Imagine a pill you could take that instantly calms your temper when it’s about to burst into a Herculean mess. That’s what researchers might be on the brink of formulating after experiments helped them to identify the brain’s anger centre. Scientists at New York University found that chemical changes in the brain’s lateral septum made the mice attack other animals. It’s a discovery that could lead to a calming drug.
Meanwhile, we remain a nation of quiet seethers. Research by PruHealth found that nearly half of us admit to snapping at colleagues, 28 per cent to shouting at people at work and one in four to slamming down phones and banging fists on desks. On social media, it takes far less than a Katie Hopkins soundbite to enrage the digital British public into attack mode. But until the anger pill is a reality, our only option is self-management…
Why are we all so angry?
The more stress someone is under, the more likely they are to have an anger problem. Because we are working harder than ever, more chronically stressed people are presenting to their GPs and mental health clinics with anger issues.
Add to this, disinhibition — there is a greater level of acceptance of anger,swearing and even violent behaviour than there was 50 years ago — and the increased speed of our reactions, thanks to social media and email (as opposed to writing letters) and the root of our anger problem is clear.
Anger manifests itself in different ways. One person might turn their anger against themselves, which can manifest as depression, addiction or self-harm. Another might explode. But anger has a necessary function: to protect, by alerting us to threat and giving us the courage to meet challenges.
That “threat system” is part of our evolution and changes your body from a calm state into one that is ready to attack or run away. A shot of the stress hormone adrenaline is released, which leads to tense muscles, increased blood circulation, short breathing and alertness.
People who are under chronic stress exist in a constant state of attack mode,which can have a detrimental effect on their health. It is like driving in second gear on the motorway — you’re using the car’s resources to tackle a problem that isn’t there, which means that your car is likely to be damaged, burn out or even explode. The other problem is that the buzz from adrenaline can be addictive. Likewise, when a person gets what they want as a result of showing their anger, they can get caught in an anger trap, where outbursts seem like the only way to express their needs. So controlling excess anger is essential.
Look out for warning signs:….CLICK & SEE
Notice when your body is moving into threat mode — this might be during a conversation, while driving or when commuting — and pay attention to your early-warning signs of anger. Everyone’s signs will be different but they might include a tenseness across the shoulders or an uncomfortable feeling in the stomach. Ask yourself: What’s the matter? Then do something about it. This might be having a constructive conversation or using a simple breathing technique. For example, making your out breath longer than your in breath can be instantly relaxing. Paying attention to the physical reality around you and taking in the bigger picture, rather than the thoughts in your head, can also help. This allows you to instantly distance yourself from your own threat system and get the mental space to ask yourself whether you need to take some time out (see below).
Escape wind-up thinking:
The language we use in our thoughts and conversations can alert the body to a threat, priming it to react with anger. Characteristic wind-up thoughts include “shoulds”, “musts” or “oughts” as well as phrases beginning with “You never”, “You always” or “It’s not fair”. These are definite, accusatory and inflexible, and can keep you fixed in threat mode where you’re more likely to blow up. It can be hard to change your thought patterns. Instead, recognise wind-up thinking and acknowledge that it’s not in your best interest to continue it.
Object without losing it:
Angry people often try to project an attitude of “I’m cool, nothing gets to me”. As a result, they may allow resentments to build up until they eventually explode. Learning to communicate assertively is essential. The key is to state what you want firmly and calmly with words such as: “Excuse me, I can’t let this go.” It’s also important to put yourself in the other person’s shoes — this is something people with anger issues often have a hard time with, as they tend to be wound up in their own position.
It can be difficult to have a constructive conversation if one or both parties have switched into attack mode. Take a couple having an argument. If one of them notices their own, or the other person’s, anger building up with physical signs, such as increased breathing and a raised voice, they might say they need to go out for a walk to clear their head. Often, this is the point where the other partner won’t let them, desperate to get one last point across. But it’s also the point where arguments can escalate to emotional or physical violence.
An expart councelor has worked with couples on negotiating this space and ensuring the other person respects it. Having such an agreement is essential for dealing with anger, especially at home. Don’t continue the discussion if you observe in someone’s behaviour or speech — or your own — that the body has gone into action mode. Take time out. Go for a walk outside, write in a journal or call a friend — set aside some alone time…...CLICK & SEE
When your body is in threat mode, anything — from being told you might lose your job to someone jumping in front of you in a queue — can feel equally outrageous and worthy of an outburst. By taking a step back with the simple breathing practices mentioned above, you can see the bigger picture and work out whether it really is outrageous and worth fighting for. Ask yourself if it will matter in five minutes. If the answer is no, let it go.
Source: The Telegraph (Kolkata, India)
Best way to get rid from sudden anger is to practice Yoga with Medition & Pranayama.
Definition: Zika virus is a member of the virus family Flaviviridae and the genus Flavivirus, transmitted by daytime-active Aedes mosquitoes, such as A. aegypti and A. albopictus, the same type of mosquito that spreads dengue, chikungunya and yellow fever. The Pan American Health Organization (PAHO) said Aedes mosquitoes are found in all countries in the Americas except Canada and continental Chile, and the virus will likely reach all countries and territories of the region where Aedes mosquitoes are found.
The infection, known as Zika fever, often causes no or only mild symptoms. Since the 1950s it has been known to occur within a narrow equatorial belt from Africa to Asia. In 2014, the virus spread eastward across the Pacific Ocean to French Polynesia, then to Easter Island and in 2015 to Mexico, Central America, the Caribbean, and South America, where the Zika outbreak has reached pandemic levels.
The Zika virus is found in tropical locales with large mosquito populations. Outbreaks of Zika virus disease have been recorded in Africa, the Americas, Southern Asia and the Western Pacific. The virus was first identified in Uganda in 1947 in rhesus monkeys and was first identified in people in 1952 in Uganda and Tanzania, according to the World Health Organization. Transmission:
The vertebrate hosts of the virus were primarily monkeys in a so-called enzootic mosquito-monkey-mosquito cycle, with only occasional transmission to humans. Before the current pandemic began in 2007, Zika virus “rarely caused recognized ‘spillover’ infections in humans, even in highly enzootic areas”. Infrequently, other arboviruses have become established as a human disease though, and spread in a mosquito–human–mosquito cycle, like the yellow fever virus and the dengue fever virus (both flaviruses), and the chikungunya virus (a togavirus)
Can Zika be transmitted through sexual contact?
Two cases of possible person-to-person sexual transmission has been described, but the PAHO said more evidence is needed to confirm whether sexual contact is a means of Zika transmission.
It is unknown whether women can transmit Zika virus to their sexual partners. As of February 2016, the CDC recommends that men “who reside in or have traveled to an area of active Zika virus transmission who have a pregnant partner should abstain from sexual activity or consistently and correctly use condoms during sex (i.e., vaginal intercourse, anal intercourse, or fellatio) for the duration of the pregnancy.” Men who reside in or have traveled to an area of active Zika virus transmission and their non-pregnant sex partners “might consider” abstinence or condom use. The CDC did not specify how long these practices should be followed with non-pregnant partners because the “incidence and duration of shedding in the male genitourinary tract is limited to one case report” and that “testing of men for the purpose of assessing risk for sexual transmission is not recommended.
The PAHO also said Zika can be transmitted through blood, but this is an infrequent transmission mechanism. There is no evidence the virus can be transmitted to babies through breast milk.
CDC issued new recommendations to those who have traveled to Zika-prone areas: Use condoms during sex or don’t have sex. – Click & See Symptoms:
Zika virus is related to dengue, yellow fever, Japanese encephalitis, and West Nile viruses. The illness it causes is similar to a mild form of dengue fever, is treated by rest, and cannot yet be prevented by drugs or vaccines. There is a possible link between Zika fever and microcephaly in newborn babies by mother-to-child transmission, as well as a stronger one with neurologic conditions in infected adults, including cases of Guillain–Barré syndrome.
People who get Zika virus disease typically have a mild fever, skin rash, conjunctivitis, muscle and joint pain and fatigue that can last for two to seven days. But as many as 80 percent of people infected never develop symptoms. The symptoms are similar to those of dengue or chikungunya, which are transmitted by the same type of mosquito.
The PAHO said there is no evidence that Zika can cause death, but some cases have been reported with more serious complications in patients with pre-existing medical conditions.
The virus has been linked to microcephaly, a condition in newborns marked by abnormally small heads and brains that have not developed properly. It also has been associated with Guillain-Barre syndrome, a rare disorder in which the body’s immune system attacks part of the nervous system. Scientists are studying whether there is a causal link between Zika and these two disorders.
There is no defenite treatment developed yet.Patients are adviced to take rest. Doctors sometimes prescribe few nominal medicines to get little relieve from extenal symptoms.
Defense against mosquitoes is defense against Zika. The CDC recommends long clothing and insect repellent. If you develop symptoms, go see a doctor.
Effective vaccines exist for several flaviviruses. Vaccines for yellow fever virus, Japanese encephalitis, and tick-borne encephalitis were introduced in the 1930s, while the vaccine for dengue fever only became available for use in the mid-2010s.
Work has begun towards developing a vaccine for Zika virus, according to Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. The researchers at the Vaccine Research Center have extensive experience from working with vaccines for other viruses such as West Nile virus, chikungunya virus, and dengue fever. Nikos Vasilakis of the Center for Biodefense and Emerging Infectious Diseases predicted that it may take two years to develop a vaccine, but 10 to 12 years may be needed before an effective Zika virus vaccine is approved by regulators for public use.
Indian company Bharat Biotech is working on two approaches to a vaccine: “recombinant”, involving genetic engineering, and “inactivated”, where the virus is incapable of reproducing itself but can still trigger an immune response. On 3 February 2016, the company claimed animal trials of the inactivated version would commence in two weeks.
Since April 2015, a large, ongoing outbreak of Zika virus that began in Brazil has spread to much of South and Central America and the Caribbean. In January 2016, the CDC issued a level 2 travel alert for people traveling to regions and certain countries where Zika virus transmission is ongoing. The agency also suggested that women thinking about becoming pregnant should consult with their physicians before traveling. Governments or health agencies of the United Kingdom, Ireland, New Zealand, Canada, and the European Union soon issued similar travel warnings. In Colombia, Minister of Health and Social Protection Alejandro Gaviria Uribe recommended to avoid pregnancy for eight months, while the countries of Ecuador, El Salvador, and Jamaica have issued similar warnings.
Plans were announced by the authorities in Rio de Janeiro, Brazil, to try to prevent the spread of the Zika virus during the 2016 Summer Olympic Games in that city.
According to the CDC, Brazilian health authorities reported more than 3,500 microcephaly cases between October 2015 and January 2016. Some of the affected infants have had a severe type of microcephaly and some have died. The full spectrum of outcomes that might be associated with infection during pregnancy and the factors that might increase risk to the fetus are not yet fully understood. More studies are planned to learn more about the risks of Zika virus infection during pregnancy. In the worst affected region of Brazil, approximately 1 percent of newborns are suspected of being microcephalic.
Click & see : 2007 Yap Islands Zika virus outbreak 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:
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.
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.
Mainstream cognitive behavioral therapy assumes that changing maladaptive thinking leads to change in affect and behavior, 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;
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)
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, 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.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. 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, 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. 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.
Alternative Names: Nephritis – lupus; Lupus glomerular disease
Lupus nephritis is an inflammation of the kidney caused by systemic lupus erythematosus (SLE), a disease of the immune system. Apart from the kidneys, SLE can also damage the skin, joints, nervous system and virtually any organ or system in the body.
General symptoms of lupus include malar rash, discoid rash, photosensitivity, oral ulcers, nonerosive arthritis, pleuropericarditis, renal disease, neurological manifestations, and haematological disorders.
Clinically, SLE usually presents with fever, weight loss (100%), arthralgias, synovitis, arthritis (95%), pleuritis, pericarditis (80%), malar facial rash, photodermatosis, alopecia (75%), anaemia, leukopaenia, thrombocytopaenia, and thromboses (50%).
About half of cases of SLE demonstrate signs of lupus nephritis at one time or another. Renal-specific signs include proteinuria (100%), nephrotic syndrome (55%), granular casts (30%), red cell casts (10%), microhematuria (80%), macrohematuria (2%), reduced renal function (60%), RPGN (30%), ARF (2%), hypertension (35%), hyperkalemia (15%) and tubular abnormalities (70%).
Stage 1: no evidence of lupus nephritis:
In histology, Stage I (minimal mesangial) disease has a normal appearance under light microscopy, but mesangial deposits are visible under electron microscopy. At this stage urinalysis is typically normal. Stage 2:mildest form, easily treated with corticosteroids:
Stage 2 disease (mesangial proliferative) is noted by mesangial hypercellularity and matrix expansion. Microscopic haematuria with or without proteinuria may be seen. Hypertension, nephrotic syndrome, and acute renal insufficiency are rare at this stage. Stage 3: earliest stage of advanced lupus. Treatment requires high amounts of corticosteroids. The outlook remains favorable.
Stage 3 disease (focal lupus nephritis) is indicated by sclerotic lesions involving less than 50% of the glomeruli, which can be segmental or global, and active or chronic, with endocapillary or extracapillary proliferative lesions. Under electron microscopy, subendothelial deposits are noted, and some mesangial changes may be present. Immunofluorescence reveals the so-called “Full House” stain, staining positively for IgG, IgA, IgM, C3, and C1q. Clinically, haematuria and proteinuria is present, with or without nephrotic syndrome, hypertension, and elevated serum creatinine.
Diffuse proliferative lupus nephritis; photo shows the classic “flea-bitten” appearance of the cortical surface in the diffuse proliferative glomerulonephritides
Stage 4 lupus nephritis (diffuse proliferative) is both the most severe, and the most common subtype. More than 50% of glomeruli are involved. Lesions can be segmental or global, and active or chronic, with endocapillary or extracapillary proliferative lesions. Under electron microscopy, subendothelial deposits are noted, and some mesangial changes may be present. Immunofluorescence reveals the so-called “Full House” stain, staining positively for IgG, IgA, IgM, C3, and C1q. Clinically, haematuria and proteinuria are present, frequently with nephrotic syndrome, hypertension, hypocomplementemia, elevated anti-dsDNA titres and elevated serum creatinine. There is the risk of kidney failure. Patients require high amounts of corticosteroids and immune suppression medications.
A wire-loop lesion may be present in stage III and IV. This is a glomerular capillary loop with subendothelial immune complex deposition that is circumferential around the loop. Stage V is denoted by a uniformly thickened, eosinophilic basement membrane. Stage III and IV are differentiated only by the number of glomeruli involved (which is subject to inherent sample bias), but clinically the presentation and prognosis are both expected to be more severe in stage 4 versus stage 3. Stage 5:
Stage 5 (membranous lupus nephritis) is characterized by diffuse thickening of the glomerular capillary wall (segmentally or globally), with diffuse membrane thickening, and subepithelial deposits seen under electron microscopy. Clinically, stage V presents with signs of nephrotic syndrome. Microscopic haematuria and hypertension may also been seen. Plasma creatinine is usually normal or slightly elevated, and stage V may not present with any other clinical/serological manifestations of SLE (complement levels may be normal; anti-DNA Ab may not be detectable). Stage 5 also predisposes the affected individual to thrombotic complications such as renal vein thromboses or pulmonary emboli.Excessive protein loss and swelling. Doctors will treat with high amounts of corticosteroids. Doctors may or may not give immune-suppressing drugs.
A final stage is usually included by most practitioners, stage VI, or advanced sclerosing lupus nephritis. It is represented by Global sclerosis involving more than 90% of glomeruli, and represents healing of prior inflammatory injury. Active glomerulonephritis is usually not present. This stage is characterised by slowly progressive renal dysfunction, with relatively bland urine sediment. Response to immunotherapy is usually poor.
A tubuloreticular inclusion is also characteristic of lupus nephritis, and can be seen under electron microscopy in all stages. It is not diagnostic however, as it exists in other conditions. It is thought to be due to chronic interferon exposure.
Systemic lupus erythematosus (SLE, or lupus) is an autoimmune disease. This means there is a problem with the body’s immune system.
Normally, the immune system helps protect the body from infection or harmful substances. But in patients with an autoimmune disease, the immune system cannot tell the difference between harmful substances and healthy ones. As a result, the immune system attacks otherwise healthy cells and tissue.
SLE may damage different parts of the kidney, leading to interstitial nephritis, nephrotic syndrome, and membranous GN. It may rapidly worsen to kidney failure.
Lupus nephritis affects approximately 3 out of every 10,000 people. In children with SLE, about half will have some form or degree of kidney involvement.
More than half of patients have not had other symptoms of SLE when they are diagnosed with lupus nephritis.
SLE is most common in women ages 20 – 40. Diagnosis:
The diagnosis of lupus nephritis depends on blood tests, urinalysis, X-rays, ultrasound scans of the kidneys, and a kidney biopsy. On urinalysis, a nephritic picture is found and RBC casts, RBCs and proteinuria is found.
The World Health Organization has divided lupus nephritis into five stages based on the biopsy. This classification was defined in 1982 and revised in 1995.
* Class I is minimal mesangial glomerulonephritis which is histologically normal on light microscopy but with mesangial deposits on electron microscopy. It constitutes about 5% of cases of lupus nephritis. Renal failure is very rare in this form.
*Class II is based on a finding of mesangial proliferative lupus nephritis. This form typically responds completely to treatment with corticosteroids. It constitutes about 20% of cases. Renal failure is rare in this form.
* Class III is focal proliferative nephritis and often successfully responds to treatment with high doses of corticosteroids. It constitutes about 25% of cases. Renal failure is uncommon in this form.
*Class IV is diffuse proliferative nephritis. This form is mainly treated with corticosteroids and immunosuppressant drugs. It constitutes about 40% of cases. Renal failure is common in this form.
* Class V is membranous nephritis and is characterized by extreme edema and protein loss. It constitutes about 10% of cases. Renal failure is uncommon in this form.
Medicines are prescribed that decrease swelling, lower blood pressure, and decrease inflammation by suppressing the immune system: Patients may need to monitor intake of protein, sodium, and potassium. Patients with severe disease should restrict their sodium intake to 2 grams per day and limit fluid as well. Depending on the histology, renal function and degree of proteinuria, patients may require steroid therapy or chemotherapy regimens such as cyclophosphamide, azathioprine, mycophenolate mofetil, or cyclosporine. Possible Complications:
There is no cure for lupus nephritis. The goal of treatment is to keep the problem from getting worse. Stopping kidney damage early can prevent the need for a kidney transplant.
Treatment can also provide relief from lupus symptoms.
Common treatments include:
*minimizing intake of protein and salt
*taking blood pressure medication
*using steroids to reduce swelling and inflammation
*taking immune-suppression medicines like prednisone to reduce immune system damage to the kidneys
Extensive kidney damage may require additional treatment.
Drug regimens prescribed for lupus nephritis include mycophenolate mofetil (MMF), intravenous cyclophosphamide with corticosteroids, and the immune suppressant azathioprine with corticosteroids. MMF and cyclophosphamide with corticosteroids are equally effective in achieving remission of the disease. MMF is safer than cyclophosphamide with corticosteroids, with less chance of causing ovarian failure, immune problems or hair loss. It also works better than azathioprine with corticosteroids for maintenance therapy.
Prognosis: How well you do depends on the specific form of lupus nephritis. You may have flare-ups, and then times when you do not have any symptoms.
Some people with this condition develop chronic kidney failure.
Although lupus nephritis may return in a transplanted kidney, it rarely leads to end-stage kidney disease. Prevention: There is no known prevention for lupus nephritis.
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:
Botanical Name : Sphaeralcea coccinea Family: Malvaceae Subfamily: Malvoideae Genus: Sphaeralcea Species: S. coccinea Kingdom: Plantae Order: Malvales
Synonyms: Malvastrum coccineum
Common Names; Scarlet Globemallow, Alkali Heath, red false globemallow, copper mallow
Habitat : Sphaeralcea coccinea is native to grasslands and prairies of the Great Plains and western regions of northern North America.
Sphaeralcea coccinea is a perennial plant growing 10–30 cm tall from spreading rhizomes with a low habit. They have grayish stems with dense, star-shaped hairs and alternately arranged leaves. The leaf blades are 2–5 cm long, palmately shaped, and deeply cut, with 3–5 main wedge-shaped segments. The undersides of the leaves have gray hairs. The 2-cm-wide flowers are reddish-orange and saucer-shaped, with 5 notched, broad petals, in small terminal clusters. Plants flower from May to October.Fruits are cheese-shaped capsules composed of 10 or more 1-seeded carpels. Each carpel about 3 mm long, densely hairy on the back, net-veined on about 90% of the sides.
This plant’s Navajo name came from the sticky mixture that occurs when the roots and leaves are pounded and soaked in water. The resulting sticky infusion is put on sores to stop bleeding and is used as a lotion for skin disease. The dried powdered plant is used as dusting powder. It is one of the life medicines and is used as a tonic to improve the appetite, and to cure colds, coughs and flu. The roots were used to stop bleeding, and they were also chewed to reduce hunger when food was scarce. The leaves are slimy and mucilaginous when crushed, and they were chewed or mashed and used as poultices or plasters on inflamed skin, sores, wounds and sore or blistered feet. Leaves were also used in lotions to relieve skin diseases, or they were dried, ground and dusted on sores. Fresh leaves and flowers were chewed to relieve hoarse or sore throats and upset stomachs. Whole plants were used to make a sweet-tasting tea that made distasteful medicines more palatable. It was also said to reduce swellings, improve appetite, relieve upset stomachs, and strengthen voices. The Dakota heyoka chewed the plants to a paste and rubbed it on their skin as protection from scalding. The tea is very effective for a raspy, dry, sore throat; and, like its relative Malva, it will soothe the urinary tract when urination is painful. The tea is used for bathing infants to prevent or retard thrush, and to soothe chafing. It is soothing to almost any skin rash in adults and children. Strong decoction, 4-6 fluid ounces up to 4 times a day for internal use, as needed externally.
Disclaimer:The information presented herein is intended for educational purposes only. Individual results may vary, and before using any supplements, it is always advisable to consult with your own health care provider