Narcolepsy

Definition:
Narcolepsy is a chronic neurological disorder caused by the brain’s inability to regulate sleep-wake cycles normally. At various times throughout the day, people with narcolepsy experience fleeting urges to sleep. If the urge becomes overwhelming, patients fall asleep for periods lasting from a few seconds to several minutes. In rare cases, some people may remain asleep for an hour or longer.

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Narcoleptic sleep episodes can occur at any time, and thus frequently prove profoundly disabling. People may involuntarily fall asleep while at work or at school, when having a conversation, playing a game, eating a meal, or, most dangerously, when driving an automobile or operating other types of potentially hazardous machinery. In addition to daytime sleepiness, three other major symptoms frequently characterize narcolepsy: cataplexy, or the sudden loss of voluntary muscle tone; vivid hallucinations during sleep onset or upon awakening; and brief episodes of total paralysis at the beginning or end of sleep.

Contrary to common beliefs, people with narcolepsy do not spend a substantially greater proportion of their time asleep during a 24-hour period than do normal sleepers. In addition to daytime drowsiness and involuntary sleep episodes, most patients also experience frequent awakenings during nighttime sleep. For these reasons, narcolepsy is considered to be a disorder of the normal boundaries between the sleeping and waking states.

For most adults, a normal night’s sleep lasts about 8 hours and is composed of four to six separate sleep cycles. A sleep cycle is defined by a segment of non-rapid eye movement (NREM) sleep followed by a period of rapid eye movement (REM) sleep. The NREM segment can be further divided into stages according to the size and frequency of brain waves. REM sleep, in contrast, is accompanied by bursts of rapid eye movement (hence the acronym REM sleep) along with sharply heightened brain activity and temporary paralysis of the muscles that control posture and body movement. When subjects are awakened from sleep, they report that they were “having a dream” more often if they had been in REM sleep than if they had been in NREM sleep. Transitions from NREM to REM sleep are governed by interactions among groups of neurons (nerve cells) in certain parts of the brain.

Scientists now believe that narcolepsy results from disease processes affecting brain mechanisms that regulate REM sleep. For normal sleepers a typical sleep cycle is about 100 – 110 minutes long, beginning with NREM sleep and transitioning to REM sleep after 80 – 100 minutes. But, people with narcolepsy frequently enter REM sleep within a few minutes of falling asleep.

Who Gets Narcolepsy?
Narcolepsy is not rare, but it is an underrecognized and underdiagnosed condition. The disorder is estimated to affect about one in every 2,000 Americans. But the exact prevalence rate remains uncerntain, and the disorder may affect a larger segment of the population.

Narcolepsy appears throughout the world in every racial and ethnic group, affecting males and females equally. But prevalence rates vary among populations. Compared to the U.S. population, for example, the prevalence rate is substantially lower in Israel (about one per 500,000) and considerably higher in Japan (about one per 600).

Most cases of narcolepsy are sporadic-that is, the disorder occurs independently in individuals without strong evidence of being inherited. But familial clusters are known to occur. Up to 10 percent of patients diagnosed with narcolepsy with cataplexy report having a close relative with the same symptoms. Genetic factors alone are not sufficient to cause narcolepsy. Other factors-such as infection, immune-system dysfunction, trauma, hormonal changes, stress-may also be present before the disease develops. Thus, while close relatives of people with narcolepsy have a statistically higher risk of developing the disorder than do members of the general population, that risk remains low in comparison to diseases that are purely genetic in origin.

* Obstructive sleep apnea is a temporary cessation of breathing that occurs repeatedly during sleep and is caused by a narrowing of the airway. Restless legs syndrome is a neurological disorder characterized by unpleasant sensations-burning, creeping, tugging-in the legs and an uncontrollable urge to move when at rest


Symptoms:

The main characteristic of narcolepsy is excessive daytime sleepiness (EDS), even after adequate night time sleep. A person with narcolepsy is likely to become drowsy or to fall asleep, often at inappropriate times and places. Daytime naps may occur without warning and may be physically irresistible. These naps can occur several times a day. They are typically refreshing, but only for a few hours. Drowsiness may persist for prolonged periods of time. In addition, night time sleep may be fragmented with frequent awakenings.

Four other “classic” symptoms of narcolepsy, which may not occur in all patients, are cataplexy, sleep paralysis, hypnogogic hallucinations, and automatic behavior. Cataplexy is an episodic condition featuring loss of muscle function, ranging from slight weakness (such as limpness at the neck or knees, sagging facial muscles, or inability to speak clearly) to complete body collapse. Episodes may be triggered by sudden emotional reactions such as laughter, anger, surprise, or fear, and may last from a few seconds to several minutes. The person remains conscious throughout the episode. Sleep paralysis is the temporary inability to talk or move when waking (or less often, falling asleep). It may last a few seconds to minutes. This is often frightening but is not dangerous. Hypnagogic hallucinations are vivid, often frightening, dreamlike experiences that occur while dozing, falling asleep and/or while awakening. Automatic behavior means that a person continues to function (talking, putting things away, etc.) during sleep episodes, but awakens with no memory of performing such activities. It is estimated that up to 40 percent of people with narcolepsy experience automatic behavior during sleep episodes. , sleep paralysis, and hypnagogic hallucinations also occur in people who do not have narcolepsy, more frequently in people who are suffering from extreme lack of sleep. Cataplexy is generally considered to be unique to narcolepsy and is analogous to sleep paralysis in that the usually protective paralysis mechanism occurring during sleep is inappropriately activated. The opposite of this situation (failure to activate this protective paralysis) occurs in rapid eye movement behavior disorder.

In most cases, the first symptom of narcolepsy to appear is excessive and overwhelming daytime sleepiness. The other symptoms may begin alone or in combination months or years after the onset of the daytime naps. There are wide variations in the development, severity, and order of appearance of cataplexy, sleep paralysis, and hypnagogic hallucinations in individuals. Only about 20 to 25 percent of people with narcolepsy experience all four symptoms. The excessive daytime sleepiness generally persists throughout life, but sleep paralysis and hypnagogic hallucinations may not.

Although these are the common symptoms of narcolepsy, many (although less than 40% of people with narcolepsy)[citation needed] also suffer from insomnia for extended periods of time.

The symptoms of narcolepsy, especially the excessive daytime sleepiness and cataplexy, often become severe enough to cause serious problems in a person’s social, personal, and professional life.

Normally, when an individual is awake, brain waves show a regular rhythm. When a person first falls asleep, the brain waves become slower and less regular. This sleep state is called non-rapid eye movement (NREM) sleep. After about an hour and a half of NREM sleep, the brain waves begin to show a more active pattern again. This sleep state, called REM sleep (rapid eye movement sleep), is when most remembered dreaming occurs. Associated with the EEG-observed waves during REM sleep, muscle atonia is present (called REM atonia).

In narcolepsy, the order and length of NREM and REM sleep periods are disturbed, with REM sleep occurring at sleep onset instead of after a period of NREM sleep. Thus, narcolepsy is a disorder in which REM sleep appears at an abnormal time. Also, some of the aspects of REM sleep that normally occur only during sleep — lack of muscular control, sleep paralysis, and vivid dreams — occur at other times in people with narcolepsy. For example, the lack of muscular control can occur during wakefulness in a cataplexy episode; it is said that there is intrusion of REM atonia during wakefulness. Sleep paralysis and vivid dreams can occur while falling asleep or waking up. Simply put, the brain does not pass through the normal stages of dozing and deep sleep but goes directly into (and out of) rapid eye movement (REM) sleep. This has several consequences:

*Night time sleep does not include as much deep sleep, so the brain tries to “catch up” during the day, hence EDS.
*People with narcolepsy may visibly fall asleep at unpredicted moments (such motions as head bobbing are common).
*People with narcolepsy fall quickly into what appears to be very deep sleep.
*They wake up suddenly and can be disoriented when they do (dizziness is a common occurrence).
*They have very vivid dreams, which they often remember in great detail.
*People with narcolepsy may dream even when they only fall asleep for a few seconds.

Causes:
While the cause of narcolepsy has not yet been determined, scientists have discovered conditions that may increase an individual’s risk of having the disorder. Specifically, there appears to be a strong link between narcoleptic individuals and certain genetic conditions. One factor that may predispose an individual to narcolepsy involves an area of Chromosome 6 known as the HLA complex. There appears to be a correlation between narcoleptic individuals and certain variations in HLA genes, although it is not required for the condition to occur.

Certain variations in the HLA complex are thought to increase the risk of an auto-immune response to protein-producing neurons in the brain. The protein produced, called hypocretin or orexin, is responsible for controlling appetite and sleep patterns. Individuals with narcolepsy often have reduced numbers of these protein-producing neurons in their brains.

The neural control of normal sleep states and the relationship to narcolepsy are only partially understood. In humans, narcoleptic sleep is characterized by a tendency to go abruptly from a waking state to REM sleep with little or no intervening non-REM sleep. The changes in the motor and proprioceptive systems during REM sleep have been studied in both human and animal models. During normal REM sleep, spinal and brainstem alpha motor neuron depolarization produces almost complete atonia of skeletal muscles via an inhibitory descending reticulospinal pathway. Acetylcholine may be one of the neurotransmitters involved in this pathway. In narcolepsy, the reflex inhibition of the motor system seen in cataplexy is believed identical to that seen in normal REM sleep.

In 2004 researchers in Australia induced narcolepsy-like symptoms in mice by injecting them with antibodies from narcoleptic humans. The research has been published in the Lancet providing strong evidence suggesting that some cases of narcolepsy might be caused by autoimmune disease.

Narcolepsy is strongly associated with HLA DQB1*0602 genotype. There is also an association with HLA DR2 and HLA DQ1. This may represent linkage disequilibrium.

Despite the experimental evidence in human narcolepsy that there may be an inherited basis for at least some forms of narcolepsy, the mode of inheritance remains unknown.

Some cases are associated with genetic diseases such as Niemann-Pick disease or Prader-Willi syndrome.

Diagnosis:

Narcolepsy is not definitively diagnosed in most patients until 10 to 15 years after the first symptoms appear. This unusually long lag-time is due to several factors, including the disorder’s subtle onset and the variability of symptoms. As important, however, is the fact that the public is largely unfamiliar with the disorder, as are many health professionals. When symptoms initially develop, people often do not recognize that they are experiencing the onset of a distinct neurological disorder and thus fail to seek medical treatment.

A clinical examination and exhaustive medical history are essential for diagnosis and treatment. However, none of the major symptoms is exclusive to narcolepsy. EDS-the most common of all narcoleptic symptoms-can result from a wide range of medical conditions, including other sleep disorders such as sleep apnea, various viral or bacterial infections, mood disorders such as depression, and painful chronic illnesses such as congestive heart failure and rheumatoid arthritis that disrupt normal sleep patterns. Various medications can also lead to EDS, as can consumption of caffeine, alcohol, and nicotine. Finally, sleep deprivation has become one of the most common causes of EDS among Americans.

This lack of specificity greatly increases the difficulty of arriving at an accurate diagnosis based on a consideration of symptoms alone. Thus, a battery of specialized tests, which can be performed in a sleep disorders clinic, is usually required before a diagnosis can be established.

Two tests in particular are considered essential in confirming a diagnosis of narcolepsy: the polysomnogram (PSG) and the multiple sleep latency test (MSLT). The PSG is an overnight test that takes continuous multiple measurements while a patient is asleep to document abnormalities in the sleep cycle. It records heart and respiratory rates, electrical activity in the brain through electroencephalography (EEG), and nerve activity in muscles through electromyography (EMG). A PSG can help reveal whether REM sleep occurs at abnormal times in the sleep cycle and can eliminate the possibility that an individual’s symptoms result from another condition.

The MSLT is performed during the day to measure a person’s tendency to fall asleep and to determine whether isolated elements of REM sleep intrude at inappropriate times during the waking hours. As part of the test, an individual is asked to take four or five short naps usually scheduled 2 hours apart over the course of a day. As the name suggests, the sleep latency test measures the amount of time it takes for a person to fall asleep. Because sleep latency periods are normally 10 minutes or longer, a latency period of 5 minutes or less is considered suggestive of narcolepsy. The MSLT also measures heart and respiratory rates, records nerve activity in muscles, and pinpoints the occurrence of abnormally timed REM episodes through EEG recordings. If a person enters REM sleep either at the beginning or within a few minutes of sleep onset during at least two of the scheduled naps, this is also considered a positive indication of narcolepsy.

Treatment:
The drowsiness is normally treated using amphetamine-like stimulants such as methylphenidate, racemic amphetamine, dextroamphetamine, and methamphetamine, or modafinil, a new stimulant with a different pharmacologic mechanism. In Fall 2007 an alert for severe adverse reactions to modafinil was issued by the FDA .

Other medications used are codeine and selegiline. Another drug that is used is atomoxetine (Strattera), a non-stimulant and Norepinephrine reuptake inhibitor (NRI), that has little or no abuse potential. In many cases, planned regular short naps can reduce the need for pharmacological treatment of the EDS to a low or non-existent level. Cataplexy is frequently treated with tricyclic antidepressants such as clomipramine, imipramine, or protriptyline. Venlafaxine, a newer antidepressant which blocks the reuptake of serotonin and norepinephrine, has shown usefulness in managing symptoms of cataplexy. Gamma-hydroxybutyrate (GHB), a medication recently approved by the US Food and Drug Administration, is the only medication specifically indicated for cataplexy. Gamma-hydroxybutyrate has also been shown to reduce symptoms of EDS associated with narcolepsy. While the exact mechanism of action is unknown, GHB is thought to improve the quality of nocturnal sleep.

Treatment is tailored to the individual based on symptoms and therapeutic response. The time required to achieve optimal control of symptoms is highly variable, and may take several months or longer. Medication adjustments are also frequently necessary, and complete control of symptoms is seldom possible. While oral medications are the mainstay of formal narcolepsy treatment, lifestyle changes are also important. The main treatment of excessive daytime sleepiness in narcolepsy is with a group of drugs called central nervous system stimulants. For cataplexy and other REM-sleep symptoms, antidepressant medications and other drugs that suppress REM sleep are prescribed.

In addition to drug therapy, an important part of treatment is scheduling short naps (10 to 15 minutes) two to three times per day to help control excessive daytime sleepiness and help the person stay as alert as possible. Daytime naps are not a replacement for nighttime sleep.

Ongoing communication between the health care provider, patient, and the patient’s family members is important for optimal management of narcolepsy.

Finally, a recent study reported that transplantation of hypocretin neurons into the pontine reticular formation in rats is feasible, indicating the development of alternative therapeutic strategies in addition to pharmacological interventions.

Coping with narcolepsy:
Learning as much about narcolepsy as possible and finding a support system can help patients and families deal with the practical and emotional effects of the disorder, possible occupational limitations, and situations that might cause injury. A variety of educational and other materials are available from sleep medicine or narcolepsy organizations.

Support groups exist to help persons with narcolepsy and their families.

To imagine what a person with narcolepsy copes with daily, keep in mind that while many are not sleep-deprived (in the classical sense), a major symptom of narcolepsy is akin to sleep deprivation in a normal person; as a normal person, imagine going years functioning off just 3-4 hours of sleep per night. While lifestyle changes and drug therapy can help largely mitigate many symptoms of narcolepsy, there currently exists no complete and permanent solution, therefore patience, empathy and self-education are excellent coping tools.

Individuals with narcolepsy, their families, friends, and potential employers should know that:

Narcolepsy is a life-long condition that may require continuous medication.
Although there is no cure for narcolepsy at present, several medications can help reduce its symptoms.
People with narcolepsy can lead productive lives with proper medical care and lifestyle changes.
A major physiological and physical effect of narcolepsy is roughly akin to the effects of sleep deprivation; such effects can often be controlled and minimized through a combination of lifestyle changes and drug therapy.
Individuals with narcolepsy should avoid jobs that require driving long distances or handling hazardous equipment or that require alertness for lengthy periods (especially where the consequences of falling asleep are dangerous to themselves or others).
Parents, teachers, spouses, and employers should be aware of the symptoms of narcolepsy. This will help them avoid the mistake of confusing the person’s behavior with laziness, hostility, rejection, or lack of interest and motivation. It will also help them provide essential support and cooperation.
Employers can promote better working opportunities for individuals with narcolepsy by permitting special work schedules and nap breaks.
Doctors generally agree that lifestyle changes can be very helpful to those suffering with narcolepsy. Suggested self-care tips, from the National Sleep Foundation, University at Buffalo, and Mayo Clinic, include:

Take several short daily naps (10-15 minutes) to combat excessive sleepiness and sleep attacks.
Develop a routine sleep schedule – try to go to sleep and awaken at the same time every day.
Alert your employers, co-workers and friends in the hope that others will accommodate your condition and help when needed.
Do not drive or operate dangerous equipment if you are sleepy. Take a nap before driving if possible. Consider taking a break for a nap during a long driving trip.
Join a support group.
Break up larger tasks into small pieces and focusing on one small thing at a time.
Take several short walks during the day.
Carry a tape recorder, if possible, to record important conversations and meetings.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

What Research is Being Done?
Within the Federal government, the National Institute of Neurological Disorders and Stroke (NINDS), a component of the National Institutes of Health (NIH), has primary responsibility for sponsoring research on neurological disorders. As part of its mission, the NINDS supports research on narcolepsy and other sleep disorders with a neurological basis through grants to major medical institutions across the country.

Within the National Heart, Lung, and Blood Institute, also a component of the NIH, the National Center on Sleep Disorders Research (NCSDR) coordinates Federal government sleep research activities and shares information with private and nonprofit groups. NCSDR staff also promote doctoral and postdoctoral training programs, and educates the public and health care professional about sleep disorders. For more information, go to the NCSDR website at http://www.nhlbi.nih.gov/about/ncsdr/index.htm.

NINDS-sponsored researchers are conducting studies devoted to further clarifying the wide range of genetic factors-both HLA genes and non-HLA genes-that may cause narcolepsy. Other scientists are conducting investigations using animal models to identify neurotransmitters other than the hypocretins that may contribute to disease development. A greater understanding of the complex genetic and biochemical bases of narcolepsy will eventually lead to the formulation of new therapies to control symptoms and may lead to a cure. Researchers are also investigating the modes of action of wake-promoting compounds to widen the range of available therapeutic options.

Scientists have long suspected that abnormal immunological processes may be an important element in the cause of narcolepsy, but until recently clear evidence supporting this suspicion has been lacking. NINDS-sponsored scientists have recently uncovered evidence demonstrating the presence of unusual, possibly pathological, forms of immunological activity in narcoleptic dogs. These researchers are now investigating whether drugs that suppress immunological processes may interrupt the development of narcolepsy in this animal model.

Recently there has been a growing awareness that narcolepsy can develop during childhood and may contribute to the development of behavior disorders. A group of NINDS-sponsored scientists is now conducting a large epidemiological study to determine the prevalence of narcolepsy in children aged 2 to 14 years who have been diagnosed with attention-deficit hyperactivity disorder.

Finally, the NINDS continues to support investigations into the basic biology of sleep, including the brain mechanisms involved in generating and regulating REM sleep. Scientists are now examining physiological processes occurring in a portion of the hindbrain called the amygdala in order to uncover novel biochemical processes underlying REM sleep. A more comprehensive understanding of the complex biology of sleep will undoubtedly further clarify the pathological processes that underlie narcolepsy and other sleep disorders.

How Can you Help Research?
The NINDS contributes to the support of the Human Brain and Spinal Fluid Resource Center in Los Angeles. This bank supplies investigators around the world with tissue from patients with neurological and other disorders. Tissue from individuals with narcolepsy is needed to enable scientists to study this disorder more intensely. Prospective donors may contact:

Human Brain and Spinal Fluid Resource Center
Neurology Research (127A)
W. Los Angeles Healthcare Center
11301 Wilshire Blvd. Bldg. 212
Los Angeles, CA 90073
310-268-3536
24-hour pager: 310-636-5199
Email: RMNbbank@ucla.edu

http://www.loni.ucla.edu/~nnrsb/NNRSB

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Where you can get more information?

For more information on neurological disorders or research programs funded by the National Institute of Neurological Disorders and Stroke, contact the Institute’s Brain Resources and Information Network (BRAIN) at:

BRAIN
P.O. Box 5801
Bethesda, MD 20824
(800) 352-9424

http://www.ninds.nih.gov

Information also is available from the following organizations:

Narcolepsy Network, Inc.
79 Main Street
North Kingstown, RI 02852
narnet@narcolepsynetwork.org

http://www.narcolepsynetwork.org

Tel: 888-292-6522 401-667-2523
Fax: 401-633-6567

National Sleep Foundation
1522 K Street NW
Suite 500
Washington, DC 20005
nsf@sleepfoundation.org

http://www.sleepfoundation.org

Tel: 202-347-3472
Fax: 202-347-3472

National Heart, Lung, and Blood Institute (NHBLI)
National Institutes of Health, DHHS
31 Center Drive, Rm. 4A21 MSC 2480
Bethesda, MD 20892-2480

http://www.nhlbi.nih.gov

Tel: 301-592-8573/240-629-3255 (TTY) Recorded Info: 800-575-WELL (-9355)

Resources:

http://www.ninds.nih.gov/disorders/narcolepsy/detail_narcolepsy.htm#109043201

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

Benefits of Aerobics for Elderly

Aerobic exercises have multiple benefits; it helps boost mental agility and manual dexterity in elderly people and improves the way they can concentrate on visual and auditory tasks.

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These findings are based on a review of 11 studies that examined the effects of getting healthy people over 55 to take on additional physical exercise.

The studies showed that they bettered at least one aspect of cognitive function.

“This benefit adds to the other known benefits of aerobic exercise,” said Maaike Angevaren of University of Applied Sciences, Netherlands, who led the research team.

“Larger studies are still required to confirm whether the aerobic training component is necessary, or whether the same can be achieved with any type of physical exercise,” he said.

Sources: The Times Of India

Shocking Facts About the Pharmaceutical Industry

Big drug companies have been accused of putting profits above patients, spinning false PR campaigns and more. Here are some of the most shocking facts about the pharmaceutical industry.

The price of drugs is increasing faster than anything else a patient pays for: The prices of the most heavily prescribed drugs are routinely jacked up, sometimes several times a year. Some medications have a mark-up of 1,000 percent over the cost of their ingredients.

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Your doctor may have an ulterior motive behind your prescription: Drug reps often give gifts to convince doctors to prescribe the medications that they represent. These drug reps usually have no medical or science education.

Pharmaceutical companies spend more on marketing than research: Almost twice as much!

Guilty of Medicare fraud: Pharmaceutical companies are being tried in federal courts as a result of their exploitation of Medicare. AstraZeneca had to pay more than $340 million in penalties for coaching doctors to cheat Medicare.

The combined wealth of the top 5 pharmaceutical companies outweigh GNP of sub-Saharan Africa: In fact, the combined worth of the world’s top five drug companies is twice the combined GNP of that entire region.

Americans pay more for prescription meds than anyone else in the world: $200 billion in 2002 alone.

“New” Drugs aren’t really new: Two-thirds of “new” prescription drugs are identical to existing drugs or modified versions of them.

Drug companies are taking advantage of underdeveloped countries to perform clinical trials: In developing countries, government oversight is more lax.

For more shocking facts, click the link below.

Sources:
Nursing Online Education Database March 27, 2008

Vitamins ‘May Shorten Your Life’

Alpha-carotene 2d structureImage via Wikipedia

Research has suggested certain vitamin supplements do not extend life and could even lead to a premature death.

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……..Could they be doing more harm than good?

A review of 67 studies found “no convincing evidence” that antioxidant supplements cut the risk of dying.

Scientists at Copenhagen University said vitamins A and E could interfere with the body’s natural defences.

“Even more, beta-carotene, vitamin A, and vitamin E seem to increase mortality,” according to the review by the respected Cochrane Collaboration.

The research involved selecting various studies from 817 on beta-carotene, vitamin A, vitamin C, vitamin E, and selenium which the team felt were the most likely to fairly reflect the impact of the supplements on reducing mortality.

It has been thought that these supplements may be able to prevent damage to the body’s tissues called “oxidative stress” by eliminating the molecules called “free radicals” which are said to cause it.

This damage has been implicated in several major diseases including cancer and heart disease.

‘Just eat well’
The trials involved 233,000 people who were either sick or were healthy and taking supplements for disease prevention.

After various factors were taken into account and a further 20 studies excluded, the researchers linked vitamin A supplements to a 16% increased risk of dying, beta-carotene to a 7% increased risk and vitamin E to a 4% increased risk.

Vitamin C did not appear to have any effect one way or the other, and the team said more work was needed into this supplement – as well as into selenium.

In conclusion, “we found no evidence to support antioxidant supplements for primary or secondary prevention,” they said.

It was unclear exactly why the supplements could have this effect, but the team speculated that they could interfere with how the body works: beta-carotene, for instance, is thought to change the way a body uses fats.

The Department of Health said people should try to get the vitamins they need from their diet, and avoid taking large doses of supplements – a market which is worth over £330m in the UK.

There is a need to exercise caution in the use of high doses of purified supplements of vitamins, including antioxidant vitamins, and minerals,” a spokesperson said.

“Their impact on long-term health may not have been fully established and they cannot be assumed to be without risk.”

A ‘stitch-up’

But the Health Supplements Information Service, which is funded by the association which represents those who sell supplements, said many people were simply not able to get everything they needed from their diet.

For the millions who are not able to do that, vitamins can be a useful supplement and they should not stop taking them,” said spokeswoman Pamela Mason.

Another nutritionist who has formulated supplements described the review as a “stitch-up”, arguing it only looked at studies which examined the effect they had on reducing mortality, rather than other advantages.

“Antioxidants are not meant to be magic bullets and should not be expected to undo a lifetime of unhealthy habits,” said Patrick Holford.

“But when used properly, in combination with eating a healthy diet full of fruit and vegetables, getting plenty of exercise and not smoking, antioxidant supplements can play an important role in maintaining and promoting overall health.”


VITAL VITAMIN FACTS :-

Vitamin A: Found in: Oily fish, eggs and liver; Good for: Thought to boost immune system, and help skin, sight and sperm formation
Vitamin C: Found in: Many fruit and vegetables; Good for: Helps heal wounds and assists the body in absorbing iron, may boost the immune system
Vitamin E: Found in: Vegetable oils, seeds and nuts; Good for: May help boost circulation and keep elderly people active
Beta-carotene: Found in: Vegetables that are reddish-orange in colour; Good for: May boost vision and keep the mind sharp
Selenium:
Found in: Butter, nuts, liver and fish; Good for: May boost the immune system
How many take vitamins? Between 10-20% of people in the West

Sources:BBC NEWS:16th. April.’08

Plastic Recycling Symbols

The Daily Green offers this handy guide on the various types of plastic:

Number 1 Plastics — PET or PETE (polyethylene terephthalate)

* Found In: Soft drinks, water and beer bottles; mouthwash bottles; peanut butter containers; salad dressing and vegetable oil containers; ovenable food trays.
* Recycling: Pick up through most curbside recycling programs.
* Recycled Into: Polar fleece, fiber, tote bags, furniture, carpet, paneling, straps, (occasionally) new containers

It poses low risk of leaching breakdown products. Recycling rates remain relatively low (around 20 percent), though the material is in high demand by remanufacturers.

Number 2 Plastics

-- HDPE (high density polyethylene)

* Found In: Milk jugs, juice bottles; bleach, detergent and household cleaner bottles; shampoo bottles; some trash and shopping bags; motor oil bottles; butter and yogurt tubs; cereal box liners
* Recycling: Pick up through most curbside recycling programs, although some only allow those containers with necks.
* Recycled Into: Laundry detergent bottles, oil bottles, pens, recycling containers, floor tile, drainage pipe, lumber, benches, doghouses, picnic tables, fencing

HDPE carries low risk of leaching and is readily recyclable into many goods.

Number 3 Plastics -
- V (Vinyl) or PVC

* Found In: Window cleaner and detergent bottles, shampoo bottles, cooking oil bottles, clear food packaging, wire jacketing, medical equipment, siding, windows, piping
* Recycling: Rarely recycled; accepted by some plastic lumber makers.
* Recycled Into: Decks, paneling, mudflaps, roadway gutters, flooring, cables, speed bumps, mats

PVC contains chlorine, so its manufacture can release highly dangerous dioxins. If you must cook with PVC, don’t let the plastic touch food. Never burn PVC, because it releases toxins.

Number 4 Plastics
LDPE (low density polyethylene)

* Found In: Squeezable bottles; bread, frozen food, dry cleaning and shopping bags; tote bags; clothing; furniture; carpet
* Recycling: LDPE is not often recycled through curbside programs, but some communities will accept it. Plastic shopping bags can be returned to many stores for recycling.
* Recycled Into: Trash can liners and cans, compost bins, shipping envelopes, paneling, lumber, landscaping ties, floor tile

Historically, LDPE has not been accepted through most American curbside recycling programs, but more and more communities are starting to accept it.

Number 5 Plastics -
- PP (polypropylene)

* Found In: Some yogurt containers, syrup bottles, ketchup bottles, caps, straws, medicine bottles
* Recycling: Number 5 plastics can be recycled through some curbside programs.
* Recycled Into: Signal lights, battery cables, brooms, brushes, auto battery cases, ice scrapers, landscape borders, bicycle racks, rakes, bins, pallets, trays

Polypropylene has a high melting point, and so is often chosen for containers that must accept hot liquid. It is gradually becoming more accepted by recyclers.

Number 6 Plastics — PS (polystyrene)

* Found In: Disposable plates and cups, meat trays, egg cartons, carry-out containers, aspirin bottles, compact disc cases
* Recycling: Number 6 plastics can be recycled through some curbside programs.
* Recycled Into: Insulation, light switch plates, egg cartons, vents, rulers, foam packing, carry-out containers

Polystyrene can be made into rigid or foam products — in the latter case it is popularly known as the trademark Styrofoam. Evidence suggests polystyrene can leach potential toxins into foods. The material was long on environmentalists’ hit lists for dispersing widely across the landscape, and for being notoriously difficult to recycle.

Number 7 Plastics — Miscellaneous

* Found In: Three- and five-gallon water bottles, ‘bullet-proof’ materials, sunglasses, DVDs, iPod and computer cases, signs and displays, certain food containers, nylon
* Recycling: Number 7 plastics have traditionally not been recycled, though some curbside programs now take them.
* Recycled Into: Plastic lumber, custom-made products

A wide variety of plastic resins that don’t fit into the previous categories are lumped into number 7. A few are even made from plants (polyactide) and are compostable. Polycarbonate is number 7, and is the hard plastic that has parents worried these days, after studies have shown it can leach potential hormone disruptors.

Sources: The Daily Green March 31, 2008

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Belly Fat ‘Makes More Fat Cells’

CDC's mobile obesity unitImage by applez via Flickr

The fat that some people carry around their middles could be making them even fatter, researchers have said.

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Abdominal fat increases the risk of conditions such as heart disease
The Canadian team found abdominal fat tissue produces a hormone called NPY – which also prompts the development of cells that turn into fat.

It is already known that high levels of the hormone in the brain produce constant feelings of hunger.

A UK expert said better understanding of how the hormone worked might lead to drugs to stop its effects.

It is already known that high levels of the hormone in the brain produce constant feelings of hunger.

A UK expert said better understanding of how the hormone worked might lead to drugs to stop its effects.

Being overweight is bad for health, no matter where the weight lies – but abdominal fat is known to be the most dangerous, increasing the risk of heart disease, Type 2 diabetes, high blood pressure and some cancers.

‘Vicious cycle’
The researchers, from Lawson Health Research Institute which is linked to the University of Western Ontario, carried out tests on rats which showed abdominal fat, as well as the brain, produces NPY – or Neuropeptide Y.
It is thought the excessive production of NPY in the brain is one of the main reasons why overweight people eat more food.

But the scientists found NPY in abdominal tissues increases fat cell number by stimulating the replication of fat cell precursor cells – which then change into fat cells.

Their findings were published in the Federation of American Societies of Experimental Biology journal.

Dr Kaiping Yang, who led the research, said: “This may lead to a vicious cycle where NPY produced in the brain causes you to eat more and therefore gain more fat around your middle – and then that fat produces more NYP hormone which leads to even more fat cells.”

The team will now look at whether NPY produced in the abdomen is released into the body’s circulatory system, and therefore affecting hunger messages in the brain.

If it is, it may be possible to develop a simple blood test to detect increased levels of NPY they say.

Dr Yang added: “If you can detect NPY early and identify those at risk for abdominal obesity we can then target therapy to turn off NPY.

“It would be much easier to use drugs to prevent obesity than to treat the diseases caused by obesity.”

Dr David Haslam, clinical director of the National Obesity Forum, said the study provided more information on the “complex mechanisms” which regulate how the body stores and processes fat.

He added: “This is one of those findings that, in the not too distant future, might lead to a way of manipulating this hormone’s feedback loop.

“It’s not science fiction to think you could find some way to block it.” says Dr David Haslam, National Obesity Forum.

Sources: BBC NEWS:17Th. April.’08

Aerobic Exercise

Definition:

Aerobic exercise refers to exercise that involves or improves oxygen consumption by the body. Aerobic means “with oxygen”, and refers to the use of oxygen in the body’s metabolic or energy-generating process. Many types of exercise are aerobic, and by definition are performed at moderate levels of intensity for extended periods of time. To obtain the best results, an aerobic exercise session involves a warming up period, followed by at least 20 minutes of moderate to intense exercise involving large muscle groups, and a cooling down period at the end.

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Aerobic exercise is “any activity that uses large muscle groups, can be maintained continuously, and is rhythmic in nature.” It is a type of exercise that overloads the heart and lungs and causes them to work harder than at rest. The important idea behind aerobic exercise today, is to get up and get moving!! There are more activities than ever to choose from, whether it is a new activity or an old one. Find something you enjoy doing that keeps your heart rate elevated for a continuous time period and get moving to a healthier life.

Aerobic exercise is continuous rhythmic use of large muscle groups in a weight-bearing manner at sufficient frequency, distance and intensity. Aerobics are the only exercise that changes metabolism and chemistry in enough ways to bring about a wide range of health gains. Examples include: running, cross country skiing, snow shoeing, skating, aerobic walking, swimming, cycling and a few others. Frequency is three to four times a week. Distance, most easily measured in time, is 40 to 50 minutes. As to intensity, the workout must feel like a workout –( low- mod intensity) or 12 to 15 on the Borg scale of perceived exertion. If you are just starting an exercise program, you should begin with a shorter time and lower intensity, gradually working up to target levels

History:
Both the term and the specific exercise method were developed by Kenneth H. Cooper, M.D., an exercise physiologist, and Col. Pauline Potts, a physical therapist, both of the Air Force. Dr. Cooper, an avowed exercise enthusiast, was personally and professionally puzzled about why some people with excellent muscular strength were still prone to poor performance at tasks such as long-distance running, swimming, and bicycling. He began measuring systematic human performance using a bicycle ergometer, and began measuring sustained performance in terms of the ability to utilize oxygen.

His groundbreaking book, Aerobics, was published in 1968, and included scientific exercise programs using running, walking, swimming and bicycling. The book came at a fortuitous historical moment, when increasing weakness and inactivity in the general population was causing a perceived need for increased exercise. It became a best seller.

Cooper’s data provided the scientific baseline for almost all modern aerobics programs, most of which are based on oxygen-consumption equivalency.

Aerobic versus anaerobic exercise
Aerobic exercise and fitness can be contrasted with anaerobic exercise, of which strength training and weight training are the most salient examples. The two types of exercise differ by the duration and intensity of muscular contractions involved, as well as by how energy is generated within the muscle. Initially during aerobic exercise, glycogen is broken down to produce glucose, but in its absence, fat metabolism is initiated instead. The latter is a slow process, and is accompanied by a decline in performance level. The switch to fat as fuel is a major cause of what marathon runners call “hitting the wall”. Anaerobic exercise, in contrast, refers to the initial phase of exercise, or any short burst of intense exertion, in which the glycogen or sugar is consumed without oxygen, and is a far less efficient process. Operating anaerobically, an untrained 400 meter sprinter may “hit the wall” short of the full distance.

Aerobic exercise comprises innumerable forms. In general, it is performed at a moderate level of intensity over a relatively long period of time. For example, running a long distance at a moderate pace is an aerobic exercise, but sprinting is not. Playing singles tennis, with near-continuous motion, is generally considered aerobic activity, while golf or doubles tennis, with brief bursts of activity punctuated by more frequent breaks, may not be predominantly aerobic. Some sports are thus inherently “aerobic”, while other aerobic exercises, such as fartlek training or aerobic dance classes, are designed specifically to improve aerobic capacity and fitness.

Among the recognized benefits of doing regular aerobic exercise are:
*Strengthening the muscles involved in respiration, to facilitate the flow of air in and out of the lungs

*Strengthening and enlarging the heart muscle, to improve its pumping efficiency and reduce the resting heart rate.

*Toning muscles throughout the body .

*Improving circulation efficiency and reducing blood pressure Increasing the total number of red blood cells in the body, facilitating transport of oxygen.

*Improved mental health, including reducing stress and lowering the incidence of depression.

As a result, aerobic exercise can reduce the risk of death due to cardiovascular problems. In addition, high-impact aerobic activities (such as jogging or jumping rope) can stimulate bone growth, as well as reducing the risk of osteoporosis for both men and women. In addition to the health benefits of aerobic exercise, there are numerous performance benefits:

*Increased storage of energy molecules such as fats and carbohydrates within the muscles, allowing for increased endurance

*Neovascularization of the muscle sarcomeres to increase blood flow through the muscles

*Increasing speed at which aerobic metabolism is activated within muscles, allowing a greater portion of energy for intense exercise to be generated aerobically

*Improving the ability of muscles to use fats during exercise, preserving intramuscular glycogen

*Enhancing the speed at which muscles recover from high intensity exercise

*Strength the heart, thereby reducing resting heart rate

*Helps lower body fat

*Improves your Cardiovascular Condition

*Lowers Blood pressure

*Lowers your total Cholesterol

*Helps to prevent several chronic diseases

*Raises your metabolism during activity

Aerobics” is a particular form of aerobic exercise. Aerobics classes generally involve rapid stepping patterns, performed to music with cues provided by an instructor. This type of aerobic activity became quite popular in the United States after the 1970 publication of The New Aerobics by Dr. Kenneth H. Cooper, and went through a brief period of intense popularity in the 1980s, when many celebrities (such as Jane Fonda and Richard Simmons) produced videos or created television shows promoting this type of aerobic exercise. Group exercise aerobics can be divided into two major types: freestyle aerobics and pre-choreographed aerobics.


How to find Target Heart Rate (THR)

60 to 90% of Maximum Heart Rate
1. 220 – Your Age
2. Minus your Resting Heart Rate
3. Multiply by .6 – .9
4. Add your RHR
This = your THR

Example:
220 – 35= 185
185- 72(RHR)= 113
113 x .6 = 67.8
113 x .9 = 101.7
67.8 + 72(RHR) = 139.8 BPM
101.7 + 72 (RHR) = 173.7 BPM

Other intensity Indicators:
Borg Scale RPE: self assessment of your exercise bout.. 6 – 20 . Your target is 12-15
Talk Test: slightly winded during activity

Duration of an Aerobic Session
20- 60 minutes Any physical activity
Housework (sweeping floors, yard work.)
Keep moving and have Fun

Criticisms:
When overall fitness is an occupational requirement, as for athletes, combat services, and police and fire personnel, aerobic exercise alone may not provide a well balanced exercise program. In particular, muscular strength, especially upper-body muscular strength, may be neglected. Also, the metabolic pathways involved in anaerobic metabolism (glycolysis and lactic acid fermentation) that generate energy during high intensity, low duration tasks such as sprinting, are not exercised at peak rates. Aerobic exercise is, however, an extremely valuable component of a balanced exercise program and is good for cardiovascular health.

Some persons suffer repetitive stress injuries with some forms of aerobics and then must choose less injurious “low-impact” forms or lengthen the gap between bouts of aerobic exercise to allow for greater recovery.

Aerobics notably does not increase the basal metabolic rate as much as some forms of weight-training, and may therefore be less effective at reducing obesity. However, this form of exercise also allows for longer, more frequent activity and consumes more energy when the individual is active. In addition, the metabolic activity of an individual is heightened for several hours following a bout of aerobic activity.

Aerobic activity is also used by individuals with anorexia as a means of suppressing appetite, since aerobic exercise increases glucose and fatty acids in the blood by stimulating tissues to release their energy stores. While there is some support for exercising while hungry as a means of tapping into fat stores, most evidence is equivocal. In addition, performance can be impaired by lack of nutrients, which can impair training effects.
Click to learn a variety of forms and information for practicing Aerobic Exercise

Resources:

http://www.bjwm.org/aerobic.html

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

http://www.claritylimited.com/aerobic.htm

A Big Belly Boosts Your Risk of Dementia


A big belly in your 40’s can boost your risk of Alzheimer’s disease decades later.

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Previous research has already shown that obesity raises your chances of developing dementia, but a new study found a separate risk from storing fat in your abdomen. Even people who weren’t overweight were endangered.

Abdominal fat, sometimes described as making people apple-shaped rather than pear-shaped, has been linked to a higher risk of diabetes, stroke and heart disease. Now dementia can be added to that list.

The study involved over 6,500 people who were monitored for an average of 36 years. Compared to people with normal body weight and a low belly measurement, people with normal body weight and high belly measurements were 89 percent more likely to have dementia. And the risk increased among overweight and obese people with high belly measurements.

It’s not known why abdominal fat may promote dementia, but it may pump out substances that harm your brain, the researchers said.

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Sources: Neurology March 26, 2008

4-20: Did You Know That This Is More Than Just a Date?

Parents are used to hearing their teens speak in code – from the trendy catchphrase of the week to the popular acronyms used for text messaging and online chatting. But one term that might come up more frequently this time of year is “420″ (pronounced “four-twenty”).

Those familiar with popular drug culture might recognize the code as a reference to the annual pot-smoking holiday on April 20 (or 4-20). There are many theories explaining the origin of the term and the date – from the supposed number of active chemicals in marijuana to an alleged police crime code for drug arrests to the time of day a group of California teens congregated to smoke up in the 1960s.

Whatever the actual origins of 420, many teens now know April 20th as the day to smoke marijuana. So parents should be especially mindful of monitoring for drug use on this day in particular.

Learn more about the risks of marijuana.

Marijuana: Then and Now

So you tried pot at some point in your life and think you’ll feel like a hypocrite telling your teen not to use? Get over it. It’s important to talk about your experiences to help your children learn from them. Be honest and emphasize that this discussion is about your child’s future and not about your past. Marijuana today is more potent than it was a generation ago and more kids are using it at a younger age, when their bodies and minds are still developing. Talk to your teens. Kids who learn about marijuana and other drugs from their parents are less likely to use them.

Tell your teens how to say no, even if you didn’t.

How can you monitor for marijuana use? Follow these four easy steps:

1. Look online. Talk to your teen about pro-drug messages they might find on sites like Facebook and YouTube. Many teens form groups and recruit members online who are proponents of certain drugs or risky behaviors .

2. Listen for slang and look out for paraphernalia. If you hear terms like 420, bake, Mary, bud, blunt, etc., or see them in text messages, call your teen on it. Likewise if you see makeshift pipes or bongs disguised to look like harmless trinkets, it’s time for a larger discussion about drug use.

3. Ask who, what, where, and when. You should always know the details about your teen’s whereabouts, but pay special attention on April 20 as many teens plan to meet for the “holiday celebration.”

4. Watch and smell for signs of use. Red and bloodshot eyes are a symptom of marijuana use, so be on the lookout for recently opened eye drops. A distinct odor is another sign – even if your teen was just hanging out with other people who were smoking. If you detect smoke, alcohol, etc., on your teen’s breath or clothes, it’s time to talk about the dangers of such risky behaviors

Sources:ParentingTips@TheAntiDrug.com

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Delusion

Definition:
A delusion is commonly defined as a fixed false belief and is used in everyday language to describe a belief that is either false, fanciful or derived from deception. In psychiatry, the definition is necessarily more precise and implies that the belief is pathological (the result of an illness or illness process). As a pathology it is distinct from a belief based on false or incomplete information or certain effects of perception which would more properly be termed an apperception or illusion.

Delusions typically occur in the context of neurological or mental illness, although they are not tied to any particular disease and have been found to occur in the context of many pathological states (both physical and mental). However, they are of particular diagnostic importance in psychotic disorders and particularly in schizophrenia and bipolar disorder.

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Psychiatric definition
Although non-specific concepts of madness have been around for several thousand years, the psychiatrist and philosopher Karl Jaspers was the first to define the three main criteria for a belief to be considered delusional in his book General Psychopathology. These criteria are:

*certainty (held with absolute conviction)

*incorrigibility (not changeable by compelling counterargument or proof to the contrary)

*impossibility or falsity of content (implausible, bizarre or patently untrue)

These criteria still continue in modern psychiatric diagnosis. In the most recent Diagnostic and Statistical Manual of Mental Disorders, a delusion is defined as:

A false belief based on incorrect inference about external reality that is firmly sustained despite what almost everybody else believes and despite what constitutes incontrovertible and obvious proof or evidence to the contrary. The belief is not one ordinarily accepted by other members of the person’s culture or subculture (e.g., it is not an article of religious faith).

Symptoms:
The criteria that define delusional disorder are furnished in the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision, or DSM-IV-TR, published by the American Psychiatric Association. The criteria for delusional disorder are as follows:

*non-bizarre delusions which have been present for at least one month

*absence of obviously odd or bizarre behavior

*absence of hallucinations, or hallucinations that only occur infrequently in comparison to other psychotic disorders

*no memory loss, medical illness or drug or alcohol-related effects are associated with the development of delusions

Diagnostic issues:
The modern definition and Jaspers’ original criteria have been criticised, as counter-examples can be shown for every defining feature.

Studies on psychiatric patients have shown that delusions can be seen to vary in intensity and conviction over time which suggests that certainty and incorrigibility are not necessary components of a delusional belief.

Delusions do not necessarily have to be false or ‘incorrect inferences about external reality’. Some religious or spiritual beliefs by their nature may not be falsifiable, and hence cannot be described as false or incorrect, no matter whether the person holding these beliefs was diagnosed as delusional or not.

In other situations the delusion may turn out to be true belief. For example, delusional jealousy, where a person believes that their partner is being unfaithful (and may even follow them into the bathroom believing them to be seeing their lover even during the briefest of partings) may result in the faithful partner being driven to infidelity by the constant and unreasonable strain put on them by their delusional spouse. In this case the delusion does not cease to be a delusion because the content later turns out to be true.

In other cases, the delusion may be assumed to be false by a doctor or psychiatrist assessing the belief, because it seems to be unlikely, bizarre or held with excessive conviction. Psychiatrists rarely have the time or resources to check the validity of a person’s claims leading to some true beliefs to be erroneously classified as delusional.This is known as the Martha Mitchell effect, after the wife of the attorney general who alleged that illegal activity was taking place in the White House. At the time her claims were thought to be signs of mental illness, and only after the Watergate scandal broke was she proved right (and hence sane).

Similar factors have led to criticisms of Jaspers’ definition of true delusions as being ultimately ‘un-understandable’. Critics (such as R. D. Laing) have argued that this leads to the diagnosis of delusions being based on the subjective understanding of a particular psychiatrist, who may not have access to all the information which might make a belief otherwise interpretable.

Another difficulty with the diagnosis of delusions is that almost all of these features can be found in “normal” beliefs. Many religious beliefs hold exactly the same features, yet are not universally considered delusional. Similarly, Thomas Kuhn argued in The Structure of Scientific Revolutions that scientists can hold strong beliefs in scientific theories despite considerable apparent discrepancies with experimental evidence.

These factors have led the psychiatrist Anthony David to note that “there is no acceptable (rather than accepted) definition of a delusion.” In practice psychiatrists tend to diagnose a belief as delusional if it is either patently bizarre, causing significant distress, or excessively pre-occupies the patient, especially if the person is subsequently unswayed in belief by counter-evidence or reasonable arguments.

Click for Delusions - Description, Types

Diagnosis:

Client interviews focused on obtaining information about the sufferer’s life situation and past history aid in identification of delusional disorder. With the client’s permission, the clinician obtains details from earlier medical records, and engages in thorough discussion with the client’s immediate family—helpful measures in determining whether delusions are present. The clinician may use a semi-structured interview called a mental status examination to assess the patient’s concentration, memory, understanding the individual’s situation and logical thinking. The mental status examination is intended to reveal peculiar thought processes in the patient. The Peters Delusion Inventory (PDI) is a psychological test that focuses on identifying and understanding delusional thinking; but its use is more common in research than in clinical practice.

Even using the DSM-IV-TRcriteria listed above, classification of delusional disorder is relatively subjective. The criteria “non-bizarre” and “resistant to change” and “not culturally accepted” are all subject to very individual interpretations. They create variability in how professionals diagnose the illness. The utility of diagnosing the syndrome rather than focusing on successful treatment of delusion in any form of illness is debated in the medical community. Some researchers further contend that delusional disorder, currently classified as a psychotic disorder, is actually a variation of depression and might respond better to antidepressants or therapy more similar to that utilized for depression. Also, the meaning and implications of “culturally accepted” can create problems. The cultural relativity of “delusions,”—most evident where the beliefs shown are typical of the person’s subculture or religion yet would be viewed as strange or delusional by the dominant culture—can force complex choices to be made in diagnosis and treatment. An example could be that of a Haitian immigrant to the United States who believed in voodoo. If that person became aggressive toward neighbors issuing curses or hexes, believing that death is imminent at the hands of those neighbors, a question arises. The belief is typical of the individual’s subculture, so the issue is whether it should be diagnosed or treated. If it were to be treated, whether the remedy should come through Western medicine, or be conducted through voodoo shamanistic treatment is the problem to be solved.

Treatments:
Delusional disorder treatment often involves atypical(also callednovelornewer-generation) antipsychotic medications, which can be effective in some patients. Risperidone(Risperdal), quetiapine(Seroquel), and olanzapine(Zyprexa) are all examples of atypical or novel antipsychotic medications. If agitationoccurs, a number of different antipsychotics can be used to conclude the outbreak of acute agitation. Agitation, a state of frantic activity experienced concurrently with anger or exaggerated fearfulness, increases the risk that the client will endanger self or others. To decrease anxiety and slow behavior in emergency situations where agitation is a factor, an injection of haloperidol(Haldol) is often given usually in combination with other medications (often lorazepam, also known as Ativan). Agitation in delusional disorder is a typical response to severe or harsh confrontation when dealing with the existence of the delusions. It can also be a result of blocking the individual from performing inappropriate actions the client views as urgent in light of the delusional reality. A novel antipsychotic is generally given orally on a daily basis for ongoing treatment meant for long-term effect on the symptoms. Response to antipsychotics in delusional disorder seems to follow the “rule of thirds,” in which about one-third of patients respond somewhat positively, one-third show little change, and one-third worsen or are unable to comply.

Cognitive therapy has shown promise as an emerging treatment for delusions. The cognitive therapist tries to capitalize on any doubt the individual has about the delusions; then attempts to develop a joint effort with the sufferer to generate alternative explanations, assisting the client in checking the evidence. This examination proceeds in favor of the various explanations. Much of the work is done by use of empathy, asking hypothetical questions in a form of therapeutic Socratic dialogue—a process that follows a basic question and answer format, figuring out what is known and unknown before reaching a logical conclusion. Combining pharmacotherapy with cognitive therapy integrates both treating the possible underlying biological problems and decreasing the symptoms with psychotherapy.

Prognosis:
Evidence collected to date indicates about 10% of cases will show some improvement of delusional symptoms though irrational beliefs may remain; 33–50% may show complete remission; and, in 30–40% of cases there will be persistent non-improving symptoms. The prognosis for clients with delusional disorder is largely related to the level of conviction regarding the delusions and the openness the person has for allowing information that contradicts the delusion.

Prevention:
Little work has been done thus far regarding prevention of the disorder. Effective means of prevention have not been identified.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.
Resources:

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

http://www.minddisorders.com/Br-Del/Delusional-disorder.html

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