Antidepressants Blog

AIDS DEMENTIA COMPLEX: HIV AND THE CENTRAL NERVOUS SYSTEM

admin — Mon, 25 Jul 2011 14:38:48 +0000

People with HIV infection often worry about dementia. In fact, people are sometimes so worried that every time they forget something or have trouble concentrating, they wonder if they are in the early stages of dementia. Many of these people can be reassured: losing memory and concentration is common and normal when people are also anxious, depressed, or overextended. Nearly everyone has, at one time or another, locked the keys in the car, forgotten an appointment, or been unable to pay attention to a TV show as a result of being stressed or worried. Usually, such lapses are temporary and a sign only of preoccupation. AIDS dementia complex occurs in 30 to 50 percent of the people with HIV infection, usually in the late stages. The cause of AIDS dementia complex is not understood. Physicians who specialize in AIDS dementia suspect it is caused by HIV invading the brain directly. It is rare before the late stages of HIV infection. After the immune system is profoundly weakened, dementia becomes relatively common. Dementia causes noticeable changes in a person’s mental abilities, attitude, and muscle control. The changes usually follow a certain pattern. At first, people with HIV infection or their caregivers notice mental slowing: they say they are less “sharp,” or they are “not as quick,” or their thinking is “cloudier.” They take longer to organize their thoughts, to respond to questions. Later, mental slowing progresses, and can be accompanied by apathy and withdrawal. Most people with AIDS dementia complex eventually have problems controlling their muscles. They walk unsteadily, and they trip or fall easily; their legs are often weak. Their coordination is reduced, and they have problems with eating and writing. Eventually, people with AIDS dementia complex may progress rapidly to the point where they are totally withdrawn. Some people with dementia experience a mild mental slowing that never becomes more serious; for these people, dementia has only a small impact on their lives. For others, dementia progresses rapidly and mental impairment is severe. Someone with the symptoms of AIDS dementia complex should be examined and tested to exclude the possibility that the symptoms are caused by depression or by an infection of the central nervous system. Diagnosis of dementia will often be made by specialists: neurologists or AIDS physicians. The tests for dementia include a series of tests of mental abilities, a neurological examination, a spinal tap, and a brain scan. The purpose of the tests is to find out what the person can and cannot do mentally, to determine the severity of the dementia, and to exclude other causes—like cryptococcal meningitis, toxoplasmosis, or lymphoma of the brain—that could be causing the same symptoms. So far, there is little in the way of specific therapy for AIDS dementia complex. AZT, unlike many antibiotics, does get into the brain. Furthermore, some studies have shown that AZT and other drugs will slow or prevent the onset of AIDS dementia complex. And AZT clearly helps some people who take it by slowing the course of the dementia. Antibiotics similar to AZT, which also inhibit the reproduction of HIV, might be similarly helpful in treating dementia, but they are still being studied. A note of caution: For reasons medical scientists do not yet understand, most drugs that act on the central nervous system, including drugs for sleep, antidepressant drugs, and antianxiety drugs, have a greater than usual effect on people with dementia. These include alcohol and all benzodiazepines: Valium, Librium, Xanax, and Ativan. Physicians must be made aware of the diagnosis of AIDS dementia complex so they can prescribe and monitor drugs carefully. People with a confirmed diagnosis of AIDS dementia complex need appropriate medical care for this and other aspects of HIV infection, need support in their living arrangements, and need to do some long-term planning. Making some decisions becomes necessary. Some of these decisions include assigning a durable power of attorney, writing wills, and writing living wills and a medical order not to resuscitate. They must also consider when to stop driving a car, especially if they feel their motor abilities or reaction times are impaired, or when they notice people blowing horns, or when they start getting tickets, or when they forget where they are, or because they worry about hurting others. They consider stopping work, especially if they think they are doing sloppy work or can’t work as well or can’t remember what they need to. Quitting work or stopping driving does not automatically mean that they are dependent and useless, or that life can’t be enjoyable. The rest of this section discusses in more detail the symptoms of AIDS dementia complex and the strategies people have worked out for living with those symptoms.*144\191\2*

HOUSING FOR PEOPLE WITH SPINAL CORD INJURY: APARTMENTS

admin — Wed, 13 Jul 2011 14:32:04 +0000

Located in a bustling urban area, the apartment complex houses many essentials for living, such as a grocery store, cleaners, restaurant, small shops, and a bar for socializing. The complex has a personal care attendant on site, hired by the people with disabilities who live in the high rise.Discrimination based on disability in renting, purchasing housing, or obtaining financing is illegal. Under the Fair Housing Amendments Act, a landlord cannot have two different rental agreements, one for people with disabilities and one for those without.Most people with disabilities require some environmental changes so that they can carry out the activities of daily living. What are “reasonable accommodations” (a term used in the Americans with Disabilities Act) to achieve this independent living? Someone who uses a wheelchair needs room under the kitchen sink to fit the chair. Someone who uses crutches needs a parking space close to his apartment entry. Another person needs a curb-cut to move from the parking lot to the sidewalk in her wheelchair. Other modifications might be needed in various rooms. Some common needs are raised toilet seats, bathroom grab bars, roll-in showers, widened doorways, door levers or automatic door openers, lowered kitchen cabinets, appliances with reachable controls, and lowered call-buttons in elevators.All such alterations are charged to the renter, unless the landlord receives funding from the federal government. According to the pamphlet Fair Housing: How to Make the Law Work for You, available from the Paralyzed Veterans of America, the renter has to agree to restore the unit to its original condition (allowing for normal wear) on leaving; to give a fair description of the changes to be made; and to assure that the work is done well and that necessary permits are obtained.Buildings with four or more living units must have basic accessibility for people with disabilities. Entryways, public areas, and common-use areas must be accessible. Doorways must be wide enough for wheelchairs.
*133/156/5*

EPILEPSY AS A PSYCHO-SOCIAL DISEASE: ATTITUDES OF BROTHERS AND SISTER

admin — Sat, 02 Jul 2011 14:16:44 +0000

SSibling love, as well as sibling rivalry, is normal. The reaction of your child’s brother or sister to a sibling with epilepsy will depend on age and developmental stage, but most of all on your reaction to epilepsy and to your children.All children fantasize, and it is not uncommon for a sibling to believe that he caused his brother’s seizures by playing roughly or pushing and causing his brother to fall. Children often wish for things to happen to their brother or sister. If something happens, then guilt is a common response. These feelings may be compounded by jealousy because you are giving too much attention to the child who has seizures. Brothers or sisters may show these feelings by “acting out,” by withdrawing, or by signs of depression, any of which may affect school performance and sleep patterns.Children often believe also that epilepsy, like measles, is contagious and that they might catch it, too. This fear should be discussed openly within the family.Your other children may be drawn into a pattern of overprotection or overindulgence. Either you or they may say, “Don’t play so roughly, you might bring on a seizure.” “Don’t let him get so excited.” “Give him the toy, or he’ll get upset and have a seizure.” Such statements give enormous leverage to your child to manipulate his environment.Most of these problems can be avoided by your sensitivity to the effects of your child’s epilepsy on his brothers and sisters and openness and honesty about your own feelings about the epilepsy and your continued love for all of your children. It is important that you initiate discussions with your other children and that no matter how time-consuming and preoccupying your child’s seizure problems may be, you find some time to spend individually with the others, talking and doing something special with them and for them.Studies have shown that, while there is always an impact on siblings whose brother or sister has a disability, if handled appropriately, that impact is positive. Brothers and sisters can become stronger, more sympathetic, more empathetic, and more caring adults.*214\208\8*

PREVENTION OF INFECTIVE ENDOCARDITIS: FUTURE DIRECTIONS

admin — Tue, 21 Jun 2011 14:30:10 +0000

In the future, a greater emphasis may be placed on providing early patient education, especially for patients with recently implanted artificial valves or recently treated infective endocarditis. It is possible that the use of a wallet card or other such reminder system may be of use in providing accurate, easily accessible information to the patient and any’ provider preparing to perform a procedure.Given that animal data strongly support the efficacy of antibiotic prophylaxis, and that the practice is well-entrenched in modern medical care, it is unlikely that there will ever be a more definitive, randomized, placebo-controlled study to assess the efficacy of antibiotic prophylaxis of IE. Because the disease is rare, even in high-risk populations, it has been estimated that such a study would require more than 6000 high-risk patients undergoing procedures likely to induce bacteremia. However, future research can and should be performed to clarify important remaining questions, including how to improve physician and patient education on this topic, how to measure the effect of antibiotic doses on evolving resistance patterns, and how to measure the significance of post-procedural bacteremias.*52/348/5*

BDD BEHAVIOURS – DIETING

admin — Tue, 14 Jun 2011 14:24:28 +0000

While dieting is a common behavior, as well as a feature of eating disorders, it can also be a symptom of BDD. I first became aware of this when reading about BDD before I’d begun my own research. I found the published case of a young man from Germany who thought his cheeks were too “rosy and round”; to make them thinner, he severely starved himself. Since then, I’ve seen peoplewho’ve dieted for similar reasons. One young man severely starved himself in the hope that losing large amounts of weight would erase wrinkles from his face. Another lost 30 pounds to make his face less wide. Other people with BDD diet for more conventional reasons. They try to flatten their stomach or slim their thighs or calves. Some people avoid salty foods or take water pills to decrease eye puffmess, stomach bloating, or facial swelling. Others eat special diets—for example, avoiding chocolate or greasy foods, or taking herbal supplements—trying to make their skin clear. One man I treated went from 160 to 120 pounds because he worried his skin would break out if he ate anything greasy or oily; in fact, he avoided most foods. After treatment with Prozac, his skin worries disappeared and his weight became normal again. Men who think their body is too small may eat high-protein low-fat diets to become larger. One man who did this, however, didn’t allow himself to get too large and muscular because he feared that compared to the rest of his body, his penis would look too small.*109\204\8*

EPILEPSY AND ITS SPECIAL FORMS/EPILEPSY SYNDROMES: LENNOX-GASTAUT SYNDROME’S MEDICATIONS

admin — Sun, 05 Jun 2011 14:14:27 +0000

Children with these multiple, difficult-to-control seizures often are given several simultaneous medications with consequent drug toxicity. The handicapping nature of the seizures, plus the drug toxicity and the continuous electrical abnormalities on the EEG, often reinforce the intrinsic brain dysfunction and produce a severely handicapped child.Valproic acid has been the most effective anticonvulsant for children with this syndrome, and it should be used alone and in high doses as the initial drug. It may, if necessary, be supplemented by one of the other anticonvulsants for generalized tonic-clonic seizures or with a benzodiazepine.We have found the ketogenic diet also quite effective and recommend its use early in the course of the syndrome. We have had less success with the MCT diet. The effectiveness of oral steroids and ACTH also has been noted. The role of a form of surgery, corpus callosum sectioning, in young children with this syndrome is under investigation.Clearly, as with infantile spasms, the Lennox-Gastaut syndrome is a most frustrating and devastating condition. This group of children make up a large proportion of the intractable seizure population. Research is badly needed to understand their condition and to develop better forms of therapy. The frustration involved in their management and the complexity of treatment lead us to suggest that these children be evaluated and managed under the consultation of sophisticated epilepsy centers with access to newer drugs.*96\208\8*

BACH FLOWER REMEDIES: CRAB APPLE

admin — Sun, 29 May 2011 14:09:52 +0000

Detests uncleanliness any where and every where, cannot stand uncleaniiness of his own body or of his thoughts, dislikes it and becomes despondent in self-condemnation, wants to get rid of any unclean thoughts, or dirty habits, or any unpleasant sensations, even wants to cutaway or throw aside any undesirable part of his body.The mind is so obsessed with minor and un-important details of a case that it loses sight of the more important overall scheme—over-emphasis on principle of purity for soul and spirit and physical body, over-sensitive to lack of order in public or private life. When the extremely sensitive mind of the negative Crab Apple type observes even the tiniest irregularity in any sight, it makes such a profound impression that all he can do is to cope with this impression only and no energy is left for the consideration of wider contexts.He is a perfectionist, cannot accept anything which has any flaw in it. If he is an artist, he will not pass on his own work of art to a customer, till it satisfies his own eyes, even if the customer is prepared to accept it in “as it is” condition.If a picture or a calender hung on the wall in his room is even slightly tilted to a side, he will immediately set it right before he does anything else, howsoever important this other thing may be.In Dr. Bach’s words “It is the remedy which helps us to get rid of anything we do not like either in our minds or bodies”.*97\308\8*

STRUCTURE OF SKIN: NERVES, BLOOD VESSELS AND LYMPHATICS

admin — Fri, 20 May 2011 13:55:04 +0000

The nerves of the skinThe skin is provided with a greater variety of nerves than any other organ in the body, and this is because it has many important functions to fulfill. There are nerves that recognize pressure and locality, those that are said to be concerned in the temperature sense, those that recognize pain and those that control the local circulation. The nerves of the skin ramify through all its parts, some of them terminating in the inner and some in the outer layer, depending, of course, on the particular function they have to fulfill.
The blood vessels and lymphatics of the skinThere is a general network in the skin of blood vessels and lymphatics, and these are required for the supply of nutriment to the hair follicles and the sweat and the sebaceous glands, and for the dispersal of the waste products of cell activity. This circulation through the skin is very important, and there is a greater proportion of the total blood content in the skin than many people imagine. This fact is known to those who practice water treatments, because the various applications are used on the surface of the body in order to influence the rich supply of blood that lies just beneath.
*4/154/5*

AFTER A HYSTERECTOMY

admin — Sun, 08 May 2011 12:58:30 +0000

There is absolutely no basis to a common belief that removal of the uterus causes a woman to lose her femininity. An old medical joke describes the hysterectomy as an operation that ‘removes the cradle but leaves the play pen*. This is very true. The organ in which the baby develops is removed. Future pregnancy is no longer possible.But as long as the ovaries are left and hormonal production continues, normal sensations, feelings of sexuality, desire, climax (orgasm), love and affection, will continue unabated. Of this there is no doubt, ft has absolutely no effect on the woman such as her suddenly ageing, becoming ‘old hat’, developing grey hair, a wrinkled countenance, or anything else that would suddenly indicate advanced years.She will respond to sexual stimulus in exactly the same way as she did previously. In fact, with all fear of pregnancy gone, and the need to take contraceptive precautions eliminated, many women find sex and intercourse far more rewarding mentally and physically.Tactile stimulation tends to increase; often sensitivity of the breasts (and nipples) to manual or oral stimulation also increase. Some women may have found this lessened after childbirth, and this could continue; but if a woman has always found sexual arousal and enjoyment from such actions, these will continue and probably at a higher level of excitation.Sexual excitation will usually stimulate the vulval glands to produce lubricating fluid. Intercourse will continue unimpaired and unhampered. The vaginal tract is usually lengthened following surgery, not shortened as some males fear.It may be several weeks before normal sexual relationships can be resumed. The internal parts must heal and, as with any wound, this takes time. But gentle intercourse by an understanding partner will usually allow the procedure to return to normal fairly rapidly.Some women believe that the operation will cause them to become suddenly obese. But this is a myth. Admittedly many women will increase weight after their operation, but a careful check will show that they usually feel better physically and mentally. This is often accompanied by a considerable increase in their daily food intake. The operation, in itself, does not cause a person to increase weight.Some women tend to make invalids of themselves after their operation. The less physical activity that takes place, the less food burnt up as energy. Again, this is self-inflicted, and is another reason why some women appear to become obese after an operation of this nature. It is totally preventable by sensible habits and commonsense eating programmes. The more starch foods that are eaten (represented by sugar and refined flour in all forms), the greater are the risks of developing obesity. This applies to everyone, men and women and children, irrespective of age, maritial status or operational status. Well worth remembering!In some older women where it was advisable to remove the ovaries as well as the uterus, doctors often back this up by the use of artificial oral hormones for a certain length of lime. This will helpreduce the risk of menopausal symptoms from flaring up. Hot flushes and sweats, a feeling of suffocation, and the other symptoms mentioned in the chapter on the change of life, all may be averted by judicious use of medication. This must be taken under a doctor’s regular supervision.Women from whom the uterus only has been removed will not experience change of life symptoms, as ovarian hormone will still continue to be produced regularly.Do not fear your forthcoming hysterectomy. It is for your own good, in your own interest, to make your future happier, symptom-free and more enjoyable. It will improve the quality of life and, most probably, longevity.Certainly any operation is uncomfortable for several days afterwards. But pain control is easily maintained whilst you are in hospital. Most doctors prefer early ambulation, so you will be up and walking quite soon after the operation. Passing urine may be difficult for a day or two, but this usually settles down quickly.*123\45\4*

GETTING READY FOR A NEW LIFE: HOW IMPORTANT IS FOOD IN YOUR LIFE?

admin — Thu, 28 Apr 2011 12:54:14 +0000

Let’s get down to basics. Any resistance you may have is directly related to how important food is in your life. I often ask my clients to list six things that bring them the most emotional or physical pleasure and satisfaction in their lives. I am astounded by the fact that food is frequently in the top three and quite often is number one. These clients are admitting that food is the most important element in their lives. This is sad and unfortunate.This is why, before embarking on this program, you need to take a look at yourself very closely. You need to examine your priorities and values. If we are going to free you from your binge-eating problem, what are we freeing you to do? Overcoming binge eating and losing weight are not the end products of this program. These changes represent the beginning, the beginning of whoever you want to be or have ever wanted to be.*55\358\8*