Narcolepsy

How common is Narcolepsy?

The limits between wakefulness and sleep are blurry which causes the patients to feel fatigued and sleepy in the daytime. They experience hallucinations, dreams even paralysis while waking up or falling asleep during the day with interrupted night sleep. In a healthy sleep cycle, there are several stages, and it takes a minimum of 90 minutes to get REM (rapid eye movement) sleep. However, in this disorder, people sleep immediately and get REM. Child or adults both can suffer from this disease. There is no known treatment, but specific changes in lifestyle can improve the condition.

Causes

The definite cause of Narcolepsy is yet not clear, but scientists have made progression in recognizing the elements allied.

• Neurotransmitters: People suffering from narcolepsy have low levels of hypocretin (also known as orexin) which is an essential chemical to regulate wakefulness. It has been observed that patients produce 90-95% less hypocretin than the healthy However, the reason behind the less production is yet unknown, but sometimes it is assumed as an autoimmune reaction.
• Family History: This is not a hereditary problem, only 8 to 10% state that their relatives suffer from this disorder.
• Injury: In rare cases it has been found that the disease has been a result of brain injury or tumor growth in REM areas.

Symptoms

• Sleep paralysis: Ineptness to speak or move while waking up or falling asleep despite conscious of the surroundings. It lasts for a limited duration with no permanent effects.
• Excessive Daytime Sleepiness (EDS): Described by episodes of sleeping without indication, chronic sleepiness and sleep attacks for few seconds. It generates a feeling of mental cloudiness, insufficient concentration and energy, extreme exhaustion and mood swings. It occurs after a sound sleep, the night
• Improper Nocturnal Sleep: Patients with Narcolepsy have broken sleep, especially during the night. Waking up five to six times due to sleep talking, vivid dreaming, and leg movements are ordinary. Sufferers face difficulty in staying awake during the day and sleeping at night.
• Cataplexy: Similar to sleep paralysis, it occurs anytime through the waking period and gets stimulated by emotions like anger, fear, stress, humor, and It has different levels of seriousness like drooping eyelids, muscle weakness, complete physical fall or inability to speak or move. During this attack, patients are conscious, but not able to regulate.
• Hallucination: Patients experience illusions while they are awake (hypnopompic) or while sleeping (hypnogogic) which is frightening and explicit.

Diagnosis

Diagnosis can be done based on the symptoms of Narcolepsy, but for a detailed check up one will need to get the specific test done in a sleep clinic.

• Polysomnogram (PSG): Nocturnal sleep study in which sufferers are wired up to equipment which records brain activity, blood pressure, eye movements, heart rate, body movements, oxygen levels, etc. It helps to know about the abnormalities and other sleep disorders causing symptoms.
• Multiple Sleep Latency Test (MSLT): It is a sleep study conducted during the day to evaluate tendency of sleepiness, swiftness with which one falls asleep and the stages he/she enter. Experts monitor the brain activity along with the eye, and body movements.

Treatments

There is no proper treatment for this disorder, but with appropriate diagnosis symptoms can be treated. However, cataplexy cannot be transposed, it remains throughout the life, but with certain habits, it can be controlled.

• Stimulants: Drugs that energize the nervous system and some amphetamine medicines are common. These are not addictive but have some side effects like nausea, headache, irritability, shakiness, nervousness, nocturnal sleep disruption and heart palpitations.
• Sodium Oxybate: Strong sedative to reduce symptoms of EDS and cataplexy. However, it has severe safety concerns, and its dispensation is also restricted. It includes side effects like enuresis (bedwetting), and nausea worsening conditions of sleepwalking. Consumption of alcohol and other medicines can lead to breathing problems, coma, or even death.
• Antidepressants: Selective serotonin inhibitors and norepinephrine reuptake inhibitors are used to repress REM sleep, hallucination, sleep paralysis, etc. Antidepressants have fewer side effects compared to stimulants but have some adverse effects like high blood pressure, digestive problems, etc.

Home remedies & Lifestyle

• Keep an un-fluctuating sleeping schedule
• Take Short naps every day
• Avoid alcoholic beverages and caffeine (2-4 hours before bedtime)
• Proper Exercise (Morning exercise followed by activity 4-5 hours before sleep improves sleep quality)
• Relaxing time that includes a relaxing bath or reading book enhances nocturnal sleep
• Support group (a condition known by the co-workers, teachers, and employers can help the situation by cooperating)
• Stop any activity if condition worsens, as it can be life-threatening

Preventing Tips

• Minimize consumption of influenza vaccines
• Avoid excessive activities
• Get proper sleep
• Sleep in an appropriate position
• Minimize disclosure to emotional environments

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Empty nest syndrome (ENS) refers to a psychological condition characterized by feelings of loneliness, depression, and loss parents experience when their kids leave home for the first time. Statistics show it to be more common among women and likely to coincide with factors like retirement and menopause.

The term, taking its name from the habitual flying away of birds from nests, was first introduced by writer Dorothy Canfield in 1914, and the condition was clinically identified during the 1970s.

Causes

The event of a kid’s leaving home to pursue higher studies or for a job is a painful reality that forces parents to undergo a host of mixed emotions. In most cases, the obstacles faced include:

• A crumbling sense of purposelessness in not being able to take part in the daily activities of the kid as earlier
• Uneasiness in sharing the home only with the spouse after living for years with children
• Profound anxiety over the safety and wellbeing of the kid in the outside world

Who Are at Risk

The syndrome is more likely to affect those who:

• Are stay‑at‑home mothers
• Are overprotective of their child’s needs
• Believe that their respective roles lend them their self-identity (chiefly mothers)
• Feel that they have lost control over their kid (mostly fathers)
• Have an only child
• Suffer from a constant fear of the separation
• Believe that the child has left too late or too early in comparison to standard norms
• Have problems in their marriage
• Have had children at an early age
• Are single parents
• Are aged
• Do not get adequate emotional support from other family members to get over the loss

Signs and Symptoms

Behavioral symptoms involve feelings of:

• Loss
• Isolation
• Panic or anxiety
• Purposelessness
• Grief
• Boredom
• Anger
• Bitterness
• Regret
• Guilt

Physical symptoms include:

• Hot flashes
• Night sweats
• Fatigue

Associated Conditions

• Depression
• Identity crisis
• Alcoholism

Diagnosis

Though the syndrome cannot be clinically diagnosed, medical professionals may help to identify the problem and take the required steps to help cope with it.

Getting Over Empty Nest Syndrome

How to Deal With ENS at Home

• Renew Interest in Hobbies: The extra time can be invested in pursuing long forgotten hobbies such as gardening or singing.
• Make Friends: ENS is a common condition undergone by most parents. So, it is a good idea to seek likeminded friends with whom time can be easily spent.
• Rediscover the Passion of Married Life: Most couples lose the necessary spark of romance and togetherness in rigorously nurturing children. Initiative can be taken to re-kindle it so depressing thoughts and feelings can be unhesitatingly discussed with the spouse.
• Be in Touch With Your Kid: Random phone calls, emails and texts to maintain regular contact with the child can help as well.

If negative feelings persist even after following the above measures, seek professional help that may involve the following:

Psychotherapy

Several guidelines stressing on the need to stay positive, or take up a job are provided to help the individual to enhance her quality of life.

Medication

Certain antidepressant and anti-anxiety drugs may help handle the symptoms and prevent associated conditions, such as depression, that may develop in the long run.

Can Empty Nest Syndrome be Prevented

The effects of empty nest blues can be better handled if some mental preparations for the departure are taken in advance such as calmly viewing it as an inevitable fact. It will also help in future if there are other kids at home.

How Long Does it Last

An individual may get over ENS within a few months, or take around 18 months to 2 years. The recovery usually depends upon the manner in which she comes to term with the loss.

Parents are now better equipped with technologies like Skype etc. that to some extent helps them to bridge the emotional gap resulted due to ENS. Moreover, issues such as unemployment, extended education, economic crisis have led many 25‑ 30-year-olds to return to their parents in the last decade.

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Othello syndrome is a rare psychological condition, in which an individual suspects his partner of infidelity, despite it being only an illusion. The non‑genetic disorder, also known as morbid jealousy, delusional jealousy, erotic jealousy syndrome, Othello psychosis, or sexual jealousy, is more common in males, with 60% of patients being men.

English psychiatrist, John Todd, named the disorder after the Shakespearean character, Othello, who kills his wife out of suspicion and jealousy.

Signs and Symptoms of Morbid Jealousy

A person suffering from morbid jealousy forms a delusion, usually an accusation of his partner of being unfaithful. Once, this idea has been established, he becomes extremely obsessive to prove it right, thereby getting involved in activities like:

• Restraining partner from having any social media account or personal hobbies outside house
• Persistently interrogating partner’s behavior, demanding where and with whom she has been
• Ceaselessly pressing partner for knowing the identity of unknown or accidental phone calls

These may degenerate to:

• Complete controlling of partner’s social life
• Forcefully detaching partner from family and friends
• Blaming and threatening to cause harm
• Resorting to verbal or physical violence

Couple in love and jealous woman in background

Causes

One of the reasons put forward by several studies is that the disorder is caused when the right frontal lobe of the brain does not function properly. As a result, activities such as self-monitoring, controlling of behavior and emotions, and analyzing the accuracy of responses of the left hemisphere gets affected, thereby causing it to form baseless interpretations, making the individual behave strangely.

Apart from this, the other two factors that tend to arouse this condition concerns:

• The afflicted person’s insecurity or fear that leads him to question his partner’s sincerity to him
• His conviction of having been drugged or given some substance to reduce his sexual potency

Triggering Factors

The strongest triggering factor for men is usually sexual infidelity, while with women, it is emotional infidelity.

Risk Factors

• Aggressive addiction to alcohol as well as other substances such as morphine, amphetamines, cocaine
• Decreased sexual function
• Schizophrenia
• Bipolar disorder
• Parkinson’s disease
• Huntington’s disease
• Stroke
• Encephalitis
• Brain tumor
• Dementia
• Multiple sclerosis
• Normal pressure hydrocephalus
• Endocrine disorders

In rare cases, medications such as pramipexole to increase the dopamine levels in those having Parkinson’s disease may arouse the disorder.

Diagnosis and Tests

The disorder is mainly accessed with the help of:

• Information on the marital relation of both partners, taken through multiple interviews
• Examination of the affected individual’s mental state and psychic history and subsequently recording both, to differentiate the nature of the jealousy – obsessional or delusional
• A history of the diseased individual’s underlying mental illness or substance abuse
• Verification of whether the jealousy has been founded on some wrong idea or thought about their partner that the person has been pondering over for some time

Treatment and Management

Since an affected individual undergoes varied psychiatric states, the initial step generally involves an assessment and resolution of the primary psychiatric condition such as an underlying mental illness, with the help of the symptoms. Other therapeutic means that usually follow are:

Medication

• Antipsychotic medication
• Antidepressant medication

Psychological Treatment

Along with medication, certain therapies that may prove useful in overcoming the condition are:

• Behavioral therapy
• Individual psychotherapy
• Cognitive therapy
• Insight-oriented psychotherapies
• Couple therapy
• Family therapy
• Psycho education imparted to the concerned individual and his partner

Apart from these, the affected person is also subjected to certain social measures for his betterment as well as for the benefit of others, such as:

• Making the concerned person stay in a different geographic location from his partner
• Treatment of alcohol and substance misuse that he might be addicted to

Other than this, significant steps are also taken regarding the protection of any children of the couple.

Can Othello Syndrome be Cured

Since the disorder encompasses different psychiatric stages, the prognosis and outcome vary, depending on the observation of the complexities an affected person is likely to exhibit in interpersonal relationships. The success of the treatment mainly involves the concerned individual’s participation and response to the standard therapies.

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It is a mental health issue that is characterized by paralysis, blindness or other neurological symptoms that cannot be medically explained. It is also known as Hysterical neurosis.

Conversion disorder Types

DSM-IV has listed four subtypes of conversion disorder:

1. Conversion disorder with motor symptom or deficit
2. With sensory symptom or deficit
3. With seizures or convulsions
4. With mixed presentation

Conversion disorder belongs to the cluster of Somatoform disorders that were specified as a class of psychiatric disorders in DSM-III of American Psychiatric Association.

Conversion disorder Symptoms

The disease may arise at any age. The peak age of onset is in the mid-to-late 30s. It is rare in older people and kids less than 10 years of age. Young children hardly suffer from the condition. It has a greater prevalence in women than men (ratio between 2:1 and 10:1).

The exact prevalence statistics for this disease is not available.

Conversion disorder is characterized by the loss of one or more physiological functions, such as:

• Blindness ^[1]
  
• Hallucinations
• Paralysis
• Inability to speak
• Loss of balance
• Difficulty in walking
• Inability to feel pain
• Loss of touch sensation or numbness
• Urinary retention

Common symptoms include:

• Deafness
• Poor coordination or balance
• Paralysis in an arm or leg
• Inability to speak
• Swallowing difficulties or “lump in the throat” sensation
• Eye problems, including double vision and blindness
• Convulsions or seizures
• Abrupt development of debilitating symptoms
• Lack of concern associated with an acute symptom
• History of a psychological issue that improves after the onset of problems

Conversion disorder Causes

Conversion disorder symptoms generally almost appear always due to:

• Any stressful event ^[2]
  
• Another mental condition, like depression

The exact cause is unknown. However, doctors suspect the brain sections controlling the senses and muscles to be involved. This can be a brain mechanism to cope with a real threat. The etiology of the disease is believed to mostly include psychological, as well as neurological and biological factors.

Conversion disorder Risk Factors

The risk factors include:

• History of sexual or physical abuse
• Acute emotional trauma or stress in recent days
• Being women (susceptibility is higher in females)
• A family history of the condition
• Financial problems
• Being a young adult or adolescent (susceptibility is higher in these stages)
• Having some other mental condition, like dissociative disorder and some personality disorders

Dissociative disorder and Conversion disorder comprise of what used to be known as “hysteria.”

Conversion disorder Diagnosis

Doctors may carry out a physical examination and recommend certain diagnostic tests; as such tests can help confirm the absence of any underlying physical cause and avoid rash determination.

Some important exams for the disorder include:

• Simple bedside tests
• Electroencephalogram (EEG) scan
• X-rays, or other imaging exams

DSM Criteria

The DSM (Diagnostic and Statistical Manual of Mental Disorders) criteria for this disorder mentions:

• Patients must have one or multiple uncontrollable symptoms that affect movement of the senses or some body part. These symptoms can result from some neurological or medical disease.
• The symptoms must arise after a stressful event.
• The symptoms are not being produced on purpose.
• The symptoms are not fully explained by some medical issue, drug use or behaviors that are culturally accepted (like a sacred ritual)
• The symptoms must result in acute stress or social or professional difficulties
• The symptoms must not be limited to sexual problems or aches, and cannot be accounted for better by some other mental disorder.

Conversion disorder Differential Diagnosis

It involves distinguishing the signs of Conversion disorder from those of the following conditions:

• Spinal cord injury
• Lupus
• Stroke
• HIV/AIDS
• Myasthenia gravis, a muscle weakness disease
• Neurological disorders, such as epilepsy, multiple sclerosis and Parkinson’s disease
• Guillain-Barre syndrome, a rare disease characterized by the immune system attacking the nerves

Conversion disorder Treatment

A reassurance of absence of an acute health disorder can help the symptoms improve in most sufferers. In case of persistent or recurring symptoms, or due to presence of other physical or mental disorders, treatment may be needed to ensure recovery.

Treatment protocol depends on specific symptoms and can involve any of the following:

• Psychotherapy, which includes counseling and can benefit patients of mental issues like depression
• Physical therapy, involving exercises and other processes that can reduce muscle rigidity and improve mobility
• Use of medications (prescribe anti-anxiety drugs ^[3], antidepressants etc) to cure associated stress and other conditions
• Hypnosis, which can detect and resolve problems associated to psychology, and be used with Psychotherapy
• Transcranial magnetic stimulation, involving brain stimulation through weak electrical currents

Conversion disorder Prognosis

The signs generally persist for a few days to weeks ^[4] and resolve abruptly. The signs are not generally fatal, although patients may suffer from debilitating complications.

Conversion disorder Complications

The symptoms may worsen over time, or recur after a year or so. Hence, immediate treatment is necessary to improve long-term outcome.

Can Conversion Disorder Kill You?

The disorder itself is not usually responsible for death. However, it can increase suicidal tendencies in sufferers and increase the risk of life-threatening complications.

Conversion disorder Prevention

As the condition is triggered by stress, practicing yoga, meditation and other stress-management techniques can help patients. If other mental disorders are present, proper treatment in the form of medicines and counseling can be useful for prevention of Conversion disorder.

Conversion disorder History

The term “Conversion” was used for the first time by Freud and Breuer. At that time, it was called La belle indifference. Sigmund Freud, the founder of psychoanalysis, believed that conflicts and painful emotions are repressed during acute emotional stress and converted into physical problems as a natural mechanism for relief from anxiety. The theory is somewhat agreed upon by many modern healthcare providers.

Famous People with Conversion disorder

They include personalities like:

• Albert Einstein
• Donald Trump
• Leonardo DiCaprio

Conversion disorder ICD-9 Code

The ICD-9 code for this disease is 300.11.

References:

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Paruresis Definition

It is a disorder characterized by an inability of an individual to urinate in front of other people or in situations where they think other persons are present.

The condition is also referred to by various other names, such as:

• Shy Bladder Syndrome, or simply Shy Bladder
• Shy Kidneys
• Bashful Bladder
• Pee Shyness
• Toilet Phobia
• Urophobia
• Avoidant Paruresis
• Shy Cock
• Restroom Phobia
• Fear of the Restroom
• Fear of Toilets
• Psychological Urinary Retention

People who suffer from this disease are referred to as Paruretics.

Paruresis History

The name of the disorder was coined by Degenhart and Williams in the year 1954 and was used in their paper “Paruresis: a survey of a disorder of micturition” in the Journal of General Psychology 51:19-29.

Paruresis Incidence

7% of the general population or around 17 million US inhabitants tend to suffer from the disease. Approximately 51 million Europeans and 3.25 million Canadians have been reported suffer from this social anxiety disorder.

Paruresis Symptoms

As aforesaid, patients of this disorder usually suffer from a fear or shyness to urinate in the presence of strangers or people who are unknown to them. The condition is much more frequent when strangers are present in loos or restrooms and peeing next to them. Those with mild forms of the condition are unable to pee in some surroundings but able in others. Those with more severe forms of the disorder can only urinate at home.

This is usually a progressive problem with fear worsening and generalizing over a period of time to more locations.

The disease can arise at any time of life and can persist for any duration. Some individuals may have a temporary episode of the disease, such as while being told to provide a urinary sample as a part of some diagnostic test, while some others suffer from the disorder for as long as they live.

People often find the condition coming and going throughout their life, based on factors like the general levels of stress or anxiety for the rest of their lives.

In many people regularly suffering from Paruresis, the condition usually arises during the teenage years.

Paruresis Causes

This disorder is likely to have more than one causes. Some patients of this disease may have had overly critical parents or guardians in childhood or had probably been victims of bullying at a very young age.

The typical causes for this disease include:

• Unresolved psychological conflicts
• Underlying stress or anxiety
• Anticipation of occurrence of Paruresis
• Worrying about previous experiences of the condition
• Fear of being judged (also referred to as social phobia or social anxiety)
• Performance Anxiety, such as fear of patients about whether they would be able to urinate in a new toilet

Growing up in an environment where urination and/or toilets were seen as ‘dirty’, or where ‘toilet issues’ were considered to be shameful can also give rise to Paruresis. Patients may feel the urge for urination actively suppressed or suffer from guilt due to such an upbringing.

The three main trigger factors for the disease are:

Presence of strangers in restrooms

The disorder is found to be more common when strangers, and not relatives or friends, are present in a restroom thus increasing the shyness and fear of patients to urinate before such people.

Proximity

The proximity referred to in this case is both physical and psychological. The physical proximity of others, such as their relative nearness of strangers to affected individuals, can have a negative impact on the desire to urinate for sufferers. The psychological proximity includes the need for privacy for patients, who may have a feeling that they are not alone even in deserted restrooms/toilets.

Temporary psychological states

Temporary psychological states of patients, such as anxiety, fear or anger can also interfere with urination.

Paruresis Risk Factors

The risk factors for this disorder include:

Being abused in childhood

Those being bullied when young can be susceptible to this disease. People with repressed upbringing in childhood can also be prone to the disorder.

Previous traumatic experiences

Inability to urinate in certain past situations, such as while providing samples for a diagnostic test, can cause the development of the condition.

Paruresis Diagnosis

The diagnosis of this disease is based on the symptoms reported by sufferers. Patients of acute cases can waste a lot of time in waiting for all others to leave a toilet before they can urinate. They might also completely avoid urinating in public toilets.

The disorder is generally self-detected when any of the three primary triggers for the condition are present and the disorder is chronic in nature.

Inability to urinate may also arise due to conditions such as Prostatitis. Physicians can carry out a series of exams to ensure that there is nothing wrong with the urinary tract of sufferers. They may ask patients whether they can comfortably urinate at home. If sufferers confirm that they can, the condition can be confirmed as Paruresis. Doctors may prescribe the short-term usage of medications like antidepressants or tranquillizers. However, these drugs cannot cure the disease and only serve to reduce associated symptoms of anxiety.

In acute cases, physicians may recommend patients to learn self-catheterisation. A catheter is a slender tubular structure that is inserted into the bladder up through the urethra to drain urine.

Paruresis Differential Diagnosis

The differential diagnosis of Paruresis includes isolating its symptoms from those of similar signs of other conditions like Prostatitis.

Paruresis Treatment

The disorder was once dismissed as a symptom of some mental problem, such as anxiety. However, there has been a growing recognition of the disease by the National Health Service (NHS) of the UK and the government. The American Urological Association also recognizes it now and has included it in their online directory of disorders. It is classified as a type of social phobia in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) in the United States and is known as a form of chronic social anxiety – which is being disputed by some medical professionals.

The most well-documented current curative options are based on cognitive-behavioral therapy, which aims at reorganizing the abnormal emotional problems arising due to factors that trigger Paruresis. This can be performed in a support-group, in self-help scenarios or through psychotherapy by a psychiatrist or psychologist.

Therapy involves three isolated, although associated, components:

Cognitive

It aims to modify the unusual ideas and thoughts around the object of anxiety. Some patients report that they have a sensation of people looking at them when they urinate in public toilets.

Behavioral

This involves a stepwise desensitization of sufferers by slowly exposing them to the situation that causes fear in their minds. This is known as “Exposure Therapy.” The process aims to reassure the subconscious of sufferers through a series of small steps that they are “safe” to urinate in public toilets or restrooms and there is nothing “shameful” in the act. This is a type of “learning” to urinate again in a social surrounding. According to the International Paruresis Association (IPA), around 80% of patients who receive this type of treatment show improvement. Sufferers are taught to gradually use restrooms in increasingly difficult situations; it is generally carried out under the supervision of trained behavioral therapists.

Relaxation

It involves teaching patients a system of exercises that bring about both psychological and physical relaxations, such as sphincter relation exercises.

Paruresis – Alternative Treatment

Saw Palmetto is a possible alternative curative option for this condition. It is used to cure urinary problems in men suffering from BPH, an enlarged prostate gland. This enlargement of prostate leads to its inflammation and obstruction of the urethra. It results in a variety of problems, such as:

• Reduced urine flow
• Painful urination
• Dribbling after urination
• More frequent nighttime urination
• Difficulty starting or stopping the flow

A typical dose of Saw Palmetto is 320 mg per day of its standardized extract. However, patients may take as long as up to 4 weeks to show any benefits.

Paruresis and Medications

The disorder can be cured with the aid of some types of medications. SSRI drugs such as Zoloft, Paxil and Prozac can be useful. Benzodiazepines such as Valium, Klonopin or Xanax can be used while in public or before the drug test to relax the muscles and bring down the anxiety level in patients enough to make them able to produce a urinary sample.

Paruresis Prognosis

Many sufferers of this disorder never seek medical assistance or treatment. They never even have a discussion about the problem with anyone. In such cases, the condition often goes unresolved and continues life-long. However, anecdotal evidence suggests that those who seek medical assistance have a good rate of success at overcoming the sensations of anxiety and fear over a period of time. The time for recovery can be a year or more.

Paruresis Complications

The disorder, if left untreated, can have a damaging impact on the mental health of sufferers. They can have serious difficulties in workplace and maintaining jobs. Those with acute cases of the condition may find it difficult to go out or have long distance-journeys. Withholding urine for long periods can also affect the kidneys and cause embarrassment when patients can no longer hold their urine. Patients may also suffer from psychological difficulties such as anxiety and depression.

Paruresis Prevention

As of now, there is no way that is known to prevent the development of this disease. According to anecdotal evidence, the condition does not arise until a person is around the pubertal age. Doctors usually recommend children to start urinating in public restrooms from an early age to prevent the development of this disorder.

If you, or any of your family members or friends, are having an embarrassment about urinating in public lavatories, seek psychological help and counseling on an immediate basis. As aforesaid, long-term episodes of this condition can affect the quality of your life and also severely affect your mental health. Naturally, it makes sense to opt for medical help as early as possible.

References:

http://en.wikipedia.org/wiki/Paruresis

http://socialanxietydisorder.about.com/od/symptomsanddiagnosis/a/paruresis.htm

http://medical-dictionary.thefreedictionary.com/Paruresis

http://www.bog-standard.org/factsheet_014.aspx

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Paraphilia Definition

“Paraphilia” is a term used in psychology to describe complex sexual behaviors that are outside socially accepted norms. It refers to sexual response to situations or objects that are considered abnormal in contemporary society.

Some of the behaviors exhibited by Paraphilia sufferers are aggressive in nature while some others are non-aggressive. Some forms of Paraphilia are criminal offenses. These are:

• Exhibitionism
• Frotteurism
• Pedophilia
• Sadism
• Voyeurism

Paraphilia Epidemiology

This is a rare condition and is more common in men than in women. It has a 20:1 male-female ratio. It is not known what exactly causes this disparity.

Paraphilia Symptoms

The abnormal sexual behaviors that are considered to be part of Paraphilia include the following, which are considered to be various types of Paraphilia:

Exhibitionism or Flashing

People with this type of behavioral problem are known as “flashers”. Such individuals have an urge to impress, shock or surprise their victims. It is characterized by fantasies that are acute and sexually arousing. They indulge in seemingly indecent behaviors like exposing their genitals to an unsuspecting stranger. The problem is usually restricted only to exposure and not any other harmful behaviors or advances. It is only rarely that any sexual contact is made with victims.

However, patients may masturbate during exposure or during fantasizing about exposure.

Fetishism

People with this form of behavior have sexual urges related to non-living objects, such as underwear, shoes, rubber clothing, lingerie or other things belonging to victims. This fetish (abnormal attraction) may be integrated into sexual activities with willing partners or replace sex with partners. Actual sexual relationships are often avoided when the fetish becomes the only object of sexual desire.

Partialism, an associated condition, is characterized by sexual arousal by a part of human body such as breasts, buttocks or feet.

Frotteurism

In this condition, the focus of the sexual urges of sufferers is associated to touching the body of unwilling partners or rubbing the genitals against the body of non-consenting people. In most case of the disease, males rub their genitals against the body of females – usually in crowded public spaces such as bus, train or stations. This is a criminal activity as bodily contact with an unwilling or unsuspecting person with sexual intent is illegal in nature.

Pedophilia

It involves urges, behaviors or fantasies that involve illegal sexual activity with a child or person who has not yet entered the stage of puberty – usually 13 or younger in age. Abnormal behaviors displayed by Pedophilic people include:

• Undressing children
• Touching or fondling the genitals of children
• Encouraging a child to watch the person masturbate
• Forcefully performing sex with the child

Some pedophiles are sexually attracted only to children and are referred to as “Exclusive pedophiles.” They are not attracted to adults at all. Some pedophiles restrict sexual activities to their own kids or those of their relatives, even younger members of the same family (incest). Others tend to victimize other children and are called “Predatory pedophiles.” They may threaten or force their victims with the fear of causing harm if they disclose the abuse. Doctors and medical professionals tending to abused minors are legally bound to report such cases. If the sexual activities constitute rape, they would be recognized as felony offenses and punished by imprisonment.

Sexual masochism

Such people have sexual fantasies of being beaten up, humiliated or made to suffer to achieve sexual arousal and climax. The acts or fantasies may be limited to verbal abuse or physical abuse including being bound, beaten or injured in some other way. Masochists may seek other partners to cause injury to themselves, such as beating or cutting them, or cause injury to their own body to have sexual excitement. They may pierce, cut or burn their own skin. Masochistic activities with a partner may involve spanking, bondage and simulated rape.

Among consenting adults, instances of sadomasochistic activities and fantasies are not uncommon. In the majority of these cases, however, the abuse and humiliation are restricted to fantasy. Those who take part in the activities know that the behavior is a part of “sexual game” and tend to avoid pain and injury.

Autoerotic partial asphyxiation is a potentially dangerous, and sometimes fatal, activity that is associated to this kind of Paraphilia. A person suffering from this form of the condition uses nooses, plastic bags or ropes to interrupt their breathing and induce a state of asphyxia to achieve a state of orgasm. This activity sometimes results in accidental death although it is mainly conducted to enhance orgasm.

Sexual sadism

Sexual sadists have constant fantasies in which inflicting physical or psychological suffering on a partner gives sexual excitement. The condition is distinct from minor acts of aggression that is common during sexual activity, such as rough sex. In certain cases, such people can find sexual partners who are willing to take part in sadistic activities.

Most extreme cases of this disorder include criminal activities like torture, rape or even murder. In cases involving murder, the death of victims can lead to sexual excitement. It is noteworthy that although rape may express sexual sadism, causing suffering to victims is not usually the aim for the majority of rapists. The pain of victims does not usually increase the sexual excitement of rapists. Sadistic actions like rape are a combination of sex and forceful dominance on victims. Sexual sadists require intensive psychiatric treatment and they may be incarcerated for such activities.

Transvestitism

Also known as Transvestic fetishism, it is characterized by heterosexual males dressing themselves up in female clothes to arouse themselves sexually. The arousal generally does not involve a real sexual partner but involves the fantasy of an actual partner. Some men suffering from this condition wear only one specific piece of female cloth, such as the underwear of a woman, while others completely dress themselves up as a female which includes feminine make-up and hairstyle. Usually, cross-dressing is not a problem. However, it can indicate a psychological problem if an individual finds it necessary to experience sexual climax or become sexually aroused.

Voyeurism

Also referred to as Peeping Tom Syndrome, it involves achieving sexual arousal by observing an unsuspecting person undressing himself or herself or engaging in sexual activity. Such behavior may have a sexual climax in the masturbation of the voyeur. Usually, such people do not seek sexual contact with their victims. Their behavior is only restricted to “peeping” and probably climaxed by masturbation.

Paraphilia Causes

The actual cause of these behaviors is not known. According to certain experts, it is the result of a childhood trauma, such as sexual abuse. Others are of the opinion that certain situations or objects can become sexually arousing if they are repeatedly and frequently associated with a sexually pleasurable activity. In the majority of cases, Paraphilic patients experience difficulties in developing healthy personal and sexual relationships with others.

The majority of cases of Paraphilia arises at the time of adolescence and continues into the stages of adulthood. The occurrence and intensity of the fantasies related with Paraphilic behaviors tend to vary from one person to another. However, they generally reduce with increasing age of sufferers.

Paraphilia Risk Factors

The risk factors of the condition include:

Being male

Males are seen to be at around 20 times greater risk of displaying Paraphilic behaviors than females. Men are naturally supposed to be more susceptible to this disorder than women.

Being sexually abused

People who are sexually abused during childhood are supposed to be more prone to the condition than those having a healthy childhood.

Paraphilia Diagnosis

Mental health care providers use the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association as a guide for detecting mental health problems. Paraphilia may be diagnosed as a subcategory of another mental disorder like Obsessive Compulsive Disorder or Impulse Control Disorder.

The diagnosis of Paraphilia may involve asking patients or their family members (or legal officials) about their problems or fantasies. In some cases, a set of questions may be used to ascertain the sexual preferences of sufferers.

Paraphilia Treatment

The majority of cases of this disorder are cured with the aid of therapy and counseling. The aim of such treatment is to modify the behavior of sufferers. Medicines may help reduce the compulsiveness related with the condition and lower the number of abnormal behaviors and sexual fantasies in sufferers.

In certain cases, hormones are prescribed to people who suffer from frequent urges of abnormal or potentially dangerous sexual behavior. Most of these drugs yield benefit by reducing the sex drive of patients.

In order to yield the best results, treatment must be administered for a long time for the disorder. Unwillingness to undergo treatment can hinder the success of cure. It is necessary for people with potentially criminal sexual urges receive professional assistance before they indulge in criminal sexual activities and cause harm to others or themselves.

Paraphilia Prognosis

With effective treatment and counseling, patients may show a positive outcome and get rid of Paraphilic behaviors. Over time, they can be able to get out of all objects and events that can give rise to abnormal sexual behaviors or acts.

Paraphilia Complications

The complications which are generally associated to this condition include:

• Struggling with shame and feelings of guilt
• Getting arrested for sexual offences
• Having an unwanted pregnancy
• Having financial debts due to purchase of sexual services or pornographic materials

Paraphilia Prevention

The complications associated with this condition can be prevented by seeking medical care and psychiatric help for childhood sexual abuse and dark fantasies of an abnormal sexual nature. One should also avoid frequenting strip clubs, pornographic websites and other activities that may promote unusual sexual fantasies and acts.

Suffering from Paraphilic fantasies or behavior does not always indicate that people having them suffer from some mental illness. The behaviors and fantasies can exist in less acute forms that may not be dysfunctional in any way. Also, they may not come in the way of development of healthy relationships or harm an individual in any way such as making them indulge in criminal offenses. They may be restricted to fantasies during masturbation or intercourse.

References:

http://us.cnn.com/HEALTH/library/compulsive-sexual-behavior/DS00144.html

http://en.wikipedia.org/wiki/Paraphilia

http://www.medicinenet.com/paraphilia/article.htm

http://www.wisegeek.com/what-is-paraphilia.htm

The post Paraphilia appeared first on Prime Health Channel.

Trichotillomania Definition

It refers to a loss of hair resulting from repeated urges to twist or pull strands of hair until they break off. This is an impulsive control disease and patients are unable to stop the urges that lead to this condition. The disorder causes a thinning of hair in sufferers.

The condition is also referred to as “Compulsive Hair Pulling.”

Trichotillomania ICD9 Code

The ICD9 Code for this disease is 312.39.

Trichotillomania Etymology

The name of this disorder was coined by Francois Henri Hallopeau, a French dermatologist. The term is a fusion of two Greek words “trich” meaning “hair,” “till” standing for “to pull” and “mania” which stands for “frenzy” or “madness.”

Trichotillomania Epidemiology

The disorder may affect as much as 4% of the entire population. The condition is four times likelier to affect women than men. The incidence for the disorder is possibly underestimated as only those present for medical treatment are taken into count.

Trichotillomania Symptoms

The signs and symptoms of this disorder tend to arise before 17 years of age. The hair may come out across the scalp or in circular patches. The condition gives an uneven appearance to the heads of sufferers. Affected individuals may pluck other hairy regions, such as:

• Trunk
• Eyelashes
• Eyebrows

In children, the following symptoms are generally noticed:

• Denying the pulling of hair
• Bare patches or diffused loss of hair
• Uneven appearance of the hair
• Other self-injurious behaviors
• Constant pulling, twisting or tugging of hair
• Re-growth of hair that feels like stubble in the bare regions
• Sense of pleasure, gratification or relief after the pulling of hair
• Elevating sense of tension before the act of pulling of hair
• Bowel obstruction in case of oral consumption of the hair by sufferers

In adults, the symptoms often include:

Pulling out hair on a repeated basis, typically from the eyelashes, eyebrows or scalp (although extraction may occur from any of the regions of the body)

• Strong urges to pull out hair, followed by sense of relief after extraction of hair
• Eating or chewing uprooted hair
• Sparse or missing eyebrows or eyelashes
• Playing with uprooted hair
• Rubbing extracted hair across face or lips

The majority of sufferers also experience the following problems:

• Anxiety
• Poor self-image
• Feeling of depression or sadness

Most patients tend to pull their hair in private and usually try to hide the condition from others, even from their close ones.

The pulling of hair is focused and intentional for certain patients. They are aware of their pulling out of hair and may even develop prominent rituals for the act. Some others also unconsciously pull their hair. An individual may both consciously and unconsciously uproot their hair, depending on their mood and the situation. Many such acts are performed during a frustrated or depressed frame of mind. Some rituals or positions may trigger the act, such as brushing hair or resting the head on the hands.

Trichotillomania Causes

This is a form of impulse control disease, the causes of which are not understood clearly. The disorder, similar to many complex conditions, possibly arises due to a combination of environmental and genetic factors. Abnormalities in the brain chemicals Dopamine and Serotonin may also play a role in the development of Trichotillomania.

Trichotillomania Risk Factors

The factors that tend to increase susceptibility to this condition include:

Age

The condition generally arises during adolescence, most often between 11 and 13 years of age. Trichotillomania is often a lifelong problem. Kids less than 5 years of age can be susceptible to this disorder. This is generally a mild disease and resolves on its own without treatment.

Sex

The condition has been found to affect women more than men. However, this may be due to the fact that females seek medical diagnosis and treatment more than males. During early childhood, both girls and boys are found to be equally affected by this disorder.

Family history

The susceptibility to this disease may be inherited in nature.

Positive reinforcement

Those affected by this disorder often find it gratifying to pull out hair and find a certain amount of relief. Due to this pleasurable sensation, they continue to extract hair to maintain positive emotions associated with the act.

Negative emotions

In many sufferers of this condition, pulling of hair is a way of dealing with uncomfortable or negative feelings like fatigue, anxiety, frustration, stress, loneliness and tension.

Other diseases

Those suffering from this disease may also suffer from other conditions, which include eating disorders, obsessive-compulsive disorders, anxiety and depression. Picking of skin and nail biting have also been related with this condition.

Trichotillomania Diagnosis

Physicians tend to perform a complete evaluation of sufferers to assess the presence of Trichotillomania. This may involve examining the amount of hair lost by patients, ruling out probable causes of hair extraction or hair loss. Patients may be given a questionnaire to fill out which can help doctors understand the possible causes for this behavior. In some cases, doctors may carry out a biopsy of the skin or hair to identify the problem accurately.

Trichotillomania DSM Diagnostic Criteria

The Diagnostic and Statistical Manual of Mental Disorders (DSM) clearly mention the criteria that have to be met for a patient to be confirmed of having this disease. The criteria have been published by the American Psychiatric Association and include:

• Relief or pleasure while pulling out hair
• Repeatedly extracting hair, leading to a prominent loss of hair
• Acute mental distress caused by self-extraction of hair
• An elevating sense of tension prior to pulling, or when sufferers attempt to resist pulling
• Loss of hair is not attributed to another dermatological or medical condition

There is some amount of debate about these criteria among doctors and patients of Trichotillomania.

Trichotillomania Treatment

There has been limited research about the treatment of this condition. The current medical approaches include:

Medications

Physicians may suggest patients to have an antidepressant, such as Clomipramine (Anafranil).

Psychotherapy

The disease can be effectively cured with the aid of a type of Psychotherapy known as Habit Reversal Training. This therapy helps patients learn to recognize those situations that can influence their mood and make them susceptible to extract their hair and instead, substitute them with other behaviors like redirecting the hands to other objects to control or divert the urge.

In some cases, Habit Reversal Training may be blended with elements of other types of therapies. Health care providers may use cognitive therapy to help sufferers examine and challenge distorted beliefs associated to the act of pulling of hair.

Acceptance and Commitment Therapy (ACT) helps patients learn to accept their impulses related to hair-pulling and simultaneously teach them ways to avoid acting on their own impulses.

Trichotillomania – Alternative Treatment

The alternative treatment for this disorder may involve:

Relaxation techniques

The impulse to pull out hair may be diverted by practicing relaxation techniques like Progressive Muscle Relaxation.

Hypnosis

It may be a successful curative option for this disorder.

Trichotillomania Management and Support

Many patients of this disease report about loneliness to be a problem during the act of hair-pulling. Due to this reason, it may be beneficial for sufferers to join a support-group consisting of Trichotillomania patients who experience the same emotions and can relate to their feelings. Sufferers may consult their doctors or visit http://www.trich.org – the official website of Trichotillomania Learning Center to know about and come across a support group.

The contact details of Trichotillomania Learning Center have been given below:

Trichotillomania Learning Center, Inc.

207 McPherson Street, Suite H

Santa Cruz, CA 95060-5863

831-457-1004 phone

831-427-5541 fax

Email id: [email protected]

Friends and family members of Trichotillomania patients may also derive benefit from group therapy.

Trichotillomania Prognosis

The form of the condition that develops in children less than 6 years of age may resolve even in the absence of medical treatment. In the majority of sufferers, the pulling of hair ends within a span of a year. In case of others, however, the condition tends to be a life-long problem. But treatment often improves the condition and resolves the feelings of anxiety, depression and poor self-image in patients.

Trichotillomania Complications

Although Trichotillomania may not seem to particularly acute in nature, it may have a great effect on the life of its patients. The complications that can be experienced by sufferers include:

Emotional distress

Many sufferers of this disease report about distressful emotions such as humiliation, shame, anxiety, depression, low-self esteem and embarrassment due to this act.

Social difficulties

Due to feelings of embarrassment associated with this disorder, patients may avoid haircuts, windy weather and activities such as swimming. Patients may also style their hair or wear wigs in order to disguise the bald patches on their body. Those prone to picking hair may also wear false eyelashes. Some sufferers may also avoid physical intimacy for fear of the condition being discovered by their sufferers.

Skin damage

Continuous pulling of hair can lead to abrasions and other types of skin damage, which involve infections to the scalp skin or the particular region from which hair has been extracted.

Hairballs

Consumption of uprooted hair may cause the development of a sizeable, matted hairball in the digestive tract of patients. Such hairballs are referred to as Trichobezoar. Over a span of several months or years, these types of hairball can result in problems like intestinal obstruction, vomiting, weight loss and even death.

Trichotillomania Prevention

The best form of prevention is early diagnosis, which leads to an early treatment of the disease and removes possibilities of development of associated complications in future. This can lead to an obstruction in the bowel or result in poor nutrition.

If you are suffering from the condition, or have someone in your family affected by it, seek assistance from a primary care provider or dermatologist who may ultimately recommend sufferers to mental healthcare providers. Early diagnosis and treatment can help in an earlier recovery from this embarrassing disorder and full recovery for patients.

References:

http://www.mayoclinic.com/health/trichotillomania/DS00895

http://en.wikipedia.org/wiki/Trichotillomania

http://www.nlm.nih.gov/medlineplus/ency/article/001517.htm

http://www.wisegeek.com/what-is-trichotillomania.htm

The post Trichotillomania appeared first on Prime Health Channel.

Selective mutism Definition

It is a disorder in which a child with the ability to speak stops talking suddenly, generally in school or in social surroundings. People affected by this disease are often unable to speak in certain situations or to some specific people.

Selective mutism ICD9 Code

The ICD9 Codes for this disorder are 309.83 and 313.23.

Selective mutism Causes

The disease commonly affects children under 5 years of age. It is not known why the condition develops and what its possible causative factor or factors are. The majority of medical experts are of the opinion that children affected by this disorder inherit a tendency to be inhibited and anxious in nature. The majority of children affected by this ailment are found to have certain type of extreme social phobia.

While parents of such children often have the opinion that their child is refusing to speak, it generally so happens that suffering children are actually unable to speak in some social settings.

Certain children with this disease have a family history of it along with other problems, such as anxiety disorders and extreme shyness which may elevate the risk for problems that are similar in nature.

Earlier, there was a theory that Selective mutism in childhood is possibly the result of an abusive home or social environment. However, this type of claim has not been supported by any scientific evidence. The primary difference between kids who have gone through a traumatic event and those dealing with SM is the point that abused children are unable to talk in any circumstance.

As per current research studies, children with SM do not remain silent willingly. It is best recognized as a childhood anxiety disorder in social communication. It is most likely to be in the spectrum of social phobia and other associated anxiety disorders.

Selective mutism Vs Mutism

The condition is not the same as Mutism. In Selective mutism, affected kids can speak and understand but are unable to utter words in some specific environments. Children suffering from mutism, on the other hand, never speak.

Selective mutism Symptoms

The typical signs and symptoms of this disorder include:

• Shyness
• Ability to speak with family or at home
• Anxiety or fear around people who are unknown to sufferers
• Lack of ability to utter words in some specific social settings

The pattern of behavior exhibited by sufferers must persist for at least one month to be confirmed as Selective mutism. It is common for children to exhibit such behavior in the first month of their school. Naturally, this period does not count.

In children, the condition is generally detected first when he or she displays marked alterations in speaking behavior in varied situations. In case of very young children, the problem is expressed in school – particularly when they are called upon to recite in a stage or even inside class. Some other typical situations or surroundings include:

• Performing in front of crowds
• While being spoken to or instructed by authority figures

Generally, such children are not found to have any difficulty in interacting with others and in other surroundings even though they exhibit difficulties in the above settings. It is only in certain situations that they experience overwhelming anxiety and fear in speaking. The anxiety is often due to the fear of being made fun of or evaluated.

Many SM-affected children never seem to smile and have a blank expression. Many of them have an awkward body language or appear stiff when in a social setting. They may also appear very unhappy and uncomfortable. They may exhibit the following behavioral patterns:

• Twirling or chewing own hair
• Turning head
• Avoiding eye contact
• Withdrawing to a corner
• Moving away from the social group
• Being more interested in playing alone

Others are less avoidant and do not appear as uncomfortable. They may choose to play with one or only a few selected children and not be extremely participatory in group activities. They would still be mute or communicate only moderately with most teachers and classmates.

Those with whom a SM sufferer does not speak to often tend to take it as a personal insult. It must be remembered that a person with this condition does not do it on purpose and not because they do not like some people. It is often due to their own fear of being evaluated or humiliated that draws such response from them. This is common with strangers and even some family members whom SM patients do not see or talk to on a regular basis. At home, they may speak freely and even to an extent that they may be referred to as chatterboxes. People, in the presence of whom SM sufferers appear ‘frozen’, should try to deal very gently and in an easygoing way with such patients to loosen them up and open up with time.

Selective mutism and Sensory Integration Dysfunction

A small number of children detected with SM have a problem called Sensory Integration Dysfunction. This is a form of brain dysfunction that prevents a kid from accepting and comprehending some sensory details. This incapability of processing information leads to panic as a consequence, which leads to speech inability. Other children with SM may not have this dysfunction although they may remain mute in some situations as a result of language anxiety.

In such cases, the condition arises due to speech problems resulting from pressure to speak. This is particularly true for the following categories of children:

• Those who grow up speaking some other language
• Those who come from foreign countries
• Those who had been taught a foreign language

Such children may feel pressured to speak the language used by other kids. This pressure can cause a lot of stress in young minds, resulting in problems in speaking.

Selective mutism Diagnosis

As such, there is no specific test for determining or confirming the presence of this condition. Diagnosis varies on the basis of the history of symptoms experienced by sufferers. The disorder is baffling to psychologists, who are still trying to analyze some common determinants for the diagnosis of this condition.

According to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), the avoidance feature of social phobia and social anxiety may be associated with this condition. Hence, these disorders should be taken into consideration. Over 90% of SM sufferers also meet the diagnostic criteria for social phobia (earlier referred to as Social Anxiety Disorder). The condition should also be taken into account at the time of diagnosis.

Selective mutism Diagnostic Criteria

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) has laid down the following criteria that patients must meet in order to be confirmed of having SM after diagnosis:

• Inability to speak in a minimum of one particular social situation where patients are expected to speak (such as at school) in spite of being able to speak in other surroundings (such as at home)
• The condition has interfered with social communication or with occupational or educational progress
• The duration of the problem is a minimum of one month and is not restricted to the first month of school
• The lack of ability to speak is not due to a unfamiliarity of or discomfort in using the primary language needed for communication in the social setting
• The disturbance cannot be better accounted for by a communication disease (such as stuttering) and does not exclusively occur during the course of Schizophrenia or other psychotic or pervasive developmental disorders.

As approximately 20-30% of children with SM have problems with speech and language, doctors often order a thorough speech and language evaluation. Occupational therapy evaluation is also recommended in case motor or sensory issues are found to exist. If the diagnosis is not clear, the following tests are often recommended:

• Complete physical exam (including hearing)
• Thorough developmental screening
• Standardized testing
• Psycho-educational testing

Selective mutism Differential Diagnosis

SM is often misdiagnosed as another similar condition known by the name Autism Spectrum Disorder. This kind of misdiagnosis happens when a child suffering from SM refuses to talk in the presence of a therapist. There are prominent differences between the two ailments although autistic children may also refuse to speak in some situations. Children with SM simply show an inability or refusal to speak while autistic children tend to avoid eye contact and flap their hands. Physicians should take into account all these disorders and carefully ensure that the symptoms exhibited by sufferers are those of SM and not of any of the aforementioned disorders.

SM is also often misdiagnosed as Asperger’s Syndrome. Due to this reason, a more widespread and comprehensive understanding of the condition and its treatment are required for a more definitive diagnosis.

Selective mutism Treatment

The treatment of this condition involves changing the behavioral pattern of sufferers. The family and school authorities of affected children should participate in the curative program to work for their betterment. Physicians have found safe and successful results by using some medicines that cure social phobia and anxiety.

Treatment of SM mainly depends on the sufferer although psychological counseling plays a major role in almost all cases in helping affected children speak in all situations and circumstances once more.

It is important that parents of SM sufferers take their children to psychologists right away. This type of condition does not resolve with age. Naturally, it should not be ignored or left untreated.

In adult sufferers, treatment can pose problems as speaking up can be very difficult after a lifetime of problems with speech in some social settings. In such cases, physicians might find effective results by encouraging increase in social interaction. They should encourage any behavior or activity that helps patients to speak up freely without any anxiety. Gradually, the activity may be altered or done away with as the sufferer gains confidence in being able to speak freely in any circumstance. However, this type of treatment must be dynamic to help patients make transition into regular speech.

Selective mutism Prognosis

The outcome may vary for sufferers of SM. Some patients may show quick response and be completely cured while others may have to continue therapy for social anxiety and shyness. In the latter cases, treatment may continue into the teenage years and possibly even during adulthood.

Selective mutism Complications

The condition can affect the ability of sufferers to function properly in social settings or school environment. This can be damaging for the academic career and psychological health of sufferers. Lack of proper and timely treatment can make the symptoms worse and patients may even be humiliated and have to face embarrassing consequences for the same. This is common in school where young children make fun of SM patients.

Some severe complications associated with SM include:

• Worsening anxiety
• Social withdrawal and isolation
• Refusal to attend school, poor academic performance, and possible quitting of school
• Depression and expressions of other anxiety disorders
• Poor self-confidence and self-esteem
• Self-medication with alcohol and/ or drugs
• Academic or professional underachievement
• Suicidal thoughts and possible suicide

Selective mutism Support Groups

Patients or their friends and family members can contact the following support groups to receive proper information and resources that can help them cope with this disorder.

American Speech-Language-Hearing Association

Official Website – www.asha.org/public/speech/disorders/selectivemutism.htm

Selective Mutism and Childhood Anxiety Disorders

Official Website – www.selectivemutism.org

If you suspect your child to be exhibiting problems that are similar to Selective mutism, which are affecting his or her performance in school or social activities, get in touch with a professional health care provider. Seeking medical attention in time can help you child grow up as normally as possible and recover from all communication problems with time.

References:

http://en.wikipedia.org/wiki/Selective_mutism

http://www.nlm.nih.gov/medlineplus/ency/article/001546.htm

http://www.wisegeek.net/what-is-selective-mutism.htm

http://www.selectivemutism.net/

The post Selective mutism appeared first on Prime Health Channel.

Seasonal affective disorder (SAD) is a mood disorder experienced by many individuals in the winter months. People suffering this condition experience “blues” or a season depression that is characterized by a desire for starchier foods, withdrawal or oversleeping.

The disease is also referred to by various other names, such as:

• Winter depression
• Summer blues
• Winter blues
• Seasonal depression
• Summer depression

Seasonal affective disorder ICD10 Code

The ICD10 Code for this disorder is F33.

Seasonal affective disorder Incidence

The prevalence of this disease in the U.S ranges from as low as 1.4% in Florida to as high as 9.7% in New Hampshire. It is supposed to be more common than was thought initially.

Seasonal affective disorder History

The condition was described formally and named as “Seasonal affective disorder” by Norman E. Rosentha; and his co-workers at the National Institute of Mental Health in 1984. The condition has been studied only since the 1980s although “winter blues” have been recognized for long.

Seasonal affective disorder Symptoms

This form of depression arises at the same time every year. The majority of SAD sufferers start experiencing the symptoms in the autumn which may continue into the winter season. Patients typically feel moody and it seems to them as if all energy has been sucked out of them.

In rare cases, SAD results in depression in the early summer months or in the spring season. In such cases, the problems begin in summer or spring and continue till winter. In either case, the problems may appear mild and gradually become more and more severe as the season progresses

SAD symptoms in winter

The signs of the winter-onset form of this condition include:

• Hopelessness
• Depression
• Anxiety
• Loss of energy
• Oversleeping
• Weight gain
• Difficulty in concentrating
• Social withdrawal
• Loss of interest in activities once enjoyed
• Sensation of heaviness in the arms or legs
• Changes in appetite, particularly a craving for carbohydrate-rich foods

SAD symptoms in summer

The symptoms of the summer-onset form of this condition are:

• Anxiety
• Sleeping difficulties (insomnia)
• Agitation
• Irritability
• Poor appetite
• Weight loss
• Increased sex drive

Reverse Seasonal affective disorder

In some people affected with Bipolar disorder, the summer and spring months can give rise to the signs of mania or hypomania (a less severe type of mania). This is referred to as Reverse Seasonal affective disorder. Its signs typically include:

• Agitation
• Hyperactivity
• Persistently elevated mood
• Rapid thoughts and speech
• Unbridled enthusiasm that are exaggerated with regard to a particular situation

Seasonal affective disorder Causes

The exact cause of this disorder is still unknown. It is possible however, that the development of the condition is influenced by various factors like:

• Age of patients
• Genetics
• Presence or absence of mental health conditions
• Natural chemical makeup of the body

Some specific factors, that may come to play a role in the occurrence of this disease, include:

Serotonin levels

A reduction in the level of serotonin, a chemical in the brain (neurotransmitter) that affects the mood, may play an important role in the development of this disease. Low amounts of sunlight also cause a reduction in serotonin and trigger symptoms of depression. It is due to this reason that people living in areas far from the equator and enjoying only low amounts of sunlight are often found to develop this condition.

Circadian rhythm

It is also known as the biological clock of the body. Reduced level of sunlight in the autumn and winter months may disrupt the internal clock of the body that usually instinctively makes people aware when to sleep and when to stay awake. The disruption of this biological clock may give rise to feelings of depression.

Melatonin levels

A change in season can cause disruption in the balance of Melatonin, a natural hormone, which plays a role in regulating the mood and sleep patterns.

Seasonal affective disorder Diagnosis

The diagnosis of this disorder requires doctors or mental health care providers to conduct a thorough evaluation of sufferers. This usually involves:

Physical examination

A physical check-up may be conducted to detect any underlying health problems that can be related to depression.

Asking detailed questions

Patients are likely to be asked about their symptoms, such as mood as well as seasonal changes in their behavior and thought patterns. They may also be questioned about their eating and sleep patterns, jobs, relationships or other aspects of their lives. In some cases, patients may be handed over a questionnaire that they have to fill. This saves time on the part of both doctors and patients and lets the former assess the psychological status of the latter more easily.

Medical exams

There are no specific medical tests for the diagnosis of SAD. However, patients may be asked to go through blood tests and other exams to rule out the presence of underlying disorders if physicians suspect a disease to be the cause or worsening factor for the disease.

Seasonal affective disorder Diagnostic Criteria

Patients must meet certain criteria, spelled out in the DSM (Diagnostic and Statistical Manual of Mental Disorders), to be diagnosed with SAD. The manual has been released by the American Psychiatric Association. It is used by mental care providers to detect mental disorders and insurance firms to reimburse for medical treatment.

The diagnostic criteria for the disorder include:

• Patients must experience depression and other signs for a minimum period of two consecutive years, during the same season each year
• The period of depression must follow periods without depression
• There are no possible explanations for the alterations in the mood or behavior of sufferers

Seasonal affective disorder Differential Diagnosis

SAD is regarded as a subtype of Bipolar disorder or depression. Even after a complete assessment, a physician or mental healthcare provider may find it difficult to distinguish this disease from other forms of depression or mental health disorders due to the similarity of symptoms. Due to this reason, physicians should take adequate steps to ensure as far as possible that patients are actually suffering from SAD and not some other mental disorders.

Seasonal affective disorder Treatment

The treatment of this disease may include:

Light therapy

In this process, also known as Phototherapy, patients have to sit a few feet away from a specialized box to be exposed to bright light. This light resembles outdoor environment and seems to produce changes in the neurotransmitters that are associated to mood.

This is one of the first line of curative procedures for SAD. The technique usually begins working in 2-4 days and leads to few side effects. Although research is limited regarding this type of cure, it seems to be the most effective for the majority of SAD sufferers and in alleviating their symptoms.

Medicines

Some SAD patients find benefit from treatment with antidepressants, particularly in cases where the symptoms are of an acute nature. The antidepressants that are commonly used for SAD include venlafaxine (Effexor), paroxetine (Paxil), fluoxetine (Prozac, Sarafem) and sertraline (Zoloft). In individuals with a history of SAD, Wellbutrin XL – an extended-release version of the antidepressant Bupropion may help prevent episodes of depression.

Doctors may recommend initiating treatment with an antidepressant before the symptoms typically arise every year. Patients may also be suggested to continue taking the medicine beyond the time the symptoms usually go away.

Psychotherapy

It is another effective curative option for SAD. It can help patients identify and alter negative behaviors and thoughts that may make them feel worse. They can also be taught healthy ways to cope with the condition and manage stress.

Seasonal affective disorder Complications

The symptoms of SAD should be taken seriously. The problems associated with this disorder, as is common with other forms of depression, can take a turn worse and give rise to various complications if left untreated. These may include:

• Social withdrawal
• Substance abuse
• Suicidal thoughts or behavior
• Problems in school or workplace

Treatment can be effective in helping patients avoid complications, particularly in case SAD is detected and cured before its symptoms take a turn for the worse.

Seasonal affective disorder Prognosis

The outcome of the disease is generally good with proper treatment. However, certain SAD sufferers are found to have the condition for as long as they live.

Seasonal affective disorder Risk Factors

The possible risk factors for this disorder include:

Family history

The condition may have a genetic association and SAD sufferers may be more likely to have blood relatives affected with the disease, as is true in other forms of depression.

Being female

SAD is detected more in women than in men although its symptoms are more acute in men.

Having other depressive conditions

An individual may suffer from worsening of depression in case he or she suffers from either Bipolar disorder or clinical depression.

Residing far from the equator

SAD seems to be more common in individuals who live in regions far north or south of the equator. This may be due to longer days during summer or reduced sunlight during winter.

Seasonal affective disorder Prevention

Doctors are yet in the dark regarding ways to prevent this condition. However, patients may be able to prevent the symptoms from getting worse progressively by taking steps in the early stages of the condition to manage its symptoms. Some individuals find benefit in starting treatment before the symptoms of SAD begin in the autumn or winter and continuing cure past the time when the symptoms usually go away.

If patients are able to control the symptoms before they get worse, it may be possible for them to avoid severe changes in the appetite, mood and energy levels.

There are days when even the most normal individuals feel down and depressed. However, it is time to see a doctor if you are feeling the “blues” for most days and cannot seem to get motivated even for the activities that you usually enjoy. This is especially important if you find your appetite and sleep patterns have changed or you are feeling hopeless, suicidal and increasingly dependent on alcohol and other similar additive substances for joy and comfort.

References:

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002499/

http://www.wisegeek.com/what-is-seasonal-affective-disorder.htm

http://www.mayoclinic.com/health/seasonal-affective-disorder/DS00195

http://en.wikipedia.org/wiki/Seasonal_affective_disorder

The post Seasonal affective disorder appeared first on Prime Health Channel.

Oppositional defiant disorder Definition

Also referred to as ODD, it is a condition arising in children or teens and is marked by argumentative, disruptive or angry behavior directed towards authority figures, such as parents or teachers. Children who are best-behaved at other times can be very difficult to handle during episodes of ODD.

Oppositional defiant disorder ICD9 Code

The ICD9 Code for this disorder is 313.81.

Oppositional defiant disorder Incidence

True ODD, or the form of ODD that can be clinically detected, affects around 1-4% of all children. It is more common in boys than girls.

Oppositional defiant disorder Causes

The exact causes or trigger factors for this condition have not yet been clearly found out. The contributory causes for the disease may be a combination of various environmental and inherited factors. These include:

• Lack of proper supervision
• Neglect or abuse
• Harsh or inconsistent discipline
• Neglect or abuse
• An imbalance of some brain chemicals like Serotonin
• Developmental delays or restricted ability of a child to process feelings and thoughts

Mental healthcare providers theorize that the problem could arise in children with parents having an antisocial tendency, low socioeconomic background and loss of a parent figure or caregiver. However, intelligent children who think outside set social patterns and question authority are also labeled as ODD sufferers. Gifted children usually grow out of such behaviors with advancing age.

Various mental health disorders are said to be associated with ODD. These include:

• Depression
• Anxiety
• Attention-deficit/hyperactivity disorder

Oppositional defiant disorder Symptoms

ODD is typically characterized by the following signs and symptoms:

• Easy loss of temper
• Negativity
• Arguments with adults
• Disobedience
• Anger and resentfulness for others
• Defiance
• Having few or no friends
• Spitefulness or seeking revenge on others
• Easy annoyance
• Deliberately annoying other people
• Having problems in academic life
• Hostility towards those in authority
• Acting aggressively towards peers
• Having a lack of self-esteem
• Being touchy on seemingly trivial issues
• Not following the requests of adults actively
• Blaming others for the mistakes of self

The problems associated with the disease are typically manifested in 4-5 year old kids, who are normal otherwise. The difficulties disappear with advancing age. The signs of ODD usually arise before a child is 8 years old. Sometimes, the condition may develop at a later stage although almost always prior to the early teen years. In case of ODD, the symptoms tend to arise slowly and worsen over a period of months or years.

Oppositional defiant disorder Diagnosis

It is essential to detect and cure this condition as well as any co-occurring syndromes as they can lead to or worsen the problems of defiance and irritability if left without being treated. The condition would also persist even when a child has turned into an adult. It us not uncommon to find adults with this syndrome displaying violent and anti-social behavior. It is also important to diagnose and treat any other causative factors, such as substance abuse or dependence on some object or individual which can bring about a change in personality and result in irritability.

Oppositional defiant disorder – DSM Diagnostic Criteria

The Diagnostic and Statistical Manual of Mental Disorders (DSM) has laid down the diagnostic criteria for ODD. For the condition to be diagnosed and confirmed, it must persist for at least 6 months and must be characterized by problems that are greater in frequency and intensity than those exhibited by mischievous but normal children. The behavioral pattern of such kids must vary from those of other kids of around the same age and level of development.

Affected kids must exhibit at least four of the following problems:

• Frequent argument with adults
• Frequent loss of temper
• Frequently getting vindictive or spiteful
• Frequently becoming angry and resentful
• Deliberately annoying other people on a frequent basis
• Often getting easily annoyed or touchy by the actions of others
• Often blaming others for their own mistakes
• Actively defying adults or refusing to comply with their orders or requests

A child suspected of having ODD should also:

• Cause much problems at home, school or during work
• Occur on its own and not as a symptom of some other mental disorder, such as bipolar disorder or depression
• Not meet the diagnostic criteria for conduct disorder, or antisocial personality disorder (if the sufferer is more than 18 years old)

Oppositional defiant disorder – Diagnostic tests

Diagnosticians should also question parents whether or not a child is causing severe problems in school, social gatherings and while pursuing other activities.

Kids exhibiting problems similar to ODD should be assessed by a mental healthcare expert, such as a psychologist or a psychiatrist.

The diagnostic examinations for this disorder involve interviewing affected kids and their parents, putting children through various psychological tests. Often, other medical tests are also carried out to rule out the possibility that the problems are caused some underlying physical disorder.

Oppositional defiant disorder Differential Diagnosis

The differential diagnosis for this condition includes excluding its symptoms from associated diseases, such as Attention-deficit/hyperactivity disorder (ADHD). ODD is often commonly detected along with ADHD.

Oppositional defiant disorder Treatment

The treatment of ODD typically involves various forms of physiotherapy and training sessions. Training may b imparted to affected children as well as their parents/co-parents. The curative process often extends for a span of several months or even more.

Treatment for this condition generally involves:

Parent-child interaction therapy (PCIT)

In this method, parents are taught how to interact with their kids. One technique consists of therapists guiding parents on effective strategies to reinforce positive behavior in their affected children. Parents are given audio equipment known as the “ear-bug” that lets therapists guide them from behind a one-way mirror as they deal with their children.

Individual and family therapy

In this technique, counselors guide children about ways to help them manage their anger and express their feelings in a more positive manner. Family counseling can be beneficial in improving relationships and communication in sufferers as well as help family members know how to work together.

Parent training

Parents are taught skills that make parenting easier and more positive for them as well as their kids. In certain cases, children are encouraged by therapists to participate in this form of training. This lets parents as well as children develop shared goals on effectively handling the problems.

Social skills training

Such therapeutic measures help children learn how to interact in a more effective and positive manner with their peers and make friends.

Cognitive problem-solving training

In case of children with co-existing disorders such as ADHD, medicines may be helpful in alleviating the symptoms. However, unless some other condition also exists, medications are not helpful alone in curing the disease.

Oppositional defiant disorder Risk Factors

There is no single factor that can result in this disease. ODD is a complicated condition that is supposed to arise as a result of combination of various genetic, environmental and social factors.

The possible risk factors for ODD include:

• Lack of supervision
• Being neglected or abused for a prolonged duration
• Absence of positive involvement of parents
• Financial problems in family
• Inconsistent or harsh discipline
• Having parents with a significantly troubled marriage
• Family instability issues due to multiple locality changes, divorce of parents or frequent changes in school or caregivers
• Having parents with a medical history of conduct problems, ADHD or oppositional defiant disorder

Anything that changes the feeling of consistency in a child, such as stressful occurrences in the form of a divorce of parents or change of care providers, can elevate the risk of development of ODD. It is essential for parents or existing care providers to talk about such happenings with a mental healthcare expert to help him or her diagnose and treat ODD successfully in a child.

Oppositional defiant disorder Complications

The majority of children suffering from ODD can develop other mental ailments, such as:

• Anxiety
• Depression
• Learning disability
• Communication disorders
• Attention-deficit/hyperactivity disorder (ADHD)

In the absence of proper and timely treatment, it can be extremely difficult for parents to manage a child with ODD. It can also be frustrating for an affected kid. Those suffering from ODD may experience problems in school to have a healthy relationship with authority figures, teachers and even peers. Such individuals struggle to make friends and have few or no companions.

In some cases, the condition may be a precursor to more severe ailments such as acute delinquency or conduct disorder. Such children may also take to substance abuse to overcome frustration and seek support.

Oppositional defiant disorder – Home Remedies and Management

Home remedy for ODD involves lifestyle management measures, such as:

• Appreciating the positive actions and behavior of an affected child
• Spending quality time together, to build a rapport
• Setting up a routine
• Avoiding power struggles with child or partner/spouse
• Working together with partner/spouse to ensure proper discipline at home
• Assigning a household chore to child to inculcate a sense of responsibility and belonging in him/her
• Setting limits on action and behavior, and enforcing consequences consistently

Oppositional defiant disorder Prognosis

Some children show excellent outcome while others do not. It is not easy being the parent of an ODD-sufferer. Seeking proper counseling can help you deal with your own frustrations. This would help you be better prepared to deal with the problematic behaviors of your kid. Counseling can train you to calm yourself. Now and then, you should also spend time away from your child to rejuvenate yourself.

If you suspect your child to be exhibiting symptoms similar to that of Oppositional defiant disorder (ODD), and you have a family history of mental conditions, get in touch with a mental healthcare provider on an immediate basis. Timely diagnosis and treatment can prevent worsening of the condition and development of additional mental problems. However, immediate detection and cure can check the disorder at an early stage and help patients recover faster from ODD.

References:

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002504/

http://www.mayoclinic.com/health/oppositional-defiant-disorder/DS00630

http://www.webmd.com/mental-health/oppositional-defiant-disorder

http://www.wisegeek.com/what-is-oppositional-defiant-disorder.htm

http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Oppositional_defiant_disorder

The post Oppositional defiant disorder appeared first on Prime Health Channel.