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Anorexia Nervosa

Anorexia Nervosa

The key feature of anorexia nervosa is self-imposed starvation resulting from a distorted body image and an intense and irrational fear of gaining weight, even when obviously emaciated. An anorexic patient is preoccupied with her body size, describes herself as “fat,” and commonly expresses dissatisfaction with a particular aspect of her physical appearance. Although the term anorexia suggests that the patient’s weight loss is associated with a loss of appetite, this is rare.

Anorexia nervosa and bulimia nervosa can occur simultaneously. In anorexia nervosa, the refusal to eat may be accompanied by compulsive exercising, self­induced vomiting, or abuse of laxatives or diuretics.

Anorexia occurs in 5% to 10% of the population; more than 90% of those affected are females. It occurs primarily in adolescents and young adults but also may affect older women and, occasionally, males.

Causes

The cause of anorexia nervosa is unknown. Researchers in neuroendocrinology are seeking a physiologic cause but have found nothing definite. Clearly, social attitudes that equate slimness with beauty play some role in provoking this disorder; family factors also are implicated. Most theorists believe that refusing to eat is a subconscious effort to exert personal control over life or to protect oneself from dealing with issues surrounding sexuality.

Signs and symptoms

One important sign that someone may be suffering from anorexia nervosa is grossly distorted body image, meaning that the person feels they are overweight and, in fact, appear thin. Other symptoms may include unnatural fear of weight gain, compulsive exercising, self-starvation, loss of energy, and, in girls who have started menstruating, amenorrhea, or absence of at least three consecutive menstrual cycles. Those with anorexia nervosa may begin to appear emaciated.

Over time, the disorder may cause serious health problems including sudden death, congestive heart failure, dental problems, growth retardation, stomach rupture, swelling of the salivary glands, anemia, abnormalities of the blood, loss of kidney function and osteoporosis.

Treatment

Appropriate treatment aims to promote weight gain or control the patient’s compulsive binge eating and purging and to correct malnutrition and the underlying psychological dysfunction. Hospitalization in a medical or psychiatric unit may be required to improve the patient’s precarious physical state. Hospitalization may be as brief as 2 weeks or may stretch from a few months to 2 years or longer.

A team approach to care – combining aggressive medical management, nutritional counseling, and individual. group, or family psychotherapy or behavior modification therapy – is the best approach. Treatment is difficult, and results may be discouraging. Many clinical centers are now developing inpatient and outpatient programs specifically for managing eating disorders.

Treatment may include behavior modification (privileges depend on weight gain); curtailed activity for physical reasons (such as arrhythmias); vitamin and mineral supplements; a reasonable diet, with or without liquid supplements; subclavian, peripheral, or enteral hyperalimentation (enteral and peripheral routes carry less risk of infection); and group, family, or individual psychotherapy.

Supportive care by health care providers, structured behavioral therapy, psychotherapy, and anti-depressant drug therapy are some of the methods that are used for treatment. Severe and life-threatening malnutrition may require intravenous feeding.

Prevention

Preventive measures to reduce the incidence of anorexia are not known at this time. However, early detection and intervention can reduce the severity of symptoms, enhance the child’s normal growth and development, and improve the quality of life experienced by children or adolescents with anorexia nervosa. Encouraging healthy eating habits and realistic attitudes toward weight and diet may also be helpful.

References

  1. https://en.wikipedia.org/wiki/Anorexia_nervosa
  2. https://www.nhs.uk/conditions/anorexia/

Delusional Disorders

Delusional Disorders

According to the DSM-IV. delusional disorders are characterized by false beliefs with a plausible basis in reality. Formerly referred to as paranoid disorders, delusional disorders are known to involve erotomanic, grandiose, jealous, or somatic themes as well as persecutory delusions. Some patients experience several types of delusions; other patients experience unspecified delusions that have no dominant theme.

Delusional disorders commonly begin in middle or late adulthood, usually between ages 40 and 55, but they can occur at a younger age. These uncommon illnesses affect less than 1 % of the population; the incidence is about equal in men and women. Typically chronic, these disorders often interfere with social and marital relationships but seldom impair intellectual or occupational functioning significantly.

Causes

Delusional disorders of later life strongly suggest a hereditary predisposition. At least one study has linked the development of delusional disorders to inferiority feelings in the family. Some researchers suggest that delusional disorders are the product of specific early childhood experiences with an authoritarian family structure. Others hold that anyone with a sensitive personality is particularly vulnerable to developing a delusional disorder.

Certain medical conditions are known to exaggerate the risks of delusional disorders: head injury, chronic alcoholism, deafness, and aging. Predisposing factors linked to aging include isolation, lack of stimulating interpersonal relationships, physical illness, and diminished hearing and vision. In addition, severe stress (such as a move to a foreign country) may precipitate a delusional disorder.

Symptoms

The presence of non-bizarre delusions is the most obvious symptom of this disorder. Other symptoms that might appear include:

  • An irritable, angry, or low mood
  • Hallucinations (seeing, hearing, or feeling things that are not really there) that are related to the delusion (For example, a person who believes he or she has an odor problem may smell a bad odor.)

Diagnosis

Patients with delusional symptoms should undergo a thorough physical examination and patient history to rule out possible organic causes (such as dementia). If a psychological cause is suspected, a mental health professional will typically conduct an interview with the patient and administer one of several clinical inventories, or tests, to evaluate mental status

Treatment

Effective treatment of delusional disorders, consisting of a combination of drug therapy and psychotherapy, must correct the behavior and mood disturbances that result from the patient’s mistaken belief system. Treatment also may include mobilizing a support system for the isolated, aged patient.

Drug treatment with antipsychotic agents is similar to that used in schizophrenic disorders. Antipsychotics appear to work by blocking postsynaptic dopamine receptors. These drugs reduce the incidence of psychotic symptoms, such as hallucinations and delusions, and relieve anxiety and agitation. Other psychiatric drugs, such as antidepressants and anxiolytics, may be prescribed to control associated symptoms.

High-potency antipsychotics include fluphenazine, haloperidol, thiothixene, and trifluoperazine. Loxapine succinate, molindone, and perphenazine are intermediate in potency, and chlorpromazine and thioridazine are low-potency agents. Haloperidol decanoate, fluphenazine decanoate, and fluphenazine enanthate are depot formulations that are implanted I.M. and release the drug gradually over a 30-day period, improving compliance.

Clozapine, which differs chemically from other antipsychotic drugs, may be prescribed for severely ill patients who fail to respond to standard neuroleptic treatment. This agent effectively controls a wider range of psychotic symptoms without the usual adverse effects.

However, clozapine can cause drowsiness, sedation, excessive salivation, tachycardia, dizziness, and seizures, as well as agranulocytosis, a potentially fatal blood disorder characterized by a low white blood cell count and pronounced neutropenia. Routine blood monitoring is essential to detect the estimated 1 % to 2% of all patients taking clozapine who develop agranulocytosis. If caught in the early stages, the disorder is reversible.

Prevention

Effective means of prevention have not been identified.

References

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4874764/
  2. https://www.health.harvard.edu/diseases-and-conditions/delusional-disorder

Conversion Disorder

Conversion Disorder

Previously called hysterical neurosis, conversion type, a conversion disorder allows a patient to resolve a psychological conflict through the loss of a specific physical function, for example, by paralysis, blindness, or the inability to swallow. Unlike factitious disorders or malingering, the patient’s loss of physical function is involuntary. However, laboratory tests and diagnostic procedures don’t disclose an organic cause.

Conversion disorder can occur in either sex at any age. An uncommon disorder, it usually begins in adolescence or early adulthood. The conversion symptom itself isn’t life-threatening and usually has a short duration.

Causes

The patient suddenly develops the conversion symptom soon after experiencing a traumatic conflict that he believes he can’t handle. Two theories explain why this occurs. According to the first, the patient achieves a “primary gap,” when the symptom keeps a psychological conflict out of conscious awareness. For example, a person may experience blindness after witnessing a violent crime.

The second theory suggests that the patient achieves secondary gain from the symptom by avoiding a traumatic activity. For example, a soldier may develop a “paralyzed” hand that prevents him from entering into combat.

Signs and symptoms

Common signs of a conversion disorder include:

  • Sudden onset of physical symptoms
  • Recent history of a stressful experience
  • Inappropriate lack of concern over the physical symptoms

The symptoms of conversion disorder involve the loss of one or more bodily functions. These may include blindness, paralysis or the inability to speak. The loss of physical function is involuntary and diagnostic testing does not show a physical cause for the dysfunction.

Treatment

Psychotherapy, family therapy, relaxation therapy, behavior therapy, or hypnosis may be used alone or in combination (two or more) to treat conversion disorder.

References

  1. https://medlineplus.gov/ency/article/000954.htm
  2. https://www.msdmanuals.com/professional/psychiatric-disorders/somatic-symptom-and-related-disorders/conversion-disorder

Autistic Disorder

Autistic Disorder

Autistic disorder is a severe, pervasive developmental disorder marked by unresponsiveness to social contact, gross deficits in intelligence and language development, ritualistic and compulsive behaviors, restricted capacity for developmentally appropriate activities and interests, and bizarre responses to the environment.

The disorder usually becomes apparent before the child reaches age 3, but in some children the actual onset is difficult to determine. Occasionally, autistic disorder isn’t recognized until the child enters school. when his abnormal social development becomes obvious.

Autistic disorder is rare, affecting 4 to 5 children per 10,000 births. It affects four to five times more males than females, usually the firstborn male. Although the degree of impairment varies, the prognosis is poor and most patients require a structured environment throughout life.

Causes

The causes of autistic disorder remain unclear but are thought to include psychological. physiologic, and sociologic factors. Previously, it was thought that most parents of autistic children were intelligent, educated people of high socioeconomic status; recent studies suggest that this may not be true.

The parents of an autistic child may appear distant and unaffectionate toward the child. However, because autistic children are clearly different from birth, and because they are unresponsive or respond with rigid, screaming resistance to touch and attention, parental remoteness may be merely a frustrated, helpless reaction to this disorder, not its cause.

Some theorists consider autistic disorder related to early under stimulation that causes the child to seek contact with the world through self-stimulating behaviors or consider it related to overwhelming over stimulation that leads to regression, muteness, and unresponsiveness to external stimuli. Controlled studies haven’t confirmed this etiology.

Recent studies have pointed to an association between neurobiological factors and autism. Defects in the central nervous system that may arise from prenatal complications (such as rubella or phenylketonuria), high maternal stress in the first trimester, and genetic factors appear to playa role in the development of autism.

Signs and symptoms

  • does not socially interact well with others, including parents
    • shows a lack of interest in, or rejection of physical contact. Parents describe autistic infants as “unaffectionate.” Autistic infants and children are not comforted by physical contact.
    • avoids making eye contact with others, including parents
    • fails to develop friends or interact with other children
  • does not communicate well with others
    • is delayed or does not develop language
    • once language is developed, does not use language to communicate with others
    • has echolalia (repeats words or phrases repeatedly, like an echo)
  • demonstrates repetitive behaviors
    • has repetitive motor movements (such as rocking and hand or finger flapping)
  • is preoccupied, usually with lights, moving objects, or parts of objects
  • does not like noise
  • has rituals
  • requires routines

Treatment

The difficult and prolonged treatment of autistic disorder must begin early, continue for years (through adolescence), and involve the child, parents, teachers, and therapists in coordinated efforts to encourage social adjustment and speech development and to reduce self-destructive behavior.

Behavioral techniques are used to decrease symptoms and increase the child’s ability to respond. Positive reinforcement, using food and other rewards, can enhance language and social skills. Providing pleasurable sensory and motor stimulation (jogging, playing with a ball) encourages appropriate behavior and helps eliminate inappropriate behavior. Pharmacologic intervention may be helpful. Haloperidol often
mitigates withdrawn and stereotypical behavior patterns, making the child more amenable to behavior modification therapies.

Treatment may take place in a psychiatric institution, in a specialized school, or in a day-care program, but the current trend is toward home treatment. Helping family members to develop strong one-on-one relationships with the autistic child commonly initiates responsive, imitative behavior. Because family members tend to feel inadequate and guilty, they may need counseling.

Prevention

Until the causes of infantile autism are known, prevention isn’t possible.

References

  1. https://www.chw.org/medical-care/child-development-center/developmental-disorders/pervasive-developmental-disorders-pdd/autistic-disorder
  2. https://www.nimh.nih.gov/health/topics/autism-spectrum-disorders-asd/index.shtml
  3. https://medlineplus.gov/autismspectrumdisorder.html

Attention Deficit Hyperactivity Disorder (ADHD)

ADHD

The patient with attention deficit hyperactivity disorder has difficulty focusing his attention, engaging in quiet passive activities, or both. Some patients have an attention deficit without hyperactivity; they’re less likely to be diagnosed and receive treatment.

Attention-deficit hyperactivity disorder (ADHD) is one of the most common reasons children are referred for mental health services.  It affects as many as one in every 20 children. This disorder occurs in roughly 3% to 5% of school­age children. Males are three times more likely to be affected than females. The presence of other psychiatric disorders also needs to be determined.

Causes

Attention deficit hyperactivity disorder is thought to be a physiologic brain disorder with a familial tendency. Some studies indicate that it may result from altered neurotransmitter levels in the brain.

Signs and symptoms

The kinds of symptoms professionals look for in diagnosing ADHD include

  • difficulty following instructions or completing tasks
  • difficulty ‘sticking to’ an activity
  • easily distracted and forgetful
  • Having trouble waiting his or her turn
  • Interrupting or intruding on others
  • difficulty playing quietly
  • always seeming to be “on the go”
  • blurts out answers without waiting for the question to finish
  • difficulty in waiting or taking turns

In order to be diagnosed with ADHD some of these problems would have been apparent before the age of six or seven years.

These behaviours must normally occur in more than one setting (for example at home as well as at school) for ADHD to be diagnosed.

Treatment

Education is the first step in effective treatment of attention deficit hyperactivity disorder. The entire treatment team (which ideally includes parents, teachers, and therapists as well as the patient and the doctor) must fully understand the nature of this disorder as well as the disorder’s effect on the individual’s ability to function.

Specific treatments vary, depending on the severity of signs and symptoms and their effects on the patient’s ability to function adequately. Behavior modification, coaching, external structure, use of planning and organizing systems, and supportive psychotherapy can all help the patient more effectively cope with the disorder.

Some patients benefit from medication to relieve symptoms. Ideally, the treatment team identifies the symptoms to be managed, selects appropriate medication, and then tracks the patient’s symptoms carefully to determine the effectiveness of the medication. Stimulants, such as methylphenidate and dextroamphetamine, are the most commonly used agents. However, other drugs, including tricyclic antidepressants (such as desipramine and nortriptyline), mood stabilizers, and beta blockers, sometimes help control symptoms. Tomoxetine, currently in clinical trials, has been found in preliminary studies to be effective; further research will involve extending the duration of treatment to determine the effects of the medication.

Special parenting skills are often required because children with AD/HD may not respond as well to typical parenting practices. Also, because ADHD tends to run in families, parents often have some problems with organization and consistency themselves and need active coaching to help learn these skills.

Prevention

Preventive measures to reduce the incidence of ADHD in adolescents are not known at this time. However, early detection and intervention can reduce the severity of symptoms, decrease the interference of behavioral symptoms on school functioning, enhance the adolescent’s normal growth and development, and improve the quality of life experienced by children or adolescents with ADHD.

References

  1. https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml
  2. https://www.cdc.gov/ncbddd/adhd/index.html
  3. https://www.nhs.uk/conditions/attention-deficit-hyperactivity-disorder-adhd/symptoms/

Alcoholism Fact – Signs & Symptoms, Treatment

Alcoholism

Alcoholism is a chronic disorder most often described as the uncontrolled intake of alcoholic beverages that interferes with physical and mental health, social and familial relationships, and occupational responsibilities. Alcoholism cuts across all social and economic groups, involves both sexes, and occurs at all stages of the life cycle. beginning as early as elementary school age.

Most adults in the United States are light drinkers; a minority – about 10% of the population – account for 50% of all alcohol consumption. About 13% of all adults over age 18 have suffered from alcohol abuse or dependence at some time in their lives. The prevalence of drinking is highest between the ages of 21 and 34, but current statistics show that up to 19% of 12- to 17-year-olds have a serious drinking problem. Males are, two to five times more likely to abuse alcohol than are females. According to some statistics, alcohol abuse is a factor in 60% of all automobile accidents. Alcoholism has no known cure.

Causes

Numerous biological, psychological, and sociocultural factors may cause alcohol addiction, but no clear evidence confirms the influence of any of these factors. Family background may playa significant part: An offspring of one alcoholic parent is seven to eight times more likely to become an alcoholic than is a peer without such a parent. Biological factors may include genetic or biochemical abnormalities, nutritional deficiencies, endocrine imbalances, and allergic responses.

Psychological factors may include the urge to drink alcohol to reduce anxiety or symptoms of mental illness; the desire to avoid responsibility in familial, social, and work relationships; and the need to bolster self-esteem.

Sociocultural factors include the availability of alcoholic beverages, group or peer pressure, an excessively stressful lifestyle, and social attitudes that approve frequent imbibing. Advertising supports society’s message that alcohol consumption is part of a healthy lifestyle. Paradoxically, many alcoholics come from families in which alcohol is forbidden.

Signs and symptoms

Most alcoholics deny that they have a drinking problem. Other indications of alcoholism and alcohol abuse include:

  • Keeping alcohol in unlikely places at home, at work or in the car
  • Gulping drinks, ordering doubles, becoming intoxicated intentionally to feel good or drinking to feel “normal”
  • Nausea and vomiting
  • Having legal problems or problems with relationships, employment or finances
  • Rapid heart rate and sweating
  • Restlessness or agitation

Treatment

Total abstinence is the only effective treatment. Supportive programs that offer detoxification, rehabilitation, and aftercare, including continued involvement in Alcoholics Anonymous (AA), may produce long-term results.

Acute intoxication is treated symptomatically by supporting respiration, preventing aspiration of vomitus, replacing fluids, administering I.V. glucose to prevent hypoglycemia, correcting hypothermia or acidosis, and initiating emergency treatment for trauma, infection, or GI bleeding.

Treatment of chronic alcoholism relies on medications to deter alcohol use and treat effects of withdrawal; psychotherapy, using behavior modification techniques, group therapy, and family therapy; and appropriate measures to relieve associated physical problems.

Aversion, or deterrent, therapy uses a daily oral dose of disulfiram to prevent compulsive drinking. This drug interferes with alcohol metabolism and allows toxic levels of acetaldehyde to accumulate in the patient’s blood, producing immediate and potentially fatal distress if the patient consumes alcohol up to 2 weeks after taking it.

Disulfiram is contraindicated during pregnancy and in patients with diabetes, heart disease, severe hepatic disease, or any disorder in which such a reaction could be especially dangerous. Another form of aversion therapy attempts to induce aversion by administering alcohol with an emetic.

For long-term success with aversion, or deterrent, therapy, the sober alcoholic must learn to fill the place alcohol once occupied in his life with something constructive. For patients with abnormal dependence or for those who also abuse other drugs, aversion therapy with disulfiram may only substitute one drug dependence for another; so it should be used prudently.

Tranquilizers, particularly benzodiazepines, occasionally are used to relieve overwhelming anxiety during rehabilitation. However, these drugs have addictive potential (substituting one substance abuse problem for another), and they can precipitate coma or even death when combined with alcohol. Naltrexone may be useful as an adjunct to psychotherapy, especially when there are high levels of cravings. Antipsychotics are prescribed to control hyperactivity and psychosis. Anticonvulsants, anti emetics, and antidiarrheals also are used to treat symptoms of alcohol withdrawal.

Supportive counseling or individual. group, or family psychotherapy may improve the alcoholic’s ability to cope with stress, anxiety, and frustration and help him gain insight into the personal problems and conflicts that may have led him to alcohol abuse. Ongoing support groups also can help him overcome his dependence on alcohol. In AA, a self-help group with more than a million members worldwide, the alcoholic finds emotional support from others with similar problems. About 40% of AA members stay sober as long as 5 years, and 30% stay sober longer than 5 years.

Prevention

Educational programs and medical advice about alcohol abuse have been successful in decreasing alcohol abuse and its associated problems. Alcohol dependency requires more intensive management.

The National Institute on Alcohol Abuse and Alcoholism recommends that women have no more than 1 drink per day and men no more than 2 drinks per day. One drink is defined as a 12-ounce bottle of beer, a 5-ounce glass of wine, or a 1 1/2-ounce shot of liquor.

References

  1. https://medlineplus.gov/alcoholismandalcoholabuse.html
  2. https://www.mayoclinic.org/diseases-conditions/alcohol-use-disorder/symptoms-causes/syc-20369243

Clinical Depression (Major Depression)

Clinical Depression

Clinical depression is also know as major depression, it is the most severe category of depression. It is normal for people to feel depressed when something bad happens, such as the death of a loved one. This type of depression normally goes away after a couple of weeks; but sometimes it persists. It can last for periods of six months or more, and then it is classified as clinical depression. Without treatment, symptoms of clinical depression can last for weeks, months, or years. Appropriate treatment for clinical depression, however, can help most people who suffer from clinical depression.

Signs and Symptoms of Clinical depression

In a clinical depression, more of the symptoms of depression are present, and they are usually more intense or severe. However, each individual may experience symptoms differently. Symptoms may include:

  • Inability to experience pleasure
  • Hopeless about the future, excessive pessimistic feelings
  • Insomnia or excessive sleeping
  • Fatigue or loss of energy nearly every day
  • Drug or alcohol abuse
  • Thoughts of suicide
  • Feelings of guilt, worthlessness, helplessness
  • Significant weight loss or gain

What are the Causes of Clinical Depression?

Current theory suggests those clinical depression results from complex interactions between brain chemicals and hormones that influence a person’s energy level, feelings, sleeping and eating habits. These chemical interactions are linked to many complex causes–a person’s family history of illness, biochemical and psychological make-up, prolonged stress, and traumatic life crisis such as death of a loved one, job loss, or divorce. Sometimes no identifiable cause triggers an episode of clinical depression; usually one or more stresses are involved. Medical research has found that people who suffer from clinical depression have changes in important brain chemicals, such as serotonin and norepinephrine. New medications are available that restore these brain chemicals to their proper balance and relieve symptoms of clinical depression.

Complications

Major depression can profoundly alter social, family, and occupational functioning. However, suicide is the most serious complication of major depression, resulting when the patient’s feelings of worthlessness, guilt, and hopelessness are so overwhelming that he no longer considers life worth living.

Note: If specific plans for suicide are uncovered or if significant risk factors exist (previous history, profound hopelessness, concurrent medical illness. substance abuse, social isolation), refer the patient to a mental health specialist for immediate care. Nearly 15% of patients with untreated depression commit suicide, and most of these patients sought help from a doctor within 1 month of their deaths.

Diagnostic criteria

A patient is diagnosed with a major depressive episode when he fulfills the criteria documented in the DSM-IV.

  • At least five of the following symptoms must have been present during the same 2-week period and represent a change from previous functioning; one of these symptoms must be either depressed mood or loss of interest in previously pleasurable activities (Don’t include symptoms that are due to a general medical condition, delusions, or hallucinations):

– depressed mood (irritable mood in children and adolescents) most of the day. nearly every day, as indicated by either subjective account or observation by others

– a markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day

-significant weight loss or weight gain (greater than 5% of the patient’s body weight in a month) when not dieting or a change in appetite nearly every day

– insomnia or hypersomnia nearly every day

– psychomotor agitation or retardation nearly every day

– fatigue or loss of energy nearly every day

– feelings of worthlessness and excessive or inappro­priate guilt nearly every day

– diminished ability to think or concentrate or indecisiveness, nearly every day

– recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or suicide attempt or a specific plan for committing suicide.

  • The symptoms aren’t due to a mixed episode.
  • The symptoms aren’t due to a medical condition (such as hypothyroidism) or the effects of a medication or other substance (drug abuse, for example).
  • The symptoms aren’t better accounted for by bereavement (for example, symptoms persist for more than 2 months after a loved one’s death or are characterized by marked functional impairment, morbid thoughts of worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation).

Psychological tests such as the Beck Depression Inventory can be used to determine the onset, severity, duration, and progression of depressive symptoms. The dexamethasone suppression test may show a failure to suppress cortisol secretion; however, this test has a high false-negative rate. Toxicology screening may suggest a drug-induced depression.

Treatments for Clinical Depression

The first step to getting appropriate treatments for clinical depression is a physical examination by a physician. If a physical cause for the clinical depression is ruled out, a psychological evaluation should be done by referral to a psychologist or psychiatrist. Physical treatments have several options including antidepressant medication therapy, psychotherapy or electroconvulsive therapy or ECT.

  1. Antidepressant medication therapy, it takes about 5 or 6 weeks to find out if that antidepressant medication is appropriate – that is it is working and does not have untoward side effects – and then it takes 6 months or more of continuation treatment to ensure that the medication remains effective.
  2. Psychotherapy – most often cognitive-behavioral and/or interpersonal therapy) for the individual. Cognitive-behavioral focused on the negative thinking and behavioral patterns associated with depression, and teaches the individual to recognize and target the self-defeating behavioral patterns that contribute to their depression.
  3. Electroconvulsive therapy (or ECT). This usually involves 8 to 10 treatments over a 3 to 4 week period. One can consider ongoing treatment once every 2 weeks to once every 4 weeks over a several month period if this treatment has been successful. (ECT)

The effectiveness of treatment often depends on factors such as the amount of optimism and hope the sufferer is able to maintain, the control he or she has over stressors, the severity of symptoms, the amount of time the sufferer has been depressed, the results of previous treatments, and the degree of support of family, friends, and significant others.

While treatment is generally effective, there are some cases where the condition fails to respond. Treatment-resistant depression requires a full assessment which may lead to the addition of psychotherapy, higher medication doses, changes of medication or combination therapy, a trial of ECT /electroshock, or even a change in the diagnosis with subsequent treatment changes. Although this process helps many, some people’s symptoms continue unabated.

References

  1. https://www.mayoclinic.org/diseases-conditions/depression/expert-answers/clinical-depression/faq-20057770
  2. https://uhs.berkeley.edu/health-topics/mental-health/clinical-depression
  3. https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0024767/
  4. https://www.ncbi.nlm.nih.gov/pubmed/26461405

Bulimia Nervosa

bulimia nervosa

Bulimia (buh-LEE -me-ah) nervosa, typically called bulimia, is a type of eating disorder. The essential features of bulimia nervosa include eating binges followed by feelings of guilt, humiliation, and self-deprecation. These feelings precipitate the patient’s engaging in self-induced vomiting. the use of laxatives or diuretics, or strict dieting or fasting to overcome the effects of the binges. Unless the patient devotes an excessive amount of time to binging and purging, bulimia nervosa seldom is incapacitating.

Most people with bulimia nervosa are females, ranging in age from the teens to early 20s, who are preoccupied with their weight and body image. Bulimia nervosa affects all races, but is most often diagnosed in Caucasian women.

Causes

The exact cause of bulimia is unknown, but various psychosocial factors are thought to contribute to its development. Such factors include family disturbance or conflict, sexual abuse, maladaptive learned behavior, struggle for control or self-identity, cultural overemphasis on physical appearance, and parental obesity. Bulimia nervosa is strongly associated with depression.

Signs and symptoms

  • self-induced vomiting (usually secretive)
  • depression
  • inappropriate use of diuretics or laxatives
  • overachieving behavior
  • persistent preoccupation with eating and an irresistible craving for food.
  • anxiety

Treatment

Treatment of bulimia nervosa may continue for several years. Interrelated physical and psychological symptoms must be treated simultaneously. Merely promoting weight gain isn’t sufficient to guarantee long-term recovery. A patient whose physical status is severely compromised by inadequate or chaotic eating patterns is difficult to engage in the psychotherapeutic process.

Psychotherapy focuses on breaking the binge-purge cycle and helping the patient regain control over eating behavior. Treatment may occur in either an inpatient or outpatient setting. It includes behavior modification therapy, possibly in highly structured psychoeducational group meetings. Individual psychotherapy and family therapy, which address the eating disorder as a symptom of unresolved conflict, may help the patient understand the basis of her behavior and teach her self­control strategies. Antidepressant drugs such as imipramine may be used to supplement psychotherapy.

The patient also may benefit from participation in self-help groups such as Overeaters Anonymous or in a drug rehabilitation program if she has a concurrent substance abuse problem.

Prevention

Preventive measures to reduce the incidence of bulimia are not known at this time. However, early detection and intervention can reduce the severity of symptoms, enhance the process of normal growth and development, and improve the quality of life experienced by adolescents with bulimia. Encouraging healthy eating habits and realistic attitudes toward weight and diet may also be helpful.

References

  1. https://www.womenshealth.gov/mental-health/mental-health-conditions/eating-disorders/bulimia-nervosa
  2. https://www.nhs.uk/conditions/bulimia/