Tag Archives: Sleep disorder

Jet Lag

Definition:     Jet lag is nothing but circadian rhythm disorder of our body system.It is also known as time zone change syndrome or desynchronosis.It can occur when people travel rapidly from east to west, or west to east on a jet plane. Jet lag symptoms tend to be more severe when the person travels from westward compared to eastward. It is a physiological condition which upsets our body’s circadian rhythms –

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Circadian rhythm is the 24-hour cycle in the biochemical, physiological and behavioral process of our bodies. In layman’s terms, it means biological clock of our body. The word circadian comes from the Latin word circa meaning “about”, and the Latin word diem or dies meaning “day”. Our circadian rhythms are driven by an internal time-keeping system. This biological clock is entrained by external environmental occurrences, such as the light-dark cycle of night and day. Put simply, our circadian rhythm regulates our daily activities, such as sleep, waking, eating and body temperature regulation. Problems readjusting our internal biological clock causes jet lag, as do problems with shift work, and some sleeping disorders.

People with jet lag have their sleep-wake patterns disturbed. They may feel drowsy, tired, irritable, lethargic and slightly disoriented. The more time zones that are crossed rapidly, the more severe jet lag symptoms are likely to occur.

Researchers from the University of Washington revealed that the disruption occurs in two separate but linked groups of neurons in a structure called the suprachiasmatic nucleus, below the hypothalamus at the base of the brain. One group is synchronized with deep sleep that results from physical fatigue and the other controls the dream state of rapid eye movement, or REM, sleep

The condition of jet lag may last several days until one is fully adjusted to the new time zone, and a recovery rate of one day per time zone crossed is a suggested guideline. The issue of jet lag is especially pronounced for airline pilots, crew, and frequent travelers. Airlines have regulations aimed at combating pilot fatigue caused by jet lag.

The common term jet lag is used, because before the arrival of passenger jet aircraft, it was generally uncommon to travel far and fast enough to cause jet lag. Trips in propeller-driven aircraft and trains were slower and of more limited distance than jet flights, and thus did not contribute as widely to the problem.

Symptoms:
Symptoms of jet lag vary and depend on several factors, including how many time zones were travelled, the individual’s age, state of health, whether or not alcohol was consumed during the flight, how much was eaten during the flight, and how much sleep there was during the flight. Jet lag usually requires a change of three time zones or more to occur, though some individuals can be affected by as little as a single time zone or the single-hour shift of daylight saving time. Symptoms and consequences of jet lag can be a significant area of concern for athletes traveling east or west to competitions as performance is often dependent on a combination of physical and mental characteristics that are impacted by jet lag.

Light is the strongest stimulus for re-aligning a person’s sleep-wake schedule and careful control of exposure to and avoidance of bright lights can speed adjustment to a new time zone.
Traveling east causes more problems than traveling west, because the body clock has to be advanced, which is harder than delaying it, and the necessary exposure to light to realign the body clock does not tie in with the day/night cycle at the destination.Traveling east by six to nine time zones causes the biggest problems, as it is desirable to avoid light in the mornings.

General symptoms of jet lag are as follows:
*Headaches
*Head feels heavy
*Lethargy, fatigue
*Insomnia
*Irritability
*Mild depression
*Attention deficit – hard to concentrate on one thing for long
*Loss of appetite
*Slight confusion
*Dizzy unsettled feeling – this may be due to moving from the plane, which wobbles all the time, to firm land.
*Some gastrointestinal disturbances, such as diarrhea or constipation.

*Travel fatigue:
Travel fatigue is general fatigue, disorientation and headache caused by a disruption in routine, time spent in a cramped space with little chance to move around, a low-oxygen environment, and dehydration caused by limited food and dry air. It does not necessarily have the shift in circadian rhythms that cause jet lag. Travel fatigue can occur without crossing time zones, and it often disappears after a single day accompanied by a night of high-quality sleep
Causes:
Jet lag is a chronobiological problem, similar to issues often induced by shift work and the circadian rhythm sleep disorders. When travelling across a number of time zones, the body clock (circadian rhythm) will be out of synchronization with the destination time, as it experiences daylight and darkness contrary to the rhythms to which it has grown accustomed. The body’s natural pattern is upset, as the rhythms that dictate times for eating, sleeping, hormone regulation and body temperature variations no longer correspond to the environment nor to each other in some cases. To the degree that the body cannot immediately realign these rhythms, it is jet lagged.

The speed at which the body adjusts to the new schedule depends on the individual; some people may require several days to adjust to a new time zone, while others experience little disruption. Crossing one or two time zones does not typically cause jet lag.

The condition is not linked to the length of flight, but to the trans-meridian (west–east) distance traveled. A ten-hour flight from Europe to southern Africa does not cause jet lag, as travel is primarily north–south. A five-hour flight from the east to the west coast of the United States may well result in jet lag.

Crossing the International Date Line does not contribute to jet lag, as the guide for calculating jet lag is the number of time zones crossed, and the maximum possible disruption is plus or minus 12 hours. If the time difference between two locations is greater than 12 hours, subtract that number from 24. Note, for example, that the time zone GMT+14 will be at the same time of day as GMT-10, though the former is one day ahead of the latter.

Management & prevention:

Tip 1: Stay in shape

If you are in good physical condition, stay that way. In other words, long before you embark, continue to exercise, eat right, and get plenty of rest. Your physical stamina and conditioning will enable you to cope better after you land. If you are not physically fit, or have a poor diet, begin shaping up and eating right several weeks before your trip.

Tip 2: Get medical advice

If you have a medical condition that requires monitoring (such as diabetes or heart disease), consult your physician well in advance of your departure to plan a coping strategy that includes medication schedules and doctor’s appointments, if necessary, in the destination time zone.

Tip 3: Change your schedule

If your stay in the destination time zone will last more than a few days, begin adjusting your body to the new time zone before you leave. For example, if you are traveling from the U.S. to Europe for a one-month vacation, set your daily routine back an hour or more three to four weeks before departure. Then, set it back another hour the following week and the week after that. Easing into the new schedule gradually in familiar surroundings will save your body the shock of adjusting all at once.

If you are traveling east, try going to sleep earlier and getting up and out into the early morning sun. If traveling west, try to get at least an hour’s worth of sunlight as soon as possible after reaching your destination.

Tip 4: Avoid alcohol

Do not drink alcoholic beverages the day before your flight, during your flight, or the day after your flight. These beverages can cause dehydration, disrupt sleeping schedules, and trigger nausea and general discomfort.

Tip 5: Avoid caffeine

Likewise, do not drink caffeinated beverages before, during, or just after the flight. Caffeine can also cause dehydration and disrupt sleeping schedules. What’s more, caffeine can jangle your nerves and intensify any travel anxiety you may already be feeling.

Tip 6: Drink water

Drink plenty of water, especially during the flight, to counteract the effects of the dry atmosphere inside the plane. Take your own water aboard the airplane if allowed.

Tip 7: Move around on the plane

While seated during your flight, exercise your legs from time to time.Move them up and down and back and forth. Bend your knees. Stand upand sit down. Every hour or two, get up and walk around. Do not take sleeping pills, and do not nap for more than an hour at a time.

These measures have a twofold purpose. First, they reduce your risk of developing a blood clot in the legs. Research shows that long periods of sitting can slow blood movement in and to the legs, thereby increasing the risk of a clot. The seat is partly to blame. It presses against the veins in the leg, restricting blood flow. Inactivity also plays a role. It decelerates the movement of blood through veins. If a clot forms, it sometimes breaks loose and travels to the lungs (known as pulmonary embolism), lodges in an artery, and inhibits blood flow. The victim may experience pain and breathing problems and cough up blood. If the clot is large, the victim could die. Second, remaining active, even in a small way, revitalizes and refreshes your body, wards off stiffness, and promotes mental and physical acuity which can ease the symptoms of jet lag.
Tip 8: Break up your trip

On long flights traveling across eight, 10, or even 12 time zones, break up your trip, if feasible, with a stay in a city about halfway to your destination. For example, if you are traveling from New York to Bombay, India, schedule a stopover of a few days in Dublin or Paris. (At noon in New York, it is 5 p.m. in Dublin, 6 p.m. in Paris, and 10:30 p.m. in Bombay.)

Tip 9: Wear comfortable shoes and clothes

On a long trip, how you feel is more important than how you look. Wear comfortable clothes and shoes. Avoid items that pinch, restrict, or chafe. When selecting your trip outfit, keep in mind the climate in your destination time zone. Dress for your destination.

Tip 10: Check your accommodations

Upon arrival, if you are staying at a hotel, check to see that beds and bathroom facilities are satisfactory and that cooling and heating systems are in good working order. If the room is unsuitable, ask for another.

Tip 11: Adapt to the local schedule

The sooner you adapt to the local schedule, the quicker your body will adjust. Therefore, if you arrive at noon local time (but 6 a.m. your time), eat lunch, not breakfast. During the day, expose your body to sunlight by taking walks or sitting in outdoor cafés. The sunlight will cue your hypothalamus to reduce the production of sleep-inducing melatonin during the day, thereby initiating the process of resetting your internal clock.

When traveling with children, try to get them on the local schedule as well. When traveling east and you will lose time, try to keep the child awake until the local bedtime. If traveling west when you will gain time, wake your child up at the local time.

Tip 12: Use sleeping medications wisely — or not at all

Try to establish sleeping patterns without resorting to pills. However, if you have difficulty sleeping on the first two or three nights, it’s OK to take a mild sedative if your physician has prescribed one. But wean yourself off the sedative as soon as possible. Otherwise, it could become habit-forming.

There are also some homeopathic remedies that may be used. A product called No Jet Lag contains homeopathic remedies leopard’s bane (Arnica montana), daisy (Bellis perennis), wild chamomile (Matricaria chamomilla), ipecac (Cephalelis ipecacuanha), and club moss (Lycopodium).

Valerian root is an herb that can be used as treatment for insomnia. Do not take valerian with alcohol. It is important to consult your physician before taking these or any other homeopathic or herbal remedy.

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/Jet_lag
http://www.medicinenet.com/jet_lag/page4.htm#how_long_does_jet_lag_last

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Cognitive Behavioural Therapy (CBT)

Definition:
Cognitive behavior therapy (CBT) is a type of psychotherapeutic treatment that helps patients understand the thoughts and feelings that influence behaviors. CBT is commonly used to treat a wide range of disorders including phobias, addictions, depression, and anxiety.

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Cognitive behavioral therapy (CBT) is a short-term psychotherapy originally designed to treat depression, but is now used for a number of mental illnesses. It works to solve current problems and change unhelpful thinking and behavior.  The name refers to behavior therapy, cognitive therapy, and therapy based upon a combination of basic behavioral and cognitive principles.  Most therapists working with patients dealing with anxiety and depression use a blend of cognitive and behavioral therapy. This technique acknowledges that there may be behaviors that cannot be controlled through rational thought, but rather emerge based on prior conditioning from the environment and other external and/or internal stimuli. CBT is “problem focused” (undertaken for specific problems) and “action oriented” (therapist tries to assist the client in selecting specific strategies to help address those problems),  or directive in its therapeutic approach.

CBT has been demonstrated to be effective for the treatment of a variety of conditions, including mood, anxiety, personality, eating, substance abuse, tic, and psychotic disorders. Many CBT treatment programs for specific disorders have been evaluated for efficacy; the health-care trend of evidence-based treatment, where specific treatments for symptom-based diagnoses are recommended, has favored CBT over other approaches such as psychodynamic treatments.  However, other researchers have questioned the validity of such claims to superiority over other treatments.

Description:
Mainstream cognitive behavioral therapy assumes that changing maladaptive thinking leads to change in affect and behavior,[8] but recent variants emphasize changes in one’s relationship to maladaptive thinking rather than changes in thinking itself.  Therapists or computer-based programs use CBT techniques to help individuals challenge their patterns and beliefs and replace “errors in thinking such as overgeneralizing, magnifying negatives, minimizing positives and catastrophizing” with “more realistic and effective thoughts, thus decreasing emotional distress and self-defeating behavior.”  These errors in thinking are known as cognitive distortions. Cognitive distortions can be either a pseudo- discrimination belief or an over-generalization of something.  CBT techniques may also be used to help individuals take a more open, mindful, and aware posture toward them so as to diminish their impact. Mainstream CBT helps individuals replace “maladaptive… coping skills, cognitions, emotions and behaviors with more adaptive ones”,  by challenging an individual’s way of thinking and the way that they react to certain habits or behaviors,  but there is still controversy about the degree to which these traditional cognitive elements account for the effects seen with CBT over and above the earlier behavioral elements such as exposure and skills training.

Modern forms of CBT include a number of diverse but related techniques such as exposure therapy, stress inoculation training, cognitive processing therapy, cognitive therapy, relaxation training, dialectical behavior therapy, and acceptance and commitment therapy.  Some practitioners promote a form of mindful cognitive therapy which includes a greater emphasis on self-awareness as part of the therapeutic process.

CBT has six phases:
1.Assessment or psychological assessment;
2.Reconceptualization;
3.Skills acquisition;
4.Skills consolidation and application training;
5.Generalization and maintenance;
6.Post-treatment assessment follow-up.

The reconceptualization phase makes up much of the “cognitive” portion of CBT.   A summary of modern CBT approaches is given by Hofmann.

There are different protocols for delivering cognitive behavioral therapy, with important similarities among them.  Use of the term CBT may refer to different interventions, including “self-instructions (e.g. distraction, imagery, motivational self-talk), relaxation and/or biofeedback, development of adaptive coping strategies (e.g. minimizing negative or self-defeating thoughts), changing maladaptive beliefs about pain, and goal setting”. Treatment is sometimes manualized, with brief, direct, and time-limited treatments for individual psychological disorders that are specific technique-driven. CBT is used in both individual and group settings, and the techniques are often adapted for self-help applications. Some clinicians and researchers are cognitively oriented (e.g. cognitive restructuring), while others are more behaviorally oriented (e.g. in vivo exposure therapy). Interventions such as imaginal exposure therapy combine both approaches.

Types of Cognitive Behavior Therapy:
There are a number of different approaches to CBT that are regularly used by mental health professionals. These types include:
•Rational Emotive Behavior Therapy (REBT)
•Cognitive Therapy
•Multimodal Therapy

Medical uses of CBT:
In adults, CBT has been shown to have effectiveness and a role in the treatment plans for anxiety disorders,  depressioneating disorders chronic low back painpersonality disorderspsychosis,  schizophrenia,  substance use disorders,  in the adjustment, depression, and anxiety associated with fibromyalgia,  and with post-spinal cord injuries.  Evidence has shown CBT is effective in helping treat schizophrenia, and it is now offered in most treatment guidelines.

In children or adolescents, CBT is an effective part of treatment plans for anxiety disorders,  body dysmorphic disorder,  depression and suicidality,  eating disorders and obesity,  obsessive–compulsive disorder,  and posttraumatic stress disorder,  as well as tic disorders, trichotillomania, and other repetitive behavior disorders.

Cochrane reviews have found no evidence that CBT is effective for tinnitus, although there appears to be an effect on management of associated depression and quality of life in this condition.   Other recent Cochrane Reviews found no convincing evidence that CBT training helps foster care providers manage difficult behaviors in the youth under their care,  nor was it helpful in treating men who abuse their intimate partners.

According to a 2004 review by INSERM of three methods, cognitive behavioral therapy was either “proven” or “presumed” to be an effective therapy on several specific mental disorders.  According to the study, CBT was effective at treating schizophrenia, depression, bipolar disorder, panic disorder, post-traumatic stress, anxiety disorders, bulimia, anorexia, personality disorders and alcohol dependency.

Some meta-analyses find CBT more effective than psychodynamic therapy and equal to other therapies in treating anxiety and depression.  However, psychodynamic therapy may provide better long-term outcomes.

Computerized CBT (CCBT) has been proven to be effective by randomized controlled and other trials in treating depression and anxiety disorders, including children,  as well as insomnia.  Some research has found similar effectiveness to an intervention of informational websites and weekly telephone calls.  CCBT was found to be equally effective as face-to-face CBT in adolescent anxiety  and insomnia.

Criticism of CBT sometimes focuses on implementations (such as the UK IAPT) which may result initially in low quality therapy being offered by poorly trained practitioners.  However evidence supports the effectiveness of CBT for anxiety and depression.

Mounting evidence suggests that the addition of hypnotherapy as an adjunct to CBT improves treatment efficacy for a variety of clinical issues.

CBT has been applied in both clinical and non-clinical environments to treat disorders such as personality conditions and behavioral problems.  A systematic review of CBT in depression and anxiety disorders concluded that “CBT delivered in primary care, especially including computer- or Internet-based self-help programs, is potentially more effective than usual care and could be delivered effectively by primary care therapists.”

Emerging evidence suggests a possible role for CBT in the treatment of attention deficit hyperactivity disorder (ADHD);  hypochondriasis;  coping with the impact of multiple sclerosis;  sleep disturbances related to aging; dysmenorrhea;  and bipolar disorder,  but more study is needed and results should be interpreted with caution. CBT has been studied as an aid in the treatment of anxiety associated with stuttering. Initial studies have shown CBT to be effective in reducing social anxiety in adults who stutter,  but not in reducing stuttering frequency.

Martinez-Devesa et al. (2010) found no evidence that CBT is effective for tinnitus, although there appears to be an effect on management of associated depression and quality of life in this condition. Turner et al. (2007) found no convincing evidence that CBT training helps foster care providers manage difficult behaviors in the youth under their care,[39] and Smedslund et al. (2007) found that it was not helpful in treating men who abuse their intimate partners.

In the case of metastatic breast cancer, Edwards et al. (2008) maintained that the current body of evidence is not sufficient to rule out the possibility that psychological interventions may cause harm to women with this advanced neoplasm.

In adults, CBT has been shown to have a role in the treatment plans for anxiety disorders; depression;  eating disorders;  chronic low back pain;  personality disorders;  psychosis; schizophrenia;  substance use disorders;  in the adjustment, depression, and anxiety associated with fibromyalgia;  and with post-spinal cord injuries.  There is some evidence that CBT is superior in the long-term to benzodiazepines and the nonbenzodiazepines in the treatment and management of insomnia.  CBT has been shown to be moderately effective for treating chronic fatigue syndrome.

In children or adolescents, CBT is an effective part of treatment plans for anxiety disorders;  body dysmorphic disorder;  depression and suicidality;  eating disorders and obesity;  obsessive–compulsive disorder;  and posttraumatic stress disorder;  as well as tic disorders, trichotillomania, and other repetitive behavior disorders. CBT-SP, an adaptation of CBT for suicide prevention (SP), was specifically designed for treating youth who are severely depressed and who have recently attempted suicide within the past 90 days, and was found to be effective, feasible, and acceptable. Sparx is a video game to help young persons, using the CBT method to teach them how to resolve their own issues. That’s a new way of therapy, which is quite effective for child and teenager. CBT has also been shown to be effective for posttraumatic stress disorder in very young children (3 to 6 years of age).  Cognitive Behavior Therapy has also been applied to a variety of childhood disorders,  including depressive disorders and various anxiety disorders.

In the United Kingdom, the National Institute for Health and Care Excellence (NICE) recommends CBT in the treatment plans for a number of mental health difficulties, including posttraumatic stress disorder, obsessive–compulsive disorder (OCD), bulimia nervosa, and clinical depression

Use of CBT  in other different ways:
With older adults:
CBT is used to help people of all ages, but the therapy should be adjusted based on the age of the patient with whom the therapist is dealing. Older individuals in particular have certain characteristics that need to be acknowledged and the therapy altered to account for these differences thanks to age.   Some of the challenges to CBT because of age include the following:
The Cohort effect The times that each generation lives through partially shape its thought processes as well as values, so a 70-year-old may react to the therapy very differently from a 30-year-old, because of the different culture in which they were brought up. A tie-in to this effect is that each generation has to interact with one another, and the differing values clashing with one another may make the therapy more difficult.  Established role By the time one reaches old age, the person has a definitive idea of her or his role in life and is invested in that role. This social role can dominate who the person thinks he or she is and may make it difficult to adapt to the changes required in CBT. Mentality toward aging If the older individual sees aging itself as a negative this can exacerbate whatever malady the therapy is trying to help (depression and anxiety for example).  Negative stereotypes and prejudice against the elderly cause depression as the stereotypes become self-relevant.[88]Processing speed decreasesAs we age, we take longer to learn new information, and as a result may take more time to learn and retain the cognitive therapy. Therefore, therapists should slow down the pacing of the therapy and use any tools both written and verbal that will improve the retention of the cognitive behavioral therapy.

Prevention of mental illness:
For anxiety disorders, use of CBT with people at risk has significantly reduced the number of episodes of generalized anxiety disorder and other anxiety symptoms, and also given significant improvements in explanatory style, hopelessness, and dysfunctional attitudes.  In another study, 3% of the group receiving the CBT intervention developed generalized anxiety disorder by 12 months post intervention compared with 14% in the control group.  Subthreshold panic disorder sufferers were found to significantly benefit from use of CBT.  Use of CBT was found to significantly reduce social anxiety prevalence.

For depressive disorders, a stepped-care intervention (watchful waiting, CBT and medication if appropriate) achieved a 50% lower incidence rate in a patient group aged 75 or older.  Another depression study found a neutral effect compared to personal, social, and health education, and usual school provision, and included a comment on potential for increased depression scores from people who have received CBT due to greater self recognition and acknowledgement of existing symptoms of depression and negative thinking styles.[99] A further study also saw a neutral result. A meta-study of the Coping with Depression course, a cognitive behavioural intervention delivered by a psychoeducational method, saw a 38% reduction in risk of major depression.

For schizophrenia, one study of preventative CBT showed a positive effect   and another showed neutral effect.

Criticisms of Cognitive Behavior Therapy:
The research conducted for CBT has been a topic of sustained controversy. While some researchers write that CBT is more effective than other treatments,[148] many other researchers  and practitioners  have questioned the validity of such claims. For example, one study  determined CBT to be superior to other treatments in treating anxiety and depression. However, researchers responding directly to that study conducted a re-analysis and found no evidence of CBT being superior to other bona fide treatments, and conducted an analysis of thirteen other CBT clinical trials and determined that they failed to provide evidence of CBT superiority.

Furthermore, other researchers  write that CBT studies have high drop-out rates compared to other treatments. At times, the CBT drop-out rates can be more than five times higher than other treatments groups. For example, the researchers provided statistics of 28 participants in a group receiving CBT therapy dropping out, compared to 5 participants in a group receiving problem-solving therapy dropping out, or 11 participants in a group receiving psychodynamic therapy dropping out.

Other researchers  conducting an analysis of treatments for youth who self-injure found similar drop-out rates in CBT and DBT groups. In this study, the researchers analyzed several clinical trials that measured the efficacy of CBT administered to youth who self-injure. The researchers concluded that none of them were found to be efficacious. These conclusions  were made using the APA Division 12 Task Force on the Promotion and Dissemination of Psychological Procedures to determine intervention potency.

However, the research methods employed in CBT research have not been the only criticisms identified. Others have called CBT theory and therapy into question. For example, Fancher  writes the CBT has failed to provide a framework for clear and correct thinking. He states that it is strange for CBT theorists to develop a framework for determining distorted thinking without ever developing a framework for “cognitive clarity” or what would count as “healthy, normal thinking.” Additionally, he writes that irrational thinking cannot be a source of mental and emotional distress when there is no evidence of rational thinking causing psychological well-being. Or, that social psychology has proven the normal cognitive processes of the average person to be irrational, even those who are psychologically well. Fancher also says that the theory of CBT is inconsistent with basic principles and research of rationality, and even ignores many rules of logic. He argues that CBT makes something of thinking that is far less exciting and true than thinking probably is. Among his other arguments are the maintaining of the status quo promoted in CBT, the self-deception encouraged within clients and patients engaged in CBT, how poorly the research is conducted, and some of its basic tenets and norms: “The basic norm of cognitive therapy is this: except for how the patient thinks, everything is ok”.

Meanwhile, Slife and Williams  write that one of the hidden assumptions in CBT is that of determinism, or the absence of free will. They argue that CBT invokes a type of cause-and-effect relationship with cognition. They state that CBT holds that external stimuli from the environment enter the mind, causing different thoughts that cause emotional states. Nowhere in CBT theory is agency, or free will, accounted for. At its most basic foundational assumptions, CBT holds that human beings have no free will and are just determined by the cognitive processes invoked by external stimuli.

Another criticism of CBT theory, especially as applied to Major Depressive Disorder (MDD), is that it confounds the symptoms of the disorder with its causes.

A major criticism has been that clinical studies of CBT efficacy (or any psychotherapy) are not double-blind (i.e., neither subjects nor therapists in psychotherapy studies are blind to the type of treatment). They may be single-blinded, i.e. the rater may not know the treatment the patient received, but neither the patients nor the therapists are blinded to the type of therapy given (two out of three of the persons involved in the trial, i.e., all of the persons involved in the treatment, are unblinded). The patient is an active participant in correcting negative distorted thoughts, thus quite aware of the treatment group they are in.

The importance of double-blinding was shown in a meta-analysis that examined the effectiveness of CBT when placebo control and blindedness were factored in.[156] Pooled data from published trials of CBT in schizophrenia, MDD, and bipolar disorder that used controls for non-specific effects of intervention were analyzed. This study concluded that CBT is no better than non-specific control interventions in the treatment of schizophrenia and does not reduce relapse rates, treatment effects are small in treatment studies of MDD, and it is not an effective treatment strategy for prevention of relapse in bipolar disorder. For MDD, the authors note that the pooled effect size was very low. Nevertheless, the methodological processes used to select the studies in the previously mentioned meta-analysis and the worth of its findings have been called into question.

Resources:
http://en.wikipedia.org/wiki/Cognitive_behavioral_therapy
http://psychology.about.com/od/psychotherapy/a/cbt.htm

Pilonidal sinus

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Alternative Names:pilonidal cyst, pilonidal abscess or sacrococcygeal fistula

Definition:
A pilonidal sinus is a dimple in the skin in the crease of your child’s buttocks.

This may be noted at birth as a depression or hairy dimple and be present for many years without any symptoms.
Pilonidal sinus affect men more often and most commonly occur in young adults.


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Two pilonidal cysts in the natal cleft
A pilonidal sinus may also occur due to a blockage in the hair follicles, often associated with an ingrown hair.
In both situations, hair acts as a foreign body, which may produce an infection. The infection may spread into the tissues of your child’s buttocks and produce an abscess (collection of pus under the skin) at a site several inches away from the sinus.

Pilonidal means “nest of hair”, and is derived from the Latin words for hair (“pilus”) and nest (“nidus”).The term was used by Herbert Mayo as early as 1830. R.M. Hodges was the first to use the phrase “pilonidal cyst” to describe the condition in 1880.

Symptoms:
A pilonidal sinus may cause no noticeable symptoms (asymptomatic). The only sign of its presence may be a small pit on the surface of the skin.

When it’s infected, a pilonidal sinus becomes a swollen mass (abscess). Signs and symptoms of an infected pilonidal cyst include:

*Pain
*Localized swelling
*Reddening of the skin
*Drainage of pus or blood from an opening in the skin (pilonidal sinus)
*Foul smell from draining pus

Hair protruding from a passage (tract) below the surface of the skin that connects the infected pilonidal cyst to the opening on the skin’s surface (a pilonidal sinus) — more than one sinus tract may form
Fever (uncommon)

Causes:
Quite why it happens isn’t entirely clear. When they occur in the cleft between the buttocks, one popular explanation is that there’s a developmental defect in the direction that the hair grows – that is, the hair grows inwards rather than outwards.

One proposed cause of pilonidal cysts is ingrown hair. Excessive sitting is thought to predispose people to the condition because they increase pressure on the coccyx region. Trauma is not believed to cause a pilonidal cyst; however, such an event may result in inflammation of an existing cyst. However there are cases where this can occur months after a localized injury to the area. Some researchers have proposed that pilonidal cysts may be the result of a congenital pilonidal dimple. Excessive sweating can also contribute to the cause of a pilonidal cyst.

The condition was widespread in the United States Army during World War II. More than eighty thousand soldiers having the condition required hospitalization.  It was termed “jeep seat or “Jeep riders’ disease”, because a large portion of people who were being hospitalized for it rode in jeeps, and prolonged rides in the bumpy vehicles were believed to have caused the condition due to irritation and pressure on the coccyx.

Risk Factors:
Certain factors can make you more susceptible to developing pilonidal cysts. These include:

*Obesity
*Inactive lifestyle
*Occupation or sports requiring prolonged sitting
*Excess body hair
*Stiff or coarse hair
*Poor hygiene
*Excess sweating

Complications:
If a chronically infected pilonidal cyst isn’t treated properly, there may be an increased risk of developing a type of skin cancer called squamous cell carcinoma.

Differential diagnosis
A pilonidal sinus can resemble a dermoid cyst, a kind of teratoma (germ cell tumor). In particular, a pilonidal cyst in the gluteal cleft can resemble a sacrococcygeal teratoma. Correct diagnosis is important because all teratomas require complete surgical excision, if possible without any spillage, and consultation with an oncologist.

Treatment :
Treatment may include antibiotic therapy, hot compresses and application of depilatory creams.

In more severe cases, the cyst may need to be lanced or surgically excised (along with pilonidal sinus tracts). Post-surgical wound packing may be necessary, and packing typically must be replaced twice daily for 4 to 8 weeks. In some cases, one year may be required for complete granulation to occur. Sometimes the cyst is resolved via surgical marsupialization.

Surgeons can also excise the sinus and repair with a reconstructive flap technique, which is done under general anesthetic. This approach is mainly used for complicated or recurring pilonidal disease, leaves little scar tissue and flattens the region between the buttocks, reducing the risk of recurrence.

Picture of Pilonidal cyst two days after surgery.

A novel and less destructive treatment is scraping the tract out and filling it with fibrin glue. This has the advantage of causing much less pain than traditional surgical treatments and allowing return to normal activities after 1–2 days in most cases.

Pilonidal cysts recur and do so more frequently if the surgical wound is sutured in the midline, as opposed to away from the midline, which obliterates the natal cleft and removes the focus of shearing stress.

Prevention:
To prevent future pilonidal sinus from developing:

*Clean the area daily with glycerin soap, which tends to be less irritating. Rinse the area thoroughly to remove any soapy residue. Washing briskly with a washcloth helps keep the area free of hair accumulation.

*Keep the area clean and dry. Powders may help, but avoid using oils or herbal remedies.
Avoid sitting for long periods of time.

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/Pilonidal_sinus
http://www.mayoclinic.com/health/pilonidal-cyst/DS00747
http://www.bbc.co.uk/health/physical_health/conditions/pilonidalsinus.shtml
http://www.childrenshospital.org/az/Site923/mainpageS923P0.html

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Restless Legs Syndrome(RLS)

Alternative Name : Wittmaack–Ekbom syndrome

Definitipon:
Restless legs syndrome (RLS)  is a neurological disorder characterized by an irresistible urge to move one’s body to stop uncomfortable or odd sensations.  It most commonly affects the legs, but can affect the arms, torso, and even phantom limbs.  Moving the affected body part modulates the sensations, providing temporary relief.
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RLS sensations can most closely be compared to an itching or tickling in the muscles, like “an itch you can’t scratch” or an unpleasant “tickle that won’t stop.” The sensations typically begin or intensify during quiet wakefulness, such as when relaxing, reading, studying, or trying to sleep.  In addition, most individuals with RLS have limb jerking during sleep, which is an objective physiologic marker of the disorder and is associated with sleep disruption. Some controversy surrounds the marketing of drug treatments for RLS. It is a “spectrum” disease with some people experiencing only a minor annoyance and others experiencing major disruption of sleep and significant impairments in quality of life

Restless legs syndrome can begin at any age and generally worsens as you get older. Women are more likely than men to develop this condition.

A number of simple self-care steps and lifestyle changes may help you. Medications also help many people with restless legs syndrome.

Symptoms:
Commonly described sensations
People typically describe restless legs syndrome (RLS) symptoms as unpleasant sensations in their calves, thighs, feet or arms, often expressed as:

*Crawling

*Tingling

*Cramping

*Creeping

*Pulling

*Painful

*Electric

*Tense

*Uncomfortable

*Itchy

*Tugging

*Gnawing

*Aching

*Burning

Sometimes the sensations seem to defy description. Affected people usually don’t describe the condition as a muscle cramp or numbness. They do, however, consistently describe the desire to move or handle their legs.

It’s common for symptoms to fluctuate in severity, and occasionally symptoms disappear for periods of time.

NIH criteria
In 2003, a National Institutes of Health (NIH) panel modified their criteria to include the following:

1.An urge to move the limbs with or without sensations.

2.Improvement with activity. Many patients find relief when moving and the relief continues while they are moving. In more severe RLS this relief of symptoms may not be complete or the symptoms may reappear when the movement ceases.

3.Worsening at rest. Patients may describe being the most affected when sitting for a long period of time, such as when traveling in a car or airplane, attending a meeting, or watching a performance. An increased level of mental awareness may help reduce these symptoms.

4.Worsening in the evening or night. Patients with mild or moderate RLS show a clear circadian rhythm to their symptoms, with an increase in sensory symptoms and restlessness in the evening and into the night.
RLS is either primary or secondary.

*Primary RLS is considered idiopathic or with no known cause. Primary RLS usually begins slowly, before approximately 40–45 years of age and may disappear for months or even years. It is often progressive and gets worse with age. RLS in children is often misdiagnosed as growing pains.

*Secondary RLS often has a sudden onset after age 40, and may be daily from the beginning. It is most associated with specific medical conditions or the use of certain drugs

Causes:
Disease mechanism
Most research on the disease mechanism of restless legs syndrome has focused on the dopamine and iron system.   These hypotheses are based on the observation that iron and levodopa, a pro-drug of dopamine that can cross the blood-brain barrier and is metabolized in the brain into dopamine (as well as other mono-amine neurotransmitters of the catecholamine class) can be used to treat RLS, levodopa being a medicine for treating hypodopaminergic (low dopamine) conditions such as Parkinson’s disease, and also on findings from functional brain imaging (such as positron emission tomography and functional magnetic resonance imaging), autopsy series and animal experiments.  Differences in dopamine- and iron-related markers have also been demonstrated in the cerebrospinal fluid of individuals with RLS.  A connection between these two systems is demonstrated by the finding of low iron levels in the substantia nigra of RLS patients, although other areas may also be involved.

 

Heredity
RLS runs in families in up to half the people with RLS, especially if the condition started at an early age. Researchers have identified sites on the chromosomes where genes for RLS may be present.

Pregnancy
Pregnancy or hormonal changes may temporarily worsen RLS signs and symptoms. Some women experience RLS for the first time during pregnancy, especially during their last trimester. However, for most of these women, signs and symptoms usually disappear quickly after delivery.

Related conditions
For the most part, restless legs syndrome isn’t related to a serious underlying medical problem. However, RLS sometimes accompanies other conditions, such as:

*Peripheral neuropathy. This damage to the nerves in your hands and feet is sometimes due to chronic diseases such as diabetes and alcoholism.

*Iron deficiency. Even without anemia, iron deficiency can cause or worsen RLS. If you have a history of bleeding from your stomach or bowels, experience heavy menstrual periods or repeatedly donate blood, you may have iron deficiency.

* Kidney failure. If you have kidney failure, you may also have iron deficiency, often with anemia. When kidneys fail to function properly, iron stores in your blood can decrease. This, along with other changes in body chemistry, may cause or worsen RLS.

Risk Factors:
RLS can develop at any age, even during childhood. Many adults who have RLS can recall being told as a child that they had growing pains or can remember parents rubbing their legs to help them fall asleep. The disorder is more common with increasing age.

Complications:
Although RLS doesn’t lead to other serious conditions, symptoms can range from barely bothersome to incapacitating. Many people with RLS find it difficult to get to sleep or stay asleep. Insomnia may lead to excessive daytime drowsiness, but RLS may prevent you from enjoying a daytime nap.

Diagnosis:
The diagnosis of RLS relies essentially on a good medical history and physical examination. Sleep registration in a laboratory (polysomnography) is not necessary for the diagnosis. Peripheral neuropathy, radiculopathy and leg cramps should be considered in the differential diagnosis; in these conditions, pain is often more pronounced than the urge to move. Akathisia, a side effect of several antipsychotics or antidepressants, is a more constant form of leg restlessness without discomfort. Doppler ultrasound evaluation of the vascular system is essential in all cases to rule out venous disorders which is a common etiology of RLS. A rare syndrome of painful legs and moving toes has been described, with no known cause.

 

Treatment:
Treatment of restless legs syndrome involves identifying the cause of symptoms when possible. The treatment process is designed to reduce symptoms, including decreasing the number of nights with RLS symptoms, the severity of RLS symptoms and nighttime awakenings. Improving the quality of life is another goal in treatment. This means improving overall quality of life, decreasing daytime somnolence, and improving the quality of sleep. All of these goals are taken care of through nonpharmacologic and pharmacologic therapies. Pharmacotherapy involves dopamine agonists as first line drugs for daily restless legs syndrome; gabapentin (Horizant™) and opioids for treatment of resistant cases.

An algorithm created by Mayo Clinic researchers and endorsed by the RLS Foundation, provides guidance to the treating physician and patient, including non pharmacological and pharmacological treatments. Treatment of primary RLS should not be considered until possible precipitating medical conditions are ruled out, especially venous disorders. RLS Drug therapy is not curative and has side effects such as nausea, dizziness, hallucinations, orthostatic hypotension and daytime sleep attacks. In addition, it can be expensive (about $100–150 per month for life), and needs to be considered with caution.

Secondary RLS may be cured if precipitating medical conditions (anemia, venous disorder) are managed effectively. Secondary conditions causing RLS include iron deficiency, varicose veins, and thyroid problems. Karl-Axel Ekbom in his 1945 doctoral thesis on RLS suspected venous disease in about 12.5% of cases. But due to the unavailability of Doppler ultrasound imaging technology (the diagnostic tool detecting abnormal blood flow in the veins, “Venous Reflux”, the pathological basis for varicose veins) at that time, Ekbom may have underestimated the role of venous disease. In uncontrolled prospective series, improvement of RLS was achieved in a high percentage of patients presenting with a combination of RLS and venous disease and had sclerotherapy or other treatment for the correction of venous insufficiency.   In Nonpharmacologic treatments there are ways patients may be able to reduce the symptoms or decrease the severity of the symptoms. One thing that may worsen the symptoms is fatigue. Therefore using relaxation techniques, soaking in a warm bath or massaging the legs can all help aid in relaxation and relief of symptoms. Another technique is avoiding caffeine, alcohol, and tobacco. Also exercising every day and maintaining a schedule of relaxation and avoiding heavy meals before bed will all help with relief of symptoms. These techniques can be used with medication or just by themselves for those who do not want medication. For symptoms that occur in the evening patients may find that activities that alert the mind like crossword puzzles, and video games may reduce symptoms. Many patients may also benefit from RLS support groups.

Stretching and shaking legs
Stretching the leg muscles can bring relief lasting from seconds to days.   Walking around brings relief also. Tiredness can be a factor and some sufferers may find going to bed usually stops the discomfort. Bouncing or shaking the legs/feet in an up and down motion, with the ball of the foot on the floor when sitting down may bring temporary relief.

Iron supplements
According to some guidelines, all people with RLS should have their serum ferritin level tested. The ferritin level, a measure of the body’s iron stores, should be at least 50 µg for those with RLS. Oral iron supplements, taken under a doctor’s care, can increase ferritin levels. For some people, increasing ferritin will eliminate or reduce RLS symptoms. A ferritin level of 50 µg is not sufficient for some sufferers and increasing the level to 80 µg may further reduce symptoms. However, at least 40% of people will not notice any improvement. Treatment with IV iron is being tested at the US Mayo Clinic and Johns Hopkins Hospital. It is dangerous to take iron supplements without first having ferritin levels tested, as many people with RLS do not have low ferritin and taking iron when it is not called for can cause iron overload disorder, potentially a very dangerous condition

Medication therapy:
Several prescription medications, most of which were developed to treat other diseases, are available to reduce the restlessness in your legs. These include:

*Medications for Parkinson’s disease. These medications reduce the amount of motion in your legs by affecting the level of the chemical messenger dopamine in your brain. Two drugs, ropinirole (Requip) and pramipexole (Mirapex), are approved by the Food and Drug Administration for the treatment of moderate to severe RLS.

Doctors commonly also use other Parkinson’s drugs to treat restless legs syndrome, such as a combination of carbidopa and levodopa (Sinemet). People with RLS are at no greater risk of developing Parkinson’s disease than are those without RLS. Side effects of Parkinson’s medications are usually mild and include nausea, lightheadedness and fatigue.

*Opioids. Narcotic medications can relieve mild to severe symptoms, but they may be addicting if used in too high doses. Some examples include codeine, oxycodone (Roxicodone), the combination medicine oxycodone and acetaminophen (Percocet, Roxicet), and the combination medicine hydrocodone and acetaminophen (Lortab, Vicodin).

*Muscle relaxants and sleep medications. This class of medications, known as benzodiazepines, helps you sleep better at night. But these medications don’t eliminate the leg sensations, and they may cause daytime drowsiness. Commonly used sedatives for RLS include clonazepam (Klonopin), triazolam (Halcion), eszopiclone (Lunesta), ramelteon (Rozerem), temazepam (Restoril), zaleplon (Sonata) and zolpidem (Ambien).

*Medications for epilepsy. Certain epilepsy medications, such as gabapentin (Neurontin), may work for some people with RLS.It may take several trials for you and your doctor to find the right medication and dosage for you. A combination of medications may work best.

Caution about medications:
One thing to remember with drugs to treat RLS is that sometimes a medication that has worked for you for a while becomes ineffective. Or you notice your symptoms returning earlier in the day. For example, if you have been taking your medication at 8 p.m., your symptoms of RLS may start at 6 p.m. This is called augmentation. Your doctor may substitute another medication to combat the problem.

Most of the drugs prescribed to treat RLS aren’t recommended for pregnant women. Instead, your doctor may recommend self-care techniques to relieve symptoms. However, if the sensations are particularly bothersome during your last trimester, your doctor may approve the use of pain relievers.

Some medications may worsen symptoms of RLS. These include most antidepressants and some anti-nausea drugs. Your doctor may recommend that you avoid these medications if possible. However, should you need to take these medications, restless legs can still be controlled by adding drugs that manage the condition.

 

Lifestyle and home remedies

Making simple lifestyle changes can play an important role in alleviating symptoms of RLS. These steps may help reduce the extra activity in your legs:

*Take pain relievers. For very mild symptoms, taking an over-the-counter pain reliever such as ibuprofen (Advil, Motrin, others) when symptoms begin may relieve the twitching and the sensations.

*Try baths and massages. Soaking in a warm bath and massaging your legs can relax your muscles.

*Apply warm or cool packs. You may find that the use of heat or cold, or alternating use of the two, lessens the sensations in your limbs.

*Try relaxation techniques, such as meditation or yoga. Stress can aggravate RLS. Learn to relax, especially before going to bed at night.Establish good sleep hygiene. Fatigue tends to worsen symptoms of RLS, so it’s important that you practice good sleep hygiene. Ideally, sleep hygiene involves having a cool, quiet and comfortable sleeping environment, going to bed at the same time, rising at the same time, and getting enough sleep to feel well rested. Some people with RLS find that going to bed later and rising later in the day helps in getting enough sleep.

*Exercise. Getting moderate, regular exercise may relieve symptoms of RLS, but overdoing it at the gym or working out too late in the day may intensify symptoms.

*Avoid caffeine. Sometimes cutting back on caffeine may help restless legs. It’s worth trying to avoid caffeine-containing products, including chocolate and caffeinated beverages such as coffee, tea and soft drinks, for a few weeks to see if this helps.

*Cut back on alcohol and tobacco. These substances also may aggravate or trigger symptoms of RLS. Test to see whether avoiding them helps.

*Stay mentally alert in the evening. Boredom and drowsiness before bedtime may worsen RLS. Mentally stimulating activities such as video games or crossword puzzles can help you stay alert and may reduce symptoms of RLS.

Alternative Medication:
Because restless legs syndrome is sometimes due to an underlying nutritional deficiency, taking supplements to correct the deficiency may improve your symptoms. Your doctor can order blood tests to pinpoint nutritional deficiencies and give you a good sense of which supplements may help.

Doctor may also tell you whether certain dietary supplements can interfere with the way your prescription medications work or may pose health risks for you.

If blood tests show that you are deficient in any of the following nutrients, your doctor may recommend taking dietary supplements as part of your treatment plan:

*Iron
*Folic acid
*Vitamin B
*Magnesium

More research is needed to reliably establish the safety and effectiveness of all of these supplements in the treatment of RLS.

 

Prognosis:
RLS is generally a lifelong condition for which there is no cure. Symptoms may gradually worsen with age, though more slowly for those with the idiopathic form of RLS than for patients who also suffer from an associated medical condition. Nevertheless, current therapies can control the disorder, minimizing symptoms and increasing periods of restful sleep. In addition, some patients have remissions, periods in which symptoms decrease or disappear for days, weeks, or months, although symptoms usually eventually reappear. Being diagnosed with RLS does not indicate or foreshadow another neurological disease.

Prevention:
Other than preventing the  causes, no method of preventing RLS has yet been established or studied.

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://www.mayoclinic.com/health/restless-legs-syndrome/DS00191
http://en.wikipedia.org/wiki/Restless_legs_syndrome
http://www.sleepdisordersguide.com/restless-leg-syndrome-causes.html

Restless Legs Syndrome

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Will Sleeping on Your Side Reduce Snoring?

Snorers are often told to sleep on their sides rather than on their backs. This is because if you are lying on your side, the base of your tongue will not collapse into the back of your throat, obstructing breathing.
…...CLICK & SEE
However, for some snorers, changing sleep position may not make a difference. There are two types of snorers — those who snore when sleeping on their backs, and those who snore in every position.

According to the New York Times:
“… [W]eight plays a major role. In one large study, published in 1997, patients who snored or had breathing abnormalities only while sleeping on their backs were typically thinner, while their nonpositional counterparts usually were heavier … But that study also found that patients who were overweight saw reductions in the severity of their apnea when they lost weight.”

THE BOTTOM LINE :Sleeping on your side can help reduce snoring, though in people who are overweight, it may not make much difference without weight loss.

Resources:
*New York Times April 18, 2011
*Harefuah May 2009; 148(5):304-9, 351, 350
*Chest September 1997; 112(3):629-39

*http://healthmad.com/health/best-ways-that-will-help-you-stop-snoring-3-very-effective-ways/

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