Specific Phobias

  1. Symptoms: persistent, irrational, and narrowly defined fear of a specific object or situation; complete avoidance of contact with said object or situation
  2. Diagnosis: The object or situation is actively avoided; the fear/anxiety is out of proportion with the actual danger posed by the object or situation; exposure must result in an immediate fear response; avoidance or distress associated with the phobia must interfere significantly with the person’s normal activities or relationships with others
  3. Course and Outcome: long-term outcome for anxiety disorders is mixed and unpredictable though some people do completely recover
  4. Frequency of Disorder: one year prevalence of 9% in adults (most common anxiety disorder); 50% rate of comorbidity rate of an anxiety disorder with another anxiety disorder or a mood disorder; 60% of people with a primary diagnosis of major depression also qualify for an anxiety disorder diagnosis; women have higher rates of relapse than men; women are three times more likely to experience a specific phobia; anxiety disorders are higher in elderly people in their 70s and 80s
  5. Etiology: maladaptive evolutionary anxiety and fears- though some anxiety/fear can be adaptive, it is maladaptive when it becomes excessive, becomes intense at an inappropriate time or place, the response systems become more harmful than helpful; social factors- stressful life events involving danger and interpersonal conflict;  stressful life events- high stress levels; childhood adversity- maternal prenatal stress, multiple maternal partner changes, parental indifference, physical abuse;  attachment relationships and separation anxiety;  learning processes- classical conditioning, such as after a traumatic experience, but can also develop in the absence of an direct experience with the feared object; cognitive factors-perceptions, memories, and attention influence the reaction to the environment;  perception of control- people who feel they are less in control of their environment are more likely to develop an anxiety disorder;  catastrophic misinterpretation- pertaining to bodily activities such as a rapid heart rate; attention to threat and biased information processing; genetic factors;  neurobiology-  response to stimuli by the amygdala
  6. Treatment(s): psychoanalytic psychotherapy;  systematic desensitization- recalling items that cause the least to the most fear for the patient;  interoceptive exposure- going through exercises that result in the same stimuli as when the fear or anxiety appears; relaxation and breathing retraining- tensing and releasing muscles with slow breathing, emphasis of the physiological effects of hyperventilation; cognitive therapy- teaching clients more useful ways of interpreting their environment; medications- benzodiazepines (Valium and Xanax) , azapirones, SSRIs (Prozac, Luvox, Zoloft, Paxil)
Advertisements

Persistent Depressive Disorder

Persistent depressive disorder, also known as dysthymia, is a milder form of depression, but the patient is rarely without symptoms.  Symptoms of dysthymia include poor appetite or overeating, insomnia or hypersomnia, low energy or fatigue, low self-esteem, poor concentration or difficulty making decisions, and feelings of hopelessness.  Two or more of these symptoms must be present for the diagnosis of persistent depressive disorders and these symptoms cannot be absent for more than two months during a two year period.  Dysthymia has a lifetime risk of about three percent for the average person in a sample of more than nine thousand people in interviews by the National Comorbidity Survey Replication.

The typical onset for a depressive mood disorder is age thirty-two, but this may vary.  Lengths in depressive episodes vary, but must last at least two weeks and usually have to have at least two episodes.  Episodes may reoccur and may be divided with periods of partial or full recovery.  Half of all depressive patients recover within six months of an episode, and after a full recovery are less likely to relapse as the remission period gets longer.

Risk factors may include stressful life events, how people react to events in society surrounding them, genetic predisposition, hormone imbalances of the endocrine glands, brain structure, and neurotransmitter misfires.

Treatments may include interpersonal therapy focusing on relationships especially with family and antidepressant medication

Anorexia

  1. Symptoms: 2 main types are restricting (not engaged in binge eating or purging in the last 3 months) or binge eating/purging type (regular binging and purging)
    1. Classic Symptoms: significantly low weight (a BMI below 18.5; emaciation= 25-30% below regular body weight), distorted view of his/her body, intense fear of gaining weight
    2. Commonly associated symptoms: Amenorrhea (cessation of menstruation), obsessive preoccupation with food, occasional purging, “successful” struggle for control over persistent hunger, struggle for control, act impulsively, conforming and controlling; symptoms of depression (sad mood, irritability, insomnia, social withdraw, diminished interest in sex)
    3. Difficulties associated with Anorexia: mood disturbance; sexual problems; lack of impulse control; medical issues such as: constipation, abdominal pain, intolerance, lethargy, low blood pressure and low body temperature, lanugo (fine, downy hair on face and trunk of the body), anemia, infertility, inpaired kidney functioning, cardiovascular problems, dental erosion, bone loss, electrolyte imbalance leading to cardiac arrest or kidney failure
  2. Diagnosis: Must meet the following 3 criteria:
    1. Restriction of energy intake relative to requirements, leading to significantly low body weight in the context of age, sex, developmental trajectory, and physical health
    2. Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight
    3. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight r shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight
  3. Course and Outcome: 5% of people with anorexia die of starvation, suicide, or medical complications; at a 10-20 year follow-up nearly half of patients have returned to normal range, 20%  remain significantly below healthy body weight, the remainder are at an intermediate body weight; 5% of patients starve themselves to death or die of related complications including suicide; half of all women with a history of anorexia continue to be preoccupied with diet, weight, and body weight, notwithstanding weight gain;
  4. Frequency of Disorder: females are ten times more likely than males to have an eating disorder; 1995-1996 there were 54 cases per million people; 12 month prevalence of anorexia is .4 among females, similar to .9 estimate based on a recent US survey; difficult to establish prevalence in men
  5. Etiology: Typically in adolescents or early adulthood; caused by hormonal changes. Autonomy struggles, various sexual problems;
    1. Social factors: high standards of beauty for extreme thinness; working in fields that emphasize weight and appearance (models, ballet dancers, gymnasts); in adolescence culture puts an emphasis on appearance, beauty, and thinness; greater exposure to popular media, endorse more gender-role stereotypes, internalize societal standards; white women; industrialized societies; troubled family relationships; enmeshed families (overly involved in each others’ lives; child abuse
    2. Psychological factors: control issues, depression/dysphoria, body image dissatisfaction, reactions to dietary restraints; overly conforming, eager to please; perfectionism; lack of interoceptive awareness; low self-esteem; dietary restraint; weight suppression
    3. Biological factors: gene influence on personality characteristics such as anxiety; certain body types; genetic influence on pathology after puberty; hypothalamus
  6. Treatment(s): family therapy, Maudsley method (parents take complete control over the anorexic child’s eating, planning meals, preparing food, and monitoring food), age appropriate autonomy is returned to the teenager as eating and weight improve; 2 goals:
    1. Help patient gain minimal weight; if too severe they may be hospitalized and receive feeding that is forced or through intravenous methods or participate in a strict behavior therapy program that make rewards contingent on weight gain
    2. Address the broader eating difficulties

Borderline Personality Disorder (BPD)

  1. Symptoms: a pervasive pattern of instability in self-image, interpersonal relationships, and mood; difficult to be alone; intense, unstable relationships that can be seen as manipulative; mood may shift rapidly and inexplicably; intense anger that may be accompanied by temper tantrums, physical assault, or suicidal threats/gestures; identity disturbance, alternating between unrealistically positive view of the self and unrealistically negative views of the self; uncertainty about issues such as personal values, sexual preferences, and career alternatives; chronic feelings of emptiness and boredom; anxiousness; separation insecurity; submissiveness; depressivity; hostility; impulsivity; risk taking
  2. Diagnosis: Must have a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated in 5 of more of the following: 1. Frantic efforts to avoid real or imagined abandonment, 2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation, 3. Identity disturbance: markedly and persistently unstable self-image or sense of self, 4. Impulsivity in at least two areas that are potentially self-damaging (spending, sex, substance abuse, reckless driving, binge eating), 5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior, 6. Affective instability due to a marked reactivity of mood (intense episodic dysphoria, irritability, or anxiety), 7. Chronic feeling of emptiness, 8. Inappropriate. Intense anger or difficulty controlling anger (frequent displays of temper, constant anger, recurrent physical fights), 9. Transient, stress-related paranoid ideation or severe dissociative symptoms
  3. Course and Outcome: recovery rqates are relatively high among those with BPD ; if treatment is initialized early in their twenties and followed through into their thirties and forties, only 1 in 4 still qualify got the BPD diagnosis
  4. Frequency of Disorder: overall lifetime prevalence of having at least 1 personality disorder is 10%; at least 50% of people that meet the diagnostic criteria for 1 personality disorder meet the criteria for another disorder; 75% of those who meet the diagnostic criteria for a personality disorder also meet the criteria for another syndrome such as major depression, substance abuse, or an anxiety disorder; BPD is among the most common personality disorder among patients treated at a mental health facility (both inpatient and outpatient setting) accounting for 30%; BPD is somewhat more prevalent in women than men
  5. Etiology: Genetic factors; environmental factors; parental loss, neglect, and mistreatment during childhood; problematic relationships with parents; lack of supervisions, frequently witnessing domestic violence, and being subjected to inappropriate behaviors by parents/adults (verbal, physical, and sexual abuse)
  6. Treatment(s): Psychotherapy; psychodynamic therapy; ½ to 2/3 of BPD patients discontinue treatment within the first several weeks; dialectical behavior therapy (DBT)- DBT shows a higher improvement in women than those who have treatment as usual, spent fewer days in psychiatric hospitals, reduced frequency and severity of suicide attempts; psychotropic medication, though there is no disorder specific drug

Dementia

  1. Symptoms: gradually worsening (months to years) loss in memory and related cognitive functions
    1. Neurocognitive: cognitive problems in a number of areas, ranging from impaired memory and learning to deficits in language and abstract thinking; final stages: intellectual and motor functions may disappear almost completely
    2. Memory and Language:
      1. Retrograde amnesia: loss of memory for events prior to the onset of the illness or the experience of a traumatic event; late stage dementia
      2. Anterograde amnesia: inability to learn or remember new material after a particular point in time; early stage dementia
    3. Verbal Communication: sometimes subtle; may remain verbally fluent until very advanced; retain vocabulary skills and can construct grammatical sentence, but have trouble finding words and naming objects
      1. Aphasia: describes carious types of loss or impairment in language that are caused by brain damage
      2. Apraxia: difficulty performing purposeful movements in response to verbal commands
    4. Perception: problems identifying stimuli- such as visual, auditory or tactile sensations- in their environments (agnosia), but sensory functions are unimpaired
    5. Abstract thinking: bound to concrete interpretations
    6. Judgement/Social Behavior: failure of social judgement and problem solving skills
    7. Personality/Emotion: personality changes, emotional difficulties, and motivational problems; not part of diagnostic criteria; Hallucinations/delusions in at least 20% of dementia cases; may appear apathetic/emotionally flat; faces are less expressive; indifferent to surroundings; depression
    8. Motor behavior: may become agitated, pacing restlessly, or wandering away from familiar surroundings; Late stages may have problems with muscle control from the central nervous system
  2. Diagnosis: measurement of cognitive disorder; more precise from a neuropsychologist; testing may measure sensorimotor, perceptual, and speech functions; may instead use more focused tests towards specific impairments; may have patient copy a drawing
  3. Course and Outcome: downward projector overtime; lifetime disorder
  4. Frequency of Disorder: no obvious differences between prevalence in men and women; dementia in men is more likely to result from vascular disease or secondary to other medical conditions or alcohol abuse
    1. Ages 65 to 69: 1% have dementia
    2. Ages 75 to 79: 6% have dementia
    3. Age 90 and over: 40% have dementia
  5. Etiology: genetic; neurotransmitters: process of chemical transmissions within the brain is disrupted; Viral Infections; Immune system dysfunction; environmental factors
  6. Treatment(s):
    1. Medications: relieve cognitive symptoms by boosting the action of acetylcholine (Ach)
    2. Environmental/Behavioral Management: structured, daily schedule; use of signs and notes for early stage; in late stage tasks such as getting dressed need to be broken down into simple manageable steps;
      1. Knowledge of the environment: clearly labeled rooms and halls
      2. Negotiability: common rooms and dining area should be visible from patients room
      3. Safety and health: secure, but let patient remain active

Alcohol Use Disorder

  1. Symptoms: no single symptom defines alcoholism; may include onset of tolerance and withdrawal; drink more frequently and in larger quantities than the average person without alcohol use disorder; have cravings; drink to control how they feel, relieve negative mood states, avoid withdrawal symptoms from previous episodes, prepare for certain activities-such as public speaking, writing, or sex;
    1. 2 general areas of symptoms:
      1. Patterns of pathological consumptions, including impaired control over use of the drug and continued in spite of mounting problems
      2. Consequences that follow a prolonged pattern of abuse, including social and occupational impairments, disruption of important personal relationships, and deteriorating medical condition
    2. Short term effects of alcohol: slurred speech, lack of coordination, unsteady gait, nystagmus (involuntary to-and-fro movement of the eyeballs induced when the person looks upward or to the side), impaired attention or memory, stupor, and coma
    3. Long term effects of alcohol: experience blackout;, may be able to continue function without passing out; interfere with job performance; financial difficulties; problems with legal authorities, including drunken driving, public intoxication, and child/spousal abuse; organ problems with the liver, pancreas, gastrointestinal system, and endocrine system; cirrhosis of the liver; heart problems; various forms of cancer; nutritional disruption; injuries and premature death
  2. Diagnosis: a form of substance dependence disorder, referred to as alcohol use disorder; mild case has 2-3 symptoms, moderate case has 4-5 symptoms, severe case has 6 or more symptoms; must fit at least 2 symptoms from any of the categories over the last 12 months:
    1. Impaired control:
      1. Taken in larger amounts or over longer periods of time than was intended
      2. Persistent desire or unsuccessful efforts to cut down or control alcohol use
      3. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or a recover from its effects
      4. Craving or strong desire or urge to use alcohol
    2. Social impairment
      1. Recurrent alcohol use resulting in a failure to fulfill major role obligation at work, school, or home
      2. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol
      3. Important social, occupational , or recreational activities are given up or reduced because of alcohol use
    3. Risky use
      1. Recurrent alcohol use in situations in which it is physically hazardous
      2. Continued despite knowledge of having a persistent or recurrent physical or psychological problems that is likely to have been caused by alcohol
    4. Pharmacological criteria:
      1.  Tolerance
      2. Withdrawal
  3. Course and Outcome: age of onset varies widely from childhood/early adolescence to throughout the lifespan; initial exposure leads to impaired control, evidence of social impairment, and onset of pharmacological symptoms; mortality rate is higher in men who abuse alcohol; heart disease and cancer are twice as common; likely to smoke heavily; relapse is unlikely is able to remain abstinent for at least 6 years
  4. Frequency of Disorder: 21%  of college aged men and 35% of core city men met the diagnostic criteria and had a presence of 4 or more problems in the areas of employer complaints, marital and family difficulties, medical complications, and legal problems; prevalence rate for alcoholism among males who began drinking before the age of 14 is double than found among males who began drinking at age 18 (same patterns among women); 2 out of 3 males drink regularly in western culture of those 20% develop serious problems at some point in their lives as a consequence of prolonged alcohol consumption; lifetime prevalence rate in 30% for some form of alcohol use disorder; alcohol related disorders are clearly among the most common forms of mental disorder in the US; 24% of men and women who are assigned the diagnosis of alcohol dependence have ever received treatment for these problems; men outnumber women in a ratio of 2 to 1 to chronically abuse or become alcohol dependent
  5. Etiology: any of the following or any mix of the following:
    1. Social Factors: culture; initial exposure with drugs/alcohol is likely to occur among those individuals who are rebellious and extroverted and whose parents/peer model or encourage use; parents may model alcohol dependence, adolescents with alcoholic parents are more likely to drink alcohol than those whose parents do not abuse alcohol
    2. Biological Factors: lifetime prevalence of alcoholism among the parents, siblings, and children of people with alcoholism is at least 3 to 5 time higher than the rate in the general population; males have a much higher prevalence rate; 2/3 of the variance rate of alcohol is produced by a genetic factor; other genes that alter the risk for alcohol dependence may be genes involved in personality such as those that influence novelty seeking and sensation seeking; alcohol effects several different types of neurotransmitters, it may stimulate the mesolimbic dopamine pathway directly or it may act indirectly by decreasing the activity of GABA neurons; effect exaggerated activation of the endogenous opioid system in response to alcohol stimulation;
    3. Psychological Factors: Placebo effects and expectations for alcohol fall into the categories of:
      1. Transforms experiences in a positive ways
      2. Enhances social and physical pleasure
      3. Enhances sexual performances and experiences
      4. Increases power and aggression
      5. Increases social assertiveness
      6. Reduces tension
  6. Treatment(s): treatment is a difficult task, many people do not acknowledge their difficulties and relatively small numbers seek professional help; compliance with treatment is low and dropout rates are high; detoxification (removal of the drug which takes three to six weeks), may be given medications such as benzodiazepines and anticonvulsants to minimizing withdrawal symptoms; Disulfiram (Antabuse) can block the chemical breakdown of alcohol which makes the patient violently ill after consuming any alcohol; Naltrexone (Revia) is an antagonist of endogenous opioids that has been found to be useful in the treatment of alcohol dependence following detoxification which makes the patient not feel the high they normal would; acamproste (Campral) reduces the average number of drinks per day; SSRIs; group therapy such as alcoholic anonymous; cognitive behavior therapy: coping and training skills, relapse prevention, short-term motivational therapy

New Direction

HealthRD.com is in the process of undergoing changes, and we apologize for lack of postings as of late.  The umbrella of HealthRD is RD Concepts.  Due to time constraints, the partner, whose main focus is overseeing this blog, left the company over the past couple of months.  Great talent and very knowledgeable, but being in a small startup company will be demanding on time.

What RD Concepts has decided is to split the administration of this blog between multiple people.  All come from various areas of healthcare including emergency, health clinics, academia, etc……

Our goal at RD Concepts is always to bring quality and be of service to others.  We are hoping to bring variety and timely postings for your consumption.

Thank you & God bless,

RD Concepts

Advertisements

RD Concepts Health Wellness