmacotherapy

There is no research that supports the use of medications for direct treatment of antisocial personality disorder. It is proven that medications should only be utilized to treat clear, acute and serious diagnoses.

Self-Help

There are several self-help methods for the treatment of this disorder. Unfortunately they are often overlooked by the medical profession. Group therapy could be the key because individuals feel more at ease while discussing their problems in front of their peers..

Prognosis

The prognosis is not very good mostly because this disorder is characterized by a failure to conform to society's norms. People with this disorder are often incarcerated because of criminal behavior. A lack of insight into the disorder is also very common. People with antisocial personality disorder rarely seek treatment and rarely realize that they have a problem in the first place.

Read More...

Effexor - experiences

Venlafaxine (Effexor®) is a new antidepressant with a chemical structure that does not resemble those of any currently used antidepressants. Effexor XR® (Venlafaxine HCL) is a medication available to treat depression and generalized anxiety disorder .It is important to know that Effexor®...
Venlafaxine (Effexor%26reg;) is a new antidepressant with a chemical structure that does not resemble those of any currently used antidepressants. Effexor XR%26reg; (Venlafaxine HCL) is a medication available to treat depression and generalized anxiety disorder .It is important to know that Effexor%26reg; is not a tricyclic antidepressant or an MAO inhibitor. The fact is that everyone responds to medications differently. Effexor XR%26reg; will work well for some people, and not so well for others. Research has shown that Venlafaxine is the most effective among six commonly prescribed antidepressants.

What makes it so different from other antidepressants?

Effexor seems to have the relative freedom from side-effects associated with the:

%26bull; SSRIs such as fluoxetine (Prozac%26reg;), sertraline (Zoloft%26reg;), paroxetine (Paxil%26reg;), and fluvoxamine (Luvox%26reg;) and
%26bull; The impact on both serotonin and norepinephrine associated with the tricyclic antidepressants [amitriptyline (Elavi%26reg;l), imipramine (Tofranil%26reg;).

Effexor is different than other antidepressants because it contains the drug known as Venlafaxine which should be prescribed only to people suffering from major depression or extreme anxiety. This drug has been successful in treating people with depression that have not responded to other antidepressants.

Metabolism and mechanism of action

This drug belongs to a class of antidepressants called serotonin-norepinephrine reuptake inhibitors (SNRI). As Venlafaxine and its active metabolite have relatively short half-lives, 4 hours and 11 hours respectively, Effexor should be administered in divided does, two or three times a day. Venlafaxine is well absorbed, with peak plasma concentrations occurring approximately 2 hours after dosing. Structurally different from any other antidepressant, it affects two neurotransmitters involved in depression, serotonin and norepinephrine. Several researches have proven that this medication works by correcting the balance of two brain chemicals serotonin and norepinephrine.

Why are these substances so important? It is proven that these two chemicals help control moods, concentration, impulses, appetites, irritability and emotions.
That%26rsquo;s why imbalances of these substances create the cycle of depression and the nervousness and irritability associated with anxiety disorders.





It is proven that at low and medium dosages, Effexor diminishes serotonin reuptake alone and at higher dosages, it inhibits the reuptake of norepinephrine as well as serotonin and dopamine.

Like most other medications used for depression, Effexor may take several weeks before it is fully effective and that%26rsquo;s why it is important to give the medication sufficient time before judging whether it works for a given person.

Before using this medicine

Before you start taking Effexors, there are several things you should know about it and it%26rsquo;s side effects:

%26bull; Allergies
The doctor needs to be informed about any allergic reaction to Venlafaxine or about allergy to any other substances, such as foods, preservatives, or dyes.
%26bull; Pregnancy
Some research conducted on animals showed that Effexor may have serious side effects on pregnancy. You need to inform your doctor that you%26rsquo;re pregnant before he prescribes you this medicine.
%26bull; Breast-feeding
This medicine passes into breast milk and may cause unwanted effects.
%26bull; Children
Venlafaxine must be used with caution in children with depression because several studies have shown occurrences of suicidal tendencies in children who participated in clinical trials for this medicine.
%26bull; Other medicines
You should consult the physician if you plan to start taking Effexor while already on:

%26bull; Buspirone
%26bull; Bromocriptine
%26bull; Certain tricyclic antidepressants
%26bull; Dextromethorphan
%26bull; Levodopa
%26bull; Lithium
%26bull; Meperidine
%26bull; Nefazodone
%26bull; Pentazocine
%26bull; Selective serotonin reuptake inhibitors
%26bull; Street drugs (LSD, MDMA [e.g., ecstasy], marijuana)
%26bull; Sumatriptan
%26bull; Tramadol
%26bull; Trazodone
%26bull; Tryptophan
%26bull; Clozapine
%26bull; Monoamine oxidase (MAO) inhibitor activity
%26bull; Warfarin

Effexor indications

%26bull; Depression and generalized anxiety disorder
Effexor XR is recognized as an effective first-time medication for patients who suffer from depression or who have generalized anxiety disorder. It doesn%26rsquo;t matter whether they are hospitalized or treated on an outpatient basis.
%26bull; Longstanding depressive illness
It can also be useful for patients who have had longstanding depressive illness and have not responded adequately to previous treatments.
%26bull; Unsuccessful previous treatments
A great deal of so-called refractory patients or those who have not had positive results from past treatment have had success with Effexor XR.

Recommended dosage

%26bull; Effexor%26reg;
The usual starting dose is 75 milligrams a day, divided into 2 or 3 smaller doses. It should always be taken with food. If needed, the doctor may gradually increase the daily dose in steps of no more than 75 milligrams at a time up to a maximum of 375 milligrams per day.
%26bull; Effexor XR%26reg;
For both depression and anxiety the usual starting dose is 75 milligrams once a day, although some people begin with a dose of 37.5 milligrams for the first 4 to 7 days. Your doctor may gradually increase the dose, in steps of no more than 75 milligrams, up to a maximum of 225 milligrams daily.

Possible side effects of Effexor

A warning is being issued with Effexor and with other SSRI and SSRN anti-depressants advising of risk of suicidality. Family members should be advised of this potentially fatal side effect so they may bring the patient to a hospital emergency for surveillance and protection.

Common side effects include:

%26bull; Nausea
%26bull; Dizziness
%26bull; Sleepiness
%26bull; Insomnia
%26bull; Vertigo
%26bull; Dry mouth
%26bull; Sexual dysfunction
%26bull; Sweating
%26bull; Vivid dreams
%26bull; Increased blood pressure
%26bull; Electric shock like sensations

Less Common side-effects include:

%26bull; Panic Attacks
%26bull; Drowsiness
%26bull; Depressed feelings
%26bull; Cardiac arrhythmia
%26bull; Increased serum cholesterol
%26bull; Gas or stomach pain
%26bull; Abnormal vision
%26bull; Nervousness, agitation or increased anxiety
%26bull; Suicidal thoughts suicidal ideation
%26bull; Confusion
%26bull; Neuroleptic malignant syndrome
%26bull; Loss of appetite
%26bull; Constipation
%26bull; Tremor
%26bull; Tardive dyskinesia
%26bull; Difficulty swallowing
%26bull; Lack of sexual desire
%26bull; Raised blood pressure
%26bull; Allergic skin reactions
%26bull; External bleeding
%26bull; Serious bone marrow damage
%26bull; Hepatitis
%26bull; Pancreatitis
%26bull; Seizure

Effexor and other medications

Effexor XR%26reg; does not interact significantly with many other medications, including Lithium%26reg;, Valium%26reg; (diazepam), and Tagamet%26reg; (cimetidine, an anti-ulcer medication). While taking Tagamet %26reg; for high blood pressure or liver disease the patient should be cautious in taking Effexor XR%26reg; because the interaction may be more pronounced when these disorders are present. Effexor XR%26reg; definitely should not be taken at the same time as the MAOIs (Parnate%26reg; or Nardil%26reg;). Interactions with these compounds could be lethal.

Physical and Psychological Dependence

Although no researches have been conducted on humans, several in vitro studies revealed that Effexor has virtually no affinity for opiate, benzodiazepine, phencyclidine (PCP), or N-methyl-D-aspartic acid (NMDA) receptors.

There was no indication of drug-seeking behavior in the clinical trials. However, it is not possible to predict on the basis of experience the extent to which a CNS active drug will be misused, diverted, or abused once marketed.

Withdrawal symptoms

Effexor%26reg; may cause potentially serious withdrawal symptoms upon sudden discontinuation. These withdrawal symptoms have a tendency to be significantly stronger than the withdrawal effects of other antidepressants including the tricyclic antidepressants.

Discontinuation effects may include:

%26bull; irritability,
%26bull; hostility,
%26bull; headache,
%26bull; nausea,
%26bull; fatigue,
%26bull; dysphoria
%26bull; brain shivers

Rarer withdrawal symptoms include:

%26bull; shaking legs,
%26bull; tremor,
%26bull; vertigo,
%26bull; Abdominal or stomach pain;
%26bull; agitation;
%26bull; black, tarry stools;
%26bull; bleeding gums;
%26bull; blistering,
%26bull; peeling,
%26bull; loosening of skin;
%26bull; bloating of abdomen;
%26bull; blood in eye;
%26bull; bloody urine;
%26bull; confusion
%26bull; dizziness
%26bull; paresthesia
%26bull; impaired concentration,
%26bull; bizarre dreams,
%26bull; agitation
%26bull; suicidal thoughts

Effexor and suicide

The possibility of a suicide attempt in seriously depressed patients is inherent to the illness and may persist until significant remission occurs.
Close supervision of high-risk patients should accompany initial drug therapy, and consideration should be given to the need for hospitalization. In order to reduce the risk of overdose, prescriptions for Effexor should be written for the smallest quantity of tablets consistent with good patient management.


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Am I pregnant?

“Am I pregnant” is a favorite question of anyone who is trying to get pregnant and a good question for everyone. Since there are so many different signs and symptoms, many women do not know how to be sure. That is why you should read this article if you are interested in signs and sympto...
%26ldquo;Am I pregnant%26rdquo; is a favorite question of anyone who is trying to get pregnant and a good question for everyone. Since there are so many different signs and symptoms, many women do not know how to be sure. That is why you should read this article if you are interested in signs and symptoms of pregnancy.
While a missed period is one of the biggest clues that a woman is pregnant, it is not the first sign. Some women suspect they are pregnant before their menstrual cycle is late, but also symptoms that might indicate you are pregnant include tenderness of the breasts and nipples, fatigue that occur 1-6 weeks after conception, frequent urination occurring 6-8 weeks after conception, nausea, queasiness, vomiting in first half of pregnancy and food cravings that happens during entire pregnancy. While some women are sure they are pregnant from the moment of conception, others may take five positive pregnancy tests, as well as a host of symptoms, until they are really sure. You must remember that all women are different so you may not experience all, or even any of these common signs of pregnancy.

Missed period

This is probably one of the more reliable signs that pregnancy has happened. Although some women will experience implantation bleeding about the time of their period, it is usually lighter and shorter than normal period. This is why each woman who suspects she might be pregnant will be asked for the first day of last normal period she has had. There are even a few women who will have periods throughout their pregnancy. This is a rare occurrence but it can happen. When a woman is planning for pregnancy, the day that she expects her period is probably well marked in her mind, and that it is the official day that she can take a home pregnancy test. These tests measure the levels of hCG (human chorion gonadotropine), a hormone secreted during pregnancy in woman%26rsquo;s urine.

The amount of urine each test can detect varies widely and amount of hormone each woman secret may also vary, but not as widely.






The better tests on the market will measure 25-50 mIUs of hCG, which is usually the amount found in urine between the 4thand 5th weeks of pregnancy. The levels of hCG in your urine and blood will be different. First morning urine will always contain the highest concentration of hCG but most tests do not require that you use first morning urine.

You can help better your chances of having enough hCG in your urine by waiting four hours after you last urinated, and then taking the home pregnancy test. This will allow hCG to build up in your urine if you really are pregnant. These tests rarely give false results but it would be better for your gynecologist to confirm that you are pregnant. A negative answer that is later revealed to be a pregnancy is usually the result of the test being performed too early, while positive ones that later prove to be false signs of pregnancy usually indicate a very early miscarriage. You can always talk to your practitioner if you have questions about your pregnancy tests. You must know also that blood tests are the most accurate and can be performed 7-10 days post-ovulation.

Tender breasts or nipples

If you are pregnant you will notice that your breasts and nipples become tender. It happens around three weeks after conception or when your period is about one week late. They may also feel swollen similar to the way they feel when you expect your period.

Slight spotting or cramping

If you are pregnant, light pink spotting can occur at the time of implantation. This happens when the embryo attaches to the lining of the uterus. Most commonly woman will notice it around eight to ten days following ovulation, a bit earlier than menstrual period is due. Women can usually differentiate implantation bleeding from menstrual period if it occurs a bit earlier than expected. Moreover, this will probably be cramping if it is scanty, spotty, pinkish and not red and heavy like a period, and does not follow the normal pattern of a period that should be light, progressing to heavy and then again to light. Cramping can also be common in early pregnancy, until the uterus assumes its mid-position and becomes better supported by the bony pelvis in the second trimester. During that time, it is prone to menstrual-like cramping. Contractions of the uterus occur regularly, increasing with exercise, orgasm, and even simple changes in position of the woman.

Darkening areolas

This is a famous and very common sign in very early pregnancy, around the time of your expected period. At this time the woman may notice that her areola (darker areas that ring the nipples) begin to darken and increase in diameter. It is believed that the darker color of the areola helps the newborn to find the nipple for breastfeeding after the baby is born.
You may also notice that the veins in your breasts become more visible and that Montgomery's tubercles (the tiny bumps scattered around the areola) enlarge and may increase in number. The number is averaging between 4 and 28 per areola.

Extreme fatigue

If a woman is pregnant, a very common symptom in the first eight to ten weeks is exhaustion, s her body is going through significant metabolic changes. Her entire body needs to adjust to the new process of growing a baby. For most women fatigue starts to go away by the 12th week of their pregnancy.

Nausea and vomiting

When a woman is pregnant, she may find quite early on, as early as a week after conception, that she is experiencing morning sickness. She may also find that morning sickness is a misnomer. Nausea can occur at anytime, day or night.

Frequent urination

By the time the woman%26rsquo;s period is one to two weeks late, she may find that she is peeing more frequently than usual. This is because the baby growing in uterus is putting pressure on the bladder.

Constipation

Women commonly notice a change in bowel movement in early pregnancy. The extra hormones produced during pregnancy cause the intestines to relax and become less efficient, so constipation could occur.

Raised basal body temperature

A woman may very well be pregnant if her basal body temperature remains elevated even past the time her period is due. She may notice that it does not decline to pre-ovulatory levels. When woman conceive, the egg is fertilized in the fallopian tube. After that, it takes about a week to travel to the uterus, where it will implant. It is at this time that the woman%26rsquo;s body is finally able to detect that she is pregnant. When hCG or human chorionic gonadotropine is released, women often experience a third temperature rise. This is not as dramatic as the first, but can usually be seen anywhere from about a week to 12 days after the first temperature rise at ovulation.

A positive pregnancy test

This is something each woman should do if her period is late and she could expect to become pregnant. She could do it after her period is at least a day late, and when she is ready to know the truth. In this case, she may want to take a home pregnancy test.
A urine pregnancy test can be accurate as early as 10 to 14 days after fertilization happened. If woman cannot wait until a missed period, a blood pregnancy test can be accurate as early as 8 to 10 days after fertilization. However, you should keep in mind that pregnancy tests are not 100 percent foolproof, and neither are blood tests. If you have a negative result and still feel pregnant, be sure to retest a week later and check in with your health care provider.

What if I am pregnant?

When a woman suspects that she is pregnant, she should visit a doctor to confirm her condition as soon as possible; after that she should change her life style a little bit. Laboratory blood tests can verify pregnancy as soon as 6 or 7 days after conception, while urine test may detect pregnancy as early as 10 days after conception. The blood and urine test both measure the level human chorionic gonadotropin or HCG. This is a hormone produced only in a woman%26rsquo;s body when she has placental tissue growing there. The placenta is the tissue within the uterus or womb through which the mother provides nourishment to the fetus.

The importance of prenatal care

One of the most important things that woman can do for herself and her baby is to seek proper prenatal care. Prenatal care consists of regular appointments starting early and continuing throughout the pregnancy. Laboratory testing for potential problems with the developing baby or herself and monitoring for problems such as abnormal changes in blood pressure, blood chemistry, urine chemistry, and weight are very important. Getting plenty of exercise and eating properly, giving up bad habits such as smoking, drinking alcohol, or using street drugs is something that doctor should definitely recommend. It is also important for a woman to alert her doctor immediately if anything unusual occurs during pregnancy, such as if the baby%26rsquo;s movement greatly reduce or stop, if she experiences vaginal bleeding or cramping, develops swelling of her hands and face, or persistent headaches, if she leaks amniotic fluid from her vagina, or if she develops pain in abdomen. Improved technologies and more accurate prenatal tests now make it possible to spot complications earlier. This also helps to get appropriate action in time to save the fetus and mother. A woman%26rsquo;s habits greatly influence the health of her unborn child, so when pregnant, woman should avoid few things. Alcohol is the first thing because consuming alcohol while pregnant can cause birth defects and other problems. In fact, consistent alcohol use during pregnancy can cause fetal alcohol syndrome, a permanent and lifelong condition. Cigarettes, medications, narcotics, caffeine and contact with cat feces are also things pregnant women should avoid.


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