Nurses Notes

Shared psychotic disorder

2017-02-25T00:25:00.001-08:00

Shared psychotic disorder, a rare and atypical psychotic disorder, occurs when an otherwise healthy person (secondary partner) begins believing the delusions of someone with whom they have a close relationship (primary partner) who is already suffering from a psychotic disorder with prominent delusions. This disorder is also referred to as "folie á deux."

In cases of shared psychotic disorder, the primary partner is most often in a position of strong influence over the other person. This allows them, over time, to erode the defenses of the secondary partner, forcing their strange belief upon them. In the beginning, the secondary partner is probably healthy, but has such a passive or dependent relationship with the primary partner that imposition of the delusional system is but a matter of time. Most of the time, this disorder occurs in a nuclear family. In fact, more than 95% of the cases reported involved people in the same family. Without regard to the number of persons within the family, shared delusions generally involve two people. There is the primary, most often the dominant person, and the secondary or submissive person. This becomes fertile ground for the primary (dominant) partner to press for understanding and belief by others in the family.

Shared psychotic disorder has also been referred to by other names such as psychosis of association, contagious insanity, infectious insanity, double insanity, and communicated insanity. There have been cases involving multiple persons, the most significant being a case involving an entire faamily of 12 people (folie á douze).

Symptoms

The principal feature of shared psychotic disorder is the unwavering belief by the secondary partner in the dominant partner's delusion. The delusions experienced by both primary partners in shared psychotic disorder are far less bizarre than those found in schizophrenic patients; they are, therefore, believable. Since these delusions are often within the realm of possibility, it is easier for the dominant partner to impose his/her idea upon the submissive, secondary partner.

Diagnosis

A clinical interview is required to diagnose shared psychotic disorder. There are basically three symptoms required for the determination of the existence of this disorder:

• An otherwise healthy person, in a close relationship with someone who already has an established delusion, develops a delusion himself/herself.

• The content of the shared delusion follows exactly or closely resembles that of the established delusion.

• Some other psychotic disorder, such as schizophrenia , is not in place and cannot better account for the delusion manifested by the secondary partner.

Treatment

The treatment approach most recommended is to separate the secondary partner from the source of the delusion. If symptoms have not dissipated within one to two weeks, antipsychotic medications may be in order.

Once stabilized, psychotherapy should be undertaken with the secondary partner, with an eye toward integrating the dominant partner, once he/she has also received medical treatment and is stable.

Sleep terror disorder

2017-02-22T02:20:00.001-08:00

Sleep terror disorder is sometimes referred to as pavor nocturnus when it occurs in children, and incubus when it occurs in adults. Sleep terrors are also sometimes called night terrors, though sleep terror is the preferred term, as episodes can occur during daytime naps as well as at night. Sleep terror is a disorder that primarily affects children, although a small number of adults are affected as well.

The symptoms of sleep terror are very similar to the physical symptoms of extreme fear. These include rapid heartbeat, sweating, and rapid breathing (hyperventilation). The heart rate can increase up to two to four times the person's regular rate. Sleep terrors cause people to be jolted into motion, often sitting up suddenly in bed. People sometimes scream or cry. The person's facial expression may be fearful.

People experiencing sleep terror disorder sometimes get out of bed and act as if they are fighting or fleeing something. During this time injuries can occur. Cases have been reported of people falling out of windows or falling down stairs during episodes of sleep terror.

People experiencing sleep terror are not fully awake. They are nearly impossible to bring to consciousness or comfort, and sometimes respond violently to attempts to console or restrain them. In many cases, once the episode is over the person returns to sleep without ever waking fully. People often do not have any recollection of the episode after later awaking normally, although they may recall a sense of fear.

Episodes of sleep terror usually occur during the first third of a person's night sleep, although they can occur even during naps taken in the daytime. The average sleep terror episode lasts less than 15 minutes. Usually only one episode occurs per night, but in some cases terror episodes occur in clusters. It is unusual for a person to have many episodes in a single night, although upwards of 40 have been reported. Most persons with the disorder have only one occurrence per week, or just a few per month.

Sleep terror is diagnosed most often in children when parents express concern to the child's pediatrician. A fact sheet from the American Academy of Child and Adolescent Psychiatry suggests that parents consult a child psychiatrist if the child has several episodes of sleep terror each night, if the episodes occur every night for weeks at a time, or if they interfere with the child's daytime activities. The diagnosis is usually made on the basis of the child's and parents' description of the symptoms. There are no laboratory tests for sleep terror disorder. In adults, the disorder is usually self-reported to the patient's family doctor. Again, the diagnosis is usually based on the patient's description of the symptoms.

Sleep terror is characterized by an abrupt arousal from sleep followed by symptoms of extreme fear. The symptoms often include screams, rapid heartbeat, heavy breathing, and sweating, as well as a subjective feeling of terror. According to the Diagnostic and Statistical Manual of Mental Disorders , fourth edition, text revision ( DSM-IV-TR ), which is the standard reference work used by mental health professionals to diagnose mental disorders, people with sleep terror disorder do not respond to attempts to comfort or awaken them. In order to meet criteria for the diagnosis, the patients must not be able to recall their dreams, and they must not remember the episode itself. In addition, the episodes may not be attributed to a medical condition or drug use.

Sleep terror disorder is frequently confused with nightmare disorder . The two are similar in the sense that both are related to bad dreams. Nightmare disorder, however, involves a significantly smaller amount of physical movement than does sleep terror. Normally, people experiencing nightmare disorder do not get out of bed.

Moreover, people experiencing nightmare disorder often have problems going back to sleep because of the nature of their dream. Most people experiencing sleep terrors, however, go back to deep sleep without ever having fully awakened. People experiencing nightmares can generally remember their dreams and some of the events in the dream leading up to their awakening. People often awake from nightmares just as they are about to experience the most frightening part of a disturbing dream. People experiencing sleep terrors, however, can sometimes recall a sense of profound fear, but often do not remember the episode at all.

If sleep terror episodes are infrequent, then treatment may not be necessary as long as the episodes are not interfering significantly with the person's life. Some people may want to rearrange their bedroom furniture to minimize the possibility of hurting themselves or others if they get out of bed during a sleep terror episode. To keep children from becoming overly worried about their sleep terrors, experts suggest that parents avoid placing unnecessary emphasis on the episodes. Psychotherapy is often helpful for adults concerned about the specific triggers of sleep terror episodes.

Several different medications have been used to treat sleep terror disorder, with varying degrees of success. One of the most common is diazepam (Valium). Diazepam is a hypnotic (sleep-inducing medication), and is thought to be useful in the prevention of sleep terror episodes because it acts as a nervous system depressant. There are many different types of hypnotics, and choosing one for a patient depends on other drugs that the patient may be taking, any medical or psychological conditions, and other health factors. Most studies of medications as treatments for sleep terror disorder have been done on adult patients; there is little information available on the use of medications to treat the disorder in children.

Sleepwalking Disorder

2017-02-21T15:58:00.001-08:00

Sleepwalking episodes usually occur during the first third of the night during the deepest phase of sleep. The episodes can last anywhere from a few minutes up to one hour, with five to 15 minutes being average. Sleepwalkers appear to be awake but are typically unresponsive to individuals who attempt to communicate with them. Persons who sleepwalk typically have no memory or awareness of their actions or movement upon waking.

There appears to be a genetic component for individuals who sleepwalk. The condition is 10 times more likely to occur in close relatives of known sleepwalkers than in the general public. These families also tend to be deep sleepers.

Sleepwalking may also be triggered by fever, which directly affects the nervous system, general illness, alcohol use, sleep deprivation, and emotional stress . Hormonal changes that occur during adolescence, menstruation, and pregnancy can be also be triggers for sleepwalking. Sleepwalking episodes are more likely during times of physiological or psychological stress.

Certain classes of medication have also been shown to precipitate sleepwalking episodes in some individuals. These include: Anti-anxiety or sleep-inducing drugs, antiseizure medications, stimulants, antihistamines, and anti-arrhythmic heart drugs.

Symptoms

The DSM-IV-TR specifies six diagnostic criteria for sleepwalking disorder:
Repeated episodes of rising from bed during sleep: These episodes may include sitting up in bed, looking around, and walking, and usually occur during the first third of the night.
Is unresponsive to attempts at communication: During sleepwalking, the person typically has eyes open, dilated pupils, a blank stare, and does not respond to another's attempts at communication.
Affected persons typically are only awakened with great difficulty.
No recollection of the sleepwalking incident: Upon waking, the person typically has no memory of the sleepwalking events. If the individual does awaken from the sleepwalking episode, they may have a vague memory of the incident. Often, sleepwalkers will return to bed, or fall asleep in another place with no recall as to how they got there.
No impairment of mental activity upon waking: If an individual awakens during a sleepwalking episode, there may be a short period of confusion or disorientation, but there is no impairment of mental activity or behavior.
Causes significant distress to life situations: Sleepwalking causes significant disruption of social and occupational situations, or affects other abilities to function.
Not due to substance use or abuse: Sleepwalking disorder is not diagnosed if the cause is related to drug abuse, medication, or a general medical condition.

The line that separates periodic sleepwalking from sleepwalking disorder is not clearly defined. Individuals or families most often seek professional help when the episodes of sleepwalking are violent, pose a risk for injury, or impair the person's ability to function. For a diagnosis of sleepwalking disorder to be made, the person must experience a significant amount of social, occupational, or other impairment related to the sleepwalking problem. Episodes that have a long history extending from childhood through adolescence and especially into adulthood are more likely to be diagnosed with sleepwalking disorder.

Since the individual cannot recall the sleepwalking activity, diagnosis by means of interview is of little benefit, unless it involves someone who has witnessed the sleepwalking behavior. The preferred method for accurate diagnosis is through polysomnography . This technique involves hooking electrodes to different locations on the affected person's body to monitor brain wave activity, heart rate, breathing, and other vital signs while the individual sleeps. Monitoring brain-wave patterns and physiologic responses during sleep can usually give sleep specialists an accurate diagnosis of the condition and determine the effective means of treatment, if any.

Sleepwalking disorder can be difficult to distinguish from sleep terror disorder . In both cases, the individual has motor movement, is difficult to awaken, and does not remember the incident. The primary difference is that sleep terror disorder typically has an initial scream and signs of intense fear and panic associated with the other behaviors.

Treatment

Treatment for sleepwalking is often unnecessary, especially if episodes are infrequent and pose no hazard to the sleepwalker or others. If sleepwalking is recurrent, or daytime fatigue is suspected to result from disturbed sleep patterns, polysomnography may be recommended to determine whether some form of treatment may be helpful. If stress appears to trigger sleepwalking events in adults, stress management, biofeedback training, or relaxation techniques can be beneficial. Hypnosis has been used help sleepwalkers awaken once their feet touch the floor. Psychotherapy may help individuals who have underlying psychological issues that could be contributing to sleep problems.

Medications are sometimes used in the more severe cases with adults. Benzodiazepines—anti-anxiety drugs— such as diazepam (Valium) or alprazolam (Xanax) can be used to help relax muscles, although these may not result in fewer episodes of sleepwalking. When medications are used, they are typically prescribed in the lowest dose necessary and only for a limited period.

Somatization disorder

2017-02-20T12:29:00.001-08:00

Somatization disorder is a psychiatric condition marked by multiple medically unexplained physical, or somatic, symptoms. In order to qualify for the diagnosis of somatization disorder, somatic complaints must be serious enough to interfere significantly with a person's ability to perform important activities, such as work, school or family and social responsibilities, or lead the person experiencing the symptoms to seek medical treatment.

Somatization disorder has long been recognized by psychiatrists and psychologists, and was originally called Briquet's syndrome in honor of Paul Briquet, a French physician who first described the disorder in the nineteenth century. It is included in the category of somatoform disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), the professional handbook that aids clinicians in diagnosing patients' mental disorders. The term "somatoform" means that the physical symptoms have a psychological origin.

Individuals with somatization disorder suffer from a number of vague physical symptoms, involving at least four different physical functions or parts of the body. The physical symptoms that characterize somatization disorder cannot be attributed to medical conditions or to the use of drugs, and individuals with somatization disorder often undergo numerous medical tests (with negative results) before the psychological cause of their distress is identified. They often use impressionistic and colorful language to describe their symptoms, describing burning sensations, pains that move from place to place, strange tastes on the tongue, tingling, or tremors. While many symptoms resemble those associated with genuine diseases, some of the symptoms reported by people with somatization disorder are not. The individual usually visits many different physicians, but the information they provide about the patient's symptoms can be inconsistent. It is important to note that while the physical symptoms of somatization disorder frequently lack medical explanations, they are not intentionally fabricated. The typical person with somatization disorder has suffered from physical pain, discomfort, and dysfunction for an extended period of time and consulted several doctors; they are hopeful that they one can be found who can identify the cause of their illness and provide relief.

Somatization disorder can be dangerous, since patients may end up taking several different medications, thereby risking harmful drug interactions.

Symptoms

Gastrointestinal (GI) complaints, such as nausea, bloating, diarrhea, and sensitivities to certain foods are common, and at least two different GI symptoms are required for the diagnosis. Sexual or reproductive symptoms, including pain during intercourse, menstrual problems, and erectile dysfunction are also necessary features for a diagnosis for somatization disorder. Other frequent symptoms are headaches, pain in the back or joints, difficulty swallowing or speaking, and urinary retention. To qualify for the diagnosis, at least one symptom must resemble a neurological disorder, such as seizures , problems with coordination or balance, or paralysis.

To receive a diagnosis of somatization disorder, the individual must have a history of multiple physical complaints that began before age 30 and that continued for several years ( DSM-IV-TR ). These symptoms must cause significant impairment to social, occupational or other areas of functioning—or lead the patient to seek medical treatment.

Each of the following four criteria must be met.

The individual must report a history of pain affecting at least four different parts or functions of the body. Examples include headaches, back, joint, chest or abdominal pain, or pain during menstruation or sexual intercourse.
A history of at least two gastrointestinal symptoms, such as nausea, bloating, vomiting, diarrhea, or food intolerance must be reported.
There must be a history of at least one sexual or reproductive symptom, such as lack of interest in sex, problems achieving erection or ejaculation, irregular menstrual periods, excessive menstrual bleeding, or vomiting throughout pregnancy.
One symptom must mimic a neurological condition. Examples include weakness, paralysis, problems with balance or coordination, seizures, hallucinations , loss of sensations such as touch, seeing, hearing, tasting, smelling—or difficulty swallowing or speaking, or amnesia and loss of consciousness. Pseudo-neurologic symptoms like these are the primary characteristics of another somatoform disorder known as "conversion disorder."

If a thorough medical evaluation reveals no evidence of an underlying medical- or drug- or medication-induced condition, the diagnosis of somatization disorder is likely. People with genuine medical conditions can qualify for the diagnosis if the level of functional impairment reported is more than would be expected based on medical findings. The symptoms must not be intentionally produced. If the patient is feigning symptoms, a diagnosis of factitious disorder or malingering would most likely be considered.

Treatments

Cognitive behavior therapy

Cognitive-behavioral therapy (CBT) for somatization disorder focuses on changing negative patterns of thoughts, feelings, and behavior that contribute to somatic symptoms. The cognitive component of the treatment focuses on helping patients identify dysfunctional thinking about physical sensations. With practice, patients learn to recognize catastrophic thinking and develop more rational explanations for their feelings. The behavioral component aims to increase activity. Patients with somatization disorder have usually reduced their activity levels as a result of discomfort or out of fear that activity will worsen symptoms. CBT patients are instructed to increase activity gradually while avoiding overexertion that could reinforce fears. Other important types of treatment include relaxation training, sleep hygiene, and communication skills training. Preliminary findings suggest that CBT may help reduce distress and discomfort associated with somatic symptoms; however, it has not yet been systematically compared with other forms of therapy.

Medications

Antidepressant medications may help to alleviate symptoms of somatization disorder. According to one study, patients with somatization disorder who took the antidepressant nefazodone (Serzone) showed reductions in physical symptoms, increased activity levels, and lower levels of anxiety and depression at the end of treatment.

Trichotillomania

2017-02-20T11:32:00.001-08:00

Trichotillomania (trik-o-til-o-MAY-ne-uh) is an irresistible urge to pull out hair from your scalp, eyebrows or other areas of your body. Hair pulling from the scalp often leaves patchy bald spots, which people with trichotillomania may go to great lengths to disguise.

For some people, trichotillomania may be mild and generally manageable. For others, the urge to pull hair is overwhelming and can be accompanied by considerable distress. Some treatment options have helped many people reduce their hair pulling or stop entirely.

Signs and symptoms of trichotillomania often include:

Repeatedly pulling your hair out, typically from your scalp, eyebrows or eyelashes, but it can be from other body areas as well
A strong urge to pull hair, followed by feelings of relief after the hair is pulled
Patchy bald areas on the scalp or other areas of your body
Sparse or missing eyelashes or eyebrows
Chewing or eating pulled-out hair
Playing with pulled-out hair
Rubbing pulled-out hair across your lips or face

Most people with trichotillomania pull hair in private and generally try to hide the disorder from others.

For some people, hair pulling is intentional and focused. They're aware that they're pulling their hair out and may even develop elaborate rituals for doing so. Other people pull their hair unconsciously. The same person may also do both, depending on the situation and mood. For example, focused hair pulling may occur when you're frustrated in the car. Or you may unconsciously pull hair when you're bored. Certain positions or rituals may trigger hair pulling, such as resting your head on your hand or brushing your hair.

Your doctor will perform a thorough evaluation to determine if you have trichotillomania, which may include examining how much hair loss you have, having you fill out a questionnaire and eliminating other possible causes of hair pulling or hair loss. In some cases, your doctor may also take a biopsy of your hair or skin to try to pinpoint the problem.

To be diagnosed with trichotillomania, you must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association.

DSM criteria for the diagnosis of trichotillomania include:

Repeatedly pulling out your hair, resulting in noticeable hair loss
An increasing sense of tension before pulling, or when you try to resist pulling
Pleasure or relief when pulling
Your hair loss isn't attributed to another medical or dermatologic condition
Hair pulling causes you significant distress

There is some debate among mental health providers — and people with trichotillomania — about these criteria, and they may change in the future.

Research on treatment of trichotillomania is limited. Current approaches focus on:

Psychotherapy. A form of psychotherapy called habit reversal training may be an effective treatment for trichotillomania. This type of therapy helps you learn how to recognize situations where you're likely to pull and how to substitute other behaviors instead, such as clenching your fists for a period to "freeze" the urge, or redirecting your hand from your hair to your ear. Sometimes elements of other therapies may be blended with habit reversal training. For instance, your care provider may use cognitive therapy to help you challenge and examine distorted beliefs you may have in relation to hair pulling. Another treatment, acceptance and commitment therapy (ACT), helps people learn to accept their hair-pulling urges while at the same time teaching them how to avoid acting on their impulses.

Medications. Your doctor may also recommend that you take an antidepressant, such as clomipramine (Anafranil).

Walking Corpse Syndrome

2017-02-20T10:30:00.001-08:00

Cotard Syndrome is a rare and unusual mental affliction. It is a neuropsychiatric condition in which the person has a delusional belief that he is already dead and no longer exists. The sufferers of this condition think that they are zombies. They develop delusional belief that they are putrefying and can even smell the rotting flesh and that they have lost their internal organs and all the blood. Sometimes they also believe in the delusion of self immortality.

Jules Cotard, a French Neurologist first discovered this disorder and a patient suffering from it. He presented it in a lecture by false name Mademoiselle X in the year 1880.

Symptoms

Neglect of own hygiene, constant withdrawal feeling, delusion of negation, sometimes delusion of immortality, depression and despair, distorted view of the world etc. Patient may also experience auditory and smell based hallucination.

Person suffering from it may not recognize his own face as well as his known ones. Patient can sometimes smell the odor of his own rotting flesh and feel that his internal organs and blood is lost. Patient has many delusions and nihilistic delusion about one’s own body is the central one is this condition. Patient can exhibit less interest in society and reduced reaction to pleasurable experiences.

Jules Cotard mentions some symptoms of Cotard Syndrome like:

anxious melancholy
ideas of damnation or possession
disposition towards suicide attempts and self-harm
the idea that one is immortal and therefore can't die
insensitivity to pain (analgesia)

Treatments

Medication like antidepressants, antipsychotics and mood stabilizers are used on the patients of Cotard Syndrome. Electroconvulsive therapy (ECT) is also used for the management of this condition. This treatment involves placing electrodes on the patient’s head and administering small electrical pulses. This treatment needs to be carried out in the presence of experienced Psychiatrist. Combination of the medication and the ECT seems to produce more positive effect than only a single method.

Insomnia

2017-02-20T10:18:00.001-08:00

Insomnia is a disorder that can make it hard to fall asleep, hard to stay asleep, or both. With insomnia, you usually awaken feeling unrefreshed, which takes a toll on your ability to function during the day. Insomnia can sap not only your energy level and mood but also your health, work performance and quality of life.

How much sleep is enough varies from person to person. Most adults need seven to eight hours a night. Many adults experience insomnia at some point, but some people have long-term (chronic) insomnia.

You don't have to put up with sleepless nights. Simple changes in your daily habits can help.

Insomnia symptoms may include:

Difficulty falling asleep at night
Awakening during the night
Awakening too early
Not feeling well rested after a night's sleep
Daytime fatigue or sleepiness
Irritability, depression or anxiety
Difficulty paying attention or focusing on tasks
Increased errors or accidents
Tension headaches
Gastrointestinal symptoms
Ongoing worries about sleep

Someone with insomnia will often take 30 minutes or more to fall asleep and may get only six or fewer hours of sleep for three or more nights a week.

When to see a doctor

If insomnia makes it hard for you to function during the day, see your doctor to determine what might be the cause of your sleep problem and how it can be treated. If your doctor thinks you could have a sleep disorder, you might be referred to a sleep center for special testing.

In addition to asking you a number of questions, your doctor may have you complete a questionnaire to determine your sleep-wake pattern and your level of daytime sleepiness. You may also be asked to keep a sleep diary for a couple of weeks, if you haven't already done so.

Your doctor will do a physical exam to look for signs of other problems that may be causing insomnia. Occasionally, a blood test may be done to check for thyroid problems or other conditions that can cause insomnia.

If the cause of your insomnia isn't clear, or you have signs of another sleep disorder, such as sleep apnea or restless legs syndrome, you may need to spend a night at a sleep center. Tests are done to monitor and record a variety of body activities while you sleep, including brain waves, breathing, heartbeat, eye movements and body movements.

Treatments

Changing your sleep habits and addressing any underlying causes of insomnia can restore restful sleep for many people. Good sleep hygiene — simple steps such as keeping the same bedtime and arising time — promotes sound sleep and daytime alertness. If these measures don't work, your doctor may recommend medications to help with relaxation and sleep.

Behavior therapies

Behavioral treatments teach you new sleep behaviors and ways to improve your sleeping environment. Behavior therapies are equally or more effective than are sleep medications. Behavior therapies are generally recommended as the first line of treatment for people with insomnia.

Behavior therapies include:

Education about good sleeping habits. Sleep hygiene teaches habits that promote good sleep.

Relaxation techniques. Progressive muscle relaxation, biofeedback and breathing exercises are ways to reduce anxiety at bedtime. These strategies help you control your breathing, heart rate, muscle tension and mood.

Cognitive behavioral therapy. This involves replacing worries about not sleeping with positive thoughts. Cognitive behavioral therapy can be taught through one-on-one counseling or in group sessions.

'Stimulus control.' This means limiting the time you spend awake in bed and associating your bed and bedroom only with sleep and sex.

Sleep restriction. This treatment decreases the time you spend in bed, causing partial sleep deprivation, which makes you more tired the next night. Once your sleep has improved, your time in bed is gradually increased.

Light therapy. If you fall asleep too early and then awaken too early, you can use light to push back your internal clock. During times of the year when it's light outside in the evenings, you go outside or get light via a medical-grade light box.

Medications

Taking prescription sleeping pills, such as zolpidem (Ambien), eszopiclone (Lunesta), zaleplon (Sonata) or ramelteon (Rozerem), also may help you get to sleep. However, in rare cases, these medications may cause severe allergic reactions, facial swelling and unusual behaviors, such as driving or preparing and eating food while asleep. Side effects of prescription sleeping medications are often more pronounced in older people and may include excessive drowsiness, impaired thinking, night wandering, agitation and balance problems.

Doctors generally don't recommend relying on prescription sleeping pills for more than a few weeks, but several newer medications are approved for indefinite use. However, some of these medications are habit-forming.

If you have depression as well as insomnia, your doctor may prescribe an antidepressant with a sedative effect, such as trazodone, doxepin or mirtazapine (Remeron).

Over-the-counter sleep aids

Sleep medications available over-the-counter contain antihistamines that can make you drowsy. But antihistamines may reduce the quality of your sleep, and they can cause side effects, such as daytime sleepiness, dry mouth and blurred vision. These effects may be worse in the elderly.

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2017-02-20T06:06:00.000-08:00

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Krabbe (KRAH-buh) disease | inherited disorder

2016-05-16T17:17:00.001-07:00

DEFINITION

Krabbe (KRAH-buh) disease is an inherited disorder that destroys the protective coating (myelin) of nerve cells in the brain and throughout the nervous system.

In most cases, signs and symptoms of Krabbe disease develop in babies before 6 months of age, and the disease usually results in death by age 2. When it develops in older children and adults, the course of the disease can vary greatly.

There's no cure for Krabbe disease, and treatment focuses on supportive care. However, stem cell transplants have shown some success in infants who are treated before the onset of symptoms and in some older children and adults.

Krabbe disease affects about 1 in 100,000 people in the United States. It is also known as globoid cell leukodystrophy.

SYMPTOMS

In most cases, the signs and symptoms of Krabbe disease appear during the first few months of life. They begin gradually and progressively worsen.

Infants

Common signs and symptoms early in the course of the disease include the following:

Feeding difficulties
Unexplained crying
Extreme irritability
Fever with no sign of infection
Declines in alertness
Delays in typical developmental milestones
Muscle spasms
Loss of head control
Frequent vomiting

As the disease progresses, signs and symptoms become more severe. They may include:

Seizures
Loss of developmental abilities
Progressive loss of hearing and sight
Rigid, constricted muscles
Stiff, fixed posture
Progressive loss of ability to swallow and breathe

Older children and adults

When Krabbe disease develops later in childhood or during adulthood, signs and symptoms can vary widely. They may include:

Progressive loss of vision
Difficulty walking (ataxia)
Decline in thinking skills
Loss of manual dexterity
Muscles weakness

As a general rule, the younger the age that Krabbe disease occurs, the faster the disease progresses and the more likely it is to result in death.

Some people diagnosed during adolescence or adulthood may have less severe symptoms, with muscle weakness as a primary condition. They may have no impairment of their thinking skills.

When to see a doctor

The early signs and symptoms of Krabbe disease in infancy can indicate any number of diseases or developmental problems. Therefore, it's important to get a prompt and accurate diagnosis if your child is experiencing any signs or symptoms of the disease.

Signs and symptoms most often associated with older children and adults also are not specific to Krabbe disease and require a timely diagnosis.

CAUSES

Krabbe disease is caused when a person inherits two copies of an altered (mutated) gene — one copy from each parent.

A gene provides a kind of blueprint for producing proteins. If there is an error in this blueprint, then the protein product may not work properly. In the case of Krabbe disease, two mutated copies of a particular gene result in little or no production of an enzyme called galactocerebrosidase (GALC).

Enzymes, such as GALC, are responsible for breaking down certain substances in a cell's recycling center (lysosome). In Krabbe disease, the short supply of GALC enzymes results in the accumulation of certain types of fats called galactolipids.

Damage to nerve cells

Galactolipids normally exist in cells that produce and maintain the protective coating of nerve cells (myelin). However, an abundance of galactolipids has a toxic effect. Some galactolipids trigger myelin-forming cells to self-destruct.

Other galactolipids are taken up by specialized debris-eating cells in the nervous system called microglia. The process of cleaning up excessive galactolipids transforms these normally helpful cells into abnormal, toxic cells called globoid cells, which promote myelin-damaging inflammation.

The subsequent loss of myelin (demyelination) prevents nerve cells from sending and receiving messages.

RISK FACTORS

The gene mutation associated with Krabbe disease only causes the disease if two mutated copies of the gene are inherited. A disease resulting from two mutated copies is called an autosomal recessive disorder.

If each parent has one mutated copy of the gene, the risk for a child would be as follows:

A 25 percent chance of inheriting two mutated copies, which would result in the disease
A 50 percent chance of inheriting only one mutated copy, which would result in the child being a carrier of the mutation but would not result in the disease itself
A 25 percent chance of inheriting two normal copies of the gene

Genetic testing

Genetic testing to understand the risk of having a child with Krabbe disease may be considered in certain situations:

If one or both parents are likely carriers of a GALC gene mutation because of a known family history of Krabbe disease, a couple may want to have tests to understand the risks in their own family.
If one child is diagnosed with Krabbe disease, a family may consider genetic tests to identify other children who could develop the disease later in life.
If the parents are known carriers, they may request a prenatal genetic test to determine if their child is likely to develop the disease.
Known carriers, who are using in vitro fertilization, may request a genetic test with fertilized eggs before implantation.

Genetic testing should be carefully considered. Ask your doctor about genetic counseling services that can help you understand the benefits, limits and implications of genetic testing.

COMPLICATIONS

A number of complications — including infections and respiratory difficulties — can develop in children with advanced Krabbe disease. In the later stages of the disease, children become incapacitated, are confined to their beds and eventually lapse into a vegetative state.

Most children who develop Krabbe disease in infancy die before the age of 2, most often from respiratory failure or complications of immobility and markedly decreased muscle tone. Children who develop the disease later in childhood may have a somewhat longer life expectancy, usually between two and seven years after diagnosis.

PREPARING FOR YOUR APPOINTMENT

In some cases, Krabbe disease is diagnosed in newborns with screening tests before symptoms appear. Conversations with your child's doctor and a specialist in nervous system disorders (neurologist) would begin as soon as a diagnosis is confirmed. In most cases, however, the onset of symptoms triggers an exploration of possible causes.

Well-baby visits

It's important to take your child to all regularly scheduled well-baby visits and annual appointments during childhood. These visits are an opportunity for your child's doctor to monitor your child's development in key areas, including:

Growth
Muscle tone
Muscle strength
Coordination
Posture
Age-appropriate motor skills
Sensory abilities — vision, hearing and touch

Questions you should be prepared to answer during regular checkups might include the following:

What concerns do you have about your child's growth or development?
How well does he or she eat?
How does your child respond to touch?
Is your child reaching certain milestones in development, such as rolling over, pushing up, sitting up, crawling, walking or speaking?

Preparing for other doctor visits

If you're seeing your doctor because of the recent onset of symptoms, you'll likely start by seeing your general practitioner or your child's pediatrician. After an initial evaluation, your doctor may refer you to a neurologist.

Be prepared to answer the following questions about your symptoms or on your child's behalf:

What signs or symptoms have you noticed? When did they begin?
Have these signs or symptoms changed over time?
Do you notice any changes in your child's attentiveness?
Has your child had a fever?
Have you noticed unusual or excessive irritability?
Have you noticed changes in eating habits?

Questions especially for older children or adults may include:

Has your child experienced any changes in school performance?
Have you experienced difficulty with normal tasks or job-related work?
Are you or is your child being treated for any other medical conditions?
Have you or your child recently begun a new medication?

TESTS AND DIAGNOSIS

Your doctor will conduct a general physical exam and assess signs and symptoms that may indicate a neurological disease. A diagnosis of Krabbe disease is based on a series of tests, which may include the following.

Laboratory tests

A blood sample and small skin sample (biopsy) will be sent to a laboratory to assess the level of GALC enzyme activity. Very low or no GALC activity level may indicate Krabbe disease.

Although the results help a doctor make a diagnosis, they don't provide evidence of how quickly the disease may progress. For example, very low GALC activity doesn't always mean that the condition will advance rapidly.

Imaging tests

Your doctor may order one or more imaging tests that can detect the loss of myelin (demyelination) in affected regions of the brain. These may include:

Magnetic resonance imaging (MRI), a technology that uses radio waves and a magnetic field to produce detailed 3-D images
Computerized tomography (CT), a specialized X-ray technology that produces 2-D images

Nerve conduction study

A nerve conduction study assesses the rate at which nerves conduct a signal — essentially how quickly can they send a message. A special device measures the time it takes an electrical impulse to travel from one point on the body to another. When myelin is impaired, nerve conduction is slower.

Genetic testing

A genetic test may be done with a blood sample to confirm a diagnosis. There are variant forms of the mutated gene that results in Krabbe disease. The particular type of mutation may provide some clues regarding the expected course of the disease.

Newborn screening

In some states, a screening test for Krabbe disease is part of a standard set of assessments for newborns. The initial screening test measures GALC enzyme activity. If the enzyme activity is found to be low, follow-up GALC tests and genetic tests are conducted.

The use of newborn screening tests is relatively new. Researchers are still working to understand how best to use these tests, how well the tests lead to an accurate diagnosis and how well they predict the course of the disease.

TREATMENTS AND DRUGS

For infants who have already developed symptoms of Krabbe disease, there is currently no treatment that can change the course of the disease. Treatment, therefore, focuses on managing symptoms and providing supportive care. Interventions may include the following:

Anticonvulsant medications to manage seizures
Drugs to ease muscle spasticity and irritability
Physical therapy to minimize deterioration of muscle tone
Nutritional support, such as the use of a tube to deliver fluids and nutrients directly into the stomach (gastric tube)

Interventions for older children or adults with less severe forms of the disease may include:

Physical therapy to minimize deterioration of muscle tone
Occupational therapy to achieve as much independence as possible with daily activities

Stem cell transplantation

Hematopoietic stem cells are specialized cells that can develop into all of the different types of blood cells in the body. These stem cells are also the source of microglia, specialized debris-eating cells that take up residence in the nervous system. In Krabbe disease, microglia are transformed into toxic globoid cells.

In stem cell transplantation, donor stem cells are delivered into the recipient's bloodstream through a tube called a central venous catheter. The donor stem cells help the body produce healthy microglia that can populate the nervous system and deliver functioning GALC enzymes. This treatment may help restore some degree of normal myelin production and maintenance.

This therapy may improve outcomes in infants if treatment begins before the onset of symptoms — that is, when a diagnosis results from a newborn screening test.

Presymptomatic infants receiving a stem cell transplant have had slower disease progression, but these children still experience significant difficulties with speech, walking and other motor skills.

Older children and adults with mild symptoms also may benefit from this treatment.

Sources for hematopoietic stem cells include:

Umbilical cord blood
Donor bone marrow
Donor circulating (peripheral) blood stem cells

LIFESTYLE AND HOME REMEDIES

Krabbe (KRAH-buh) disease is an inherited disorder that destroys the protective coating (myelin) of nerve cells in the brain and throughout the nervous system.

Krabbe disease affects about 1 in 100,000 people in the United States. It is also known as globoid cell leukodystrophy.

Niemann-Pick disease

2016-04-27T06:54:00.001-07:00

DEFINITION

Niemann-Pick disease primarily affects children, although it can occur at any age. Types A, B and C all affect the body's ability to metabolize fat (cholesterol and lipids) within cells. When cholesterol and other lipids accumulate in large amounts within cells, they cause cell dysfunction and ultimately cell death. Niemann-Pick disease can affect the brain, nerves, liver, spleen and bone marrow and, in severe cases, the lungs. Progressive deterioration of the brain, nerves and organs cause the main symptoms. Niemann-Pick is an inherited disease with no known cure, but research continues.

SYMPTOMS

CAUSES

RISK FACTORS

COMPLICATIONS

PREPARING FOR YOUR APPOINTMENT

TESTS AND DIAGNOSIS

TREATMENTS AND DRUGS

LIFESTYLE AND HOME REMEDIES

TRYPOPHOBIA | Fear Of Holes

2016-04-10T23:23:00.001-07:00

Definition

TRYPOPHOBIA is a pathological fear of holes, particular those that are clustered together in a pattern. Trypophobia was coined in 2005 and derives its name from the Greek τρύπα (trýpa) “hole” and φόβος (phóbos) “fear”. According to Cole and Wilkins (2015) trypophobia is a “fear of holes” in which “Sufferers report aversion to visual stimuli comprising particular configuration of holes. The stimuli are usually clusters of holes of any variety that are almost always innocuous and seemingly pose no threat” . The phobia itself claims many sufferers although not currently recognized by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM), or any other scientific literature.

Kleptomania | Impulse control disorder

2016-04-10T07:55:00.001-07:00

DEFINITION

Kleptomania is the irresistible urge to steal items that you generally don't really need and that usually have little value. Kleptomania (klep-toe-MAY-knee-uh) is a serious mental health disorder that can cause much emotional pain to you and your loved ones if not treated.

Kleptomania is a type of impulse control disorder — a disorder in which you can't resist the temptation or drive to perform an act that's harmful to you or someone else.

Many people with kleptomania live lives of secret shame because they're afraid to seek mental health treatment. Although there's no cure for kleptomania, treatment with medication or psychotherapy may be able to help end the cycle of compulsive stealing.

SYMPTOMS

Kleptomania symptoms may include:

Powerful urges to steal items that you don't need
Feeling increased tension leading up to the theft
Feeling pleasure or gratification while stealing
Feeling terrible guilt or shame after the theft

A powerful urge

Unlike typical shoplifters, people with kleptomania don't compulsively steal for personal gain. Nor do they steal as a way to exact revenge. They steal simply because the urge is so powerful that they can't resist it. This urge makes them feel uncomfortably anxious, tense or aroused. To soothe these feelings, they steal.

During the theft, they feel relief and gratification. Afterward, though, they may feel enormous guilt, remorse, self-loathing and fear of arrest. But the urge comes back, and the kleptomania cycle repeats itself.

Spontaneous occurrences and public places
Episodes of kleptomania generally occur spontaneously, without planning. Most people with kleptomania steal from public places, such as stores and supermarkets. Some may steal from friends or acquaintances, such as at a party. Often, the stolen items have no value to the person with kleptomania. The stolen items are usually stashed away, never to be used. Items may also be donated, given away to family or friends, or even secretly returned to the place from which they were stolen.

When to see a doctor

If you can't stop shoplifting or stealing, seek medical advice. Many people who may have kleptomania don't want to seek treatment because they're afraid they'll be arrested or jailed. A mental health provider doesn't have to report your thefts to authorities, however. Getting treatment may help you gain control over your kleptomania.

If a loved one has kleptomania

If you suspect a close friend or family member may have kleptomania, gently raise your concerns with your loved one. Keep in mind that kleptomania is a mental health condition, not a character flaw, and approach your loved one without blame or accusation.

It may be helpful to emphasize the following points:

You're concerned because you care about your loved one's health and well-being.
You're worried about the risks of compulsive stealing, such as being arrested, losing a job or damaging a valued relationship.
You understand that, with kleptomania, the urge to steal may be too strong to resist just by \"putting your mind to it.\"
Effective treatments are available to minimize the urge to steal and help your loved one live without addiction and shame.

If you need help preparing for this conversation, talk with your doctor. He or she may refer you to a mental health provider who can help you plan a way of raising your concerns without making your loved one feel defensive or threatened.

CAUSES

The cause of kleptomania isn't known. There are several theories that suggest that changes in the brain may be at the root of kleptomania. Kleptomania may be linked to problems with a naturally occurring brain chemical (neurotransmitter) called serotonin. Serotonin helps regulate moods and emotions. Low levels of serotonin are common in people prone to impulsive behaviors.

Kleptomania also may be related to addictive disorders, and stealing may cause the release of dopamine (another neurotransmitter). Dopamine causes pleasurable feelings, and some people seek this rewarding feeling again and again.

Other research has found that kleptomania can occur after someone sustains a head injury. More research is needed to better understand all of these possible causes of kleptomania.

RISK FACTORS

Kleptomania is considered uncommon. However because many people with kleptomania never seek treatment, or they're simply jailed after repeated thefts, many cases of kleptomania may never be diagnosed. It's thought that fewer than 5 percent of shoplifters have kleptomania. Kleptomania often begins during adolescence or in young adulthood, but in rare cases it begins after 50 years of age.

Kleptomania risk factors may include:

Family history. Having a first-degree blood relative, such as a parent or sibling, with kleptomania or obsessive-compulsive disorder may increase your risk of kleptomania.
Being female. Approximately two-thirds of people with known kleptomania are women.
Having another mental illness. People with kleptomania often have other mental illnesses, such as bipolar disorder, anxiety disorder, eating disorders, substance abuse or personality disorders.
Head trauma or brain injuries. People who've experienced a head trauma may develop kleptomania.

COMPLICATIONS

Left untreated, kleptomania can result in severe emotional, legal and financial problems. For example, many people with known kleptomania have been arrested for shoplifting. Because you know stealing is wrong but you feel powerless to resist the impulse, you may be wracked by guilt, shame, self-loathing and humiliation. You may otherwise lead a moral, upstanding life and be confused and upset by your compulsive stealing.

Complications that kleptomania may cause or be associated with include:

Arrest
Imprisonment
Depression
Alcohol and substance abuse
Eating disorders
Anxiety
Compulsive gambling or shopping
Suicidal thoughts or behavior
Social isolation

PREPARING FOR YOUR APPOINTMENT

If you struggle with an irresistible urge to steal, call your doctor. Making that call will undoubtedly be scary, but trust that your doctor is interested in caring for your health, not in judging you. Your doctor may refer you to a mental health provider, such as a psychiatrist, with experience diagnosing and treating kleptomania.

Use the information below to prepare for your first appointment and learn what to expect from the mental health provider.

What you can do:

Write down any symptoms you're experiencing, and for how long. It will help the mental health provider to know what kinds of events seem to trigger your urge to steal.
Write down key personal information,including traumatic events in your past and any current, major stressors.
Make a list of your medical information, including other physical or mental health conditions with which you've been diagnosed. Also write down the names of any medications or supplements you're taking.
Take a trusted family member or friend along, if possible. It can be difficult to remember everything your mental health provider says, and a loved one can help remember the details. In addition, someone who has known you for a long time may be able to ask questions or share information with the mental health provider that you don't remember to bring up.
Write down questions to ask your mental health provider in advance so that you can make the most of your appointment.

For kleptomania, some basic questions to ask your mental health provider include:

Why can't I stop stealing?
What treatments are available?
What treatments are most likely to work for me?
How quickly will I stop stealing?
Will I still feel the urge to steal?
How often do I need therapy sessions, and for how long?
Would family therapy be helpful in my case?
Are there medications that can help?
What are the possible side effects of these medications?
I have these other health conditions. How can I best manage these conditions together?
Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?

What to expect from your mental health provider

The mental health provider will likely ask you a number of questions to better understand your symptoms and how they're affecting your life. The mental health provider may ask:

At what age did you first experience an irresistible urge to steal?
How often do you experience the urge to steal?
Have you ever been caught or arrested for stealing?
How would you describe your feelings before, during and after you steal something?
What kinds of items do you steal? Are they things you need?
From whom do you steal?
What do you do with the items you steal?
Does anything in particular seem to trigger your urge to steal?
How would you say your urge to steal is affecting your life, including school, work and personal relationships?
Have any of your close relatives had a problem with compulsive stealing, or with other mental health conditions such as depression, addiction or obsessive-compulsive disorder?
Have you been treated for any other mental health problems, including eating disorders? If yes, what treatments were most effective?
Do you use alcohol or illegal drugs? How often?
Are you currently being treated for any other medical conditions?

TESTS AND DIAGNOSIS

When you decide to seek treatment for symptoms of possible kleptomania, you may have both a physical and psychological evaluation. The physical exam can determine if there may be any physical causes triggering your symptoms.

There's no laboratory test to diagnose kleptomania. Instead, kleptomania is diagnosed based on your signs and symptoms. Kleptomania is a type of impulse control disorder. In addition to asking questions about your impulses and how they make you feel, your doctor may review a list of situations to see if they trigger kleptomania episodes. You may also fill out psychological questionnaires or self-assessments to help pinpoint a diagnosis.

To be diagnosed with kleptomania, you must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health professionals to diagnose mental conditions and by insurance companies to reimburse for treatment. Criteria for a kleptomania diagnosis include:

You have an inability to resist urges to steal objects that aren't needed for personal use or monetary value
You feel increasing tension leading up to the theft
You sense feelings of pleasure, relief or gratification during the act of stealing
The theft isn't committed as a way to exact revenge or to express anger, and isn't done while hallucinating or delusional
The stealing isn't related to manic episodes of bipolar disorder or other mental health disorders, such as antisocial personality disorder

TREATMENTS AND DRUGS

Although fear, humiliation or embarrassment may make it difficult for you to seek treatment for kleptomania, it's important to get help. Kleptomania is difficult to overcome on your own. Treatment of kleptomania typically involves medications and psychotherapy, perhaps along with self-help groups. However, there's no standard kleptomania treatment, and researchers are still trying to understand what may work best. You may have to try several types of kleptomania treatment to find something that works well for your situation.

Medications

There's little solid scientific research about using psychiatric medications to treat kleptomania. However, certain medications may be helpful. Which medication is best for you depends on your overall situation and other conditions you may have, such as depression or obsessive-compulsive disorder. You may benefit from taking a combination of medications. Medications to consider include:

Antidepressants. Selective serotonin reuptake inhibitors (SSRIs) are commonly used to treat kleptomania. These include fluoxetine (Prozac, Prozac Weekly), paroxetine (Paxil, Paxil CR), fluvoxamine (Luvox, Luvox CR) and others.
Mood stabilizers. These medications are meant to even out your mood so that you don't have rapid or uneven changes that may trigger urges to steal. One mood stabilizer used to treat kleptomania is lithium (Lithobid).
Anti-seizure medications. Although originally intended for seizure disorders, these medications have shown benefits in certain mental health disorders, possibly including kleptomania. Examples include topiramate (Topamax) and valproic acid (Depakene, Stavzor).
Addiction medications. Naltrexone (Revia, Vivitrol), known technically as an opioid antagonist, blocks the part of your brain that feels pleasure with certain addictive behaviors. It may reduce the urges and pleasure associated with stealing.

You may have to try several different medications or combinations of medications to see what works best for you with the fewest side effects. Keep in mind that it may take several weeks to notice full benefits. Talk to your doctor or mental health provider if you're bothered by side effects. Under his or her guidance, you may be able to switch medications or change your dosage. Many side effects eventually go away.

Psychotherapy

Cognitive behavioral therapy has become the psychotherapy of choice for kleptomania. In general, cognitive behavioral therapy helps you identify unhealthy, negative beliefs and behaviors and replace them with healthy, positive ones. Cognitive behavioral therapy may include these techniques to help you overcome kleptomania urges:

Covert sensitization, in which you picture yourself stealing and then facing negative consequences, such as being caught
Aversion therapy, in which you practice mildly painful techniques, such as holding your breath until you become uncomfortable, when you get an urge to steal
Systematic desensitization, in which you practice relaxation techniques and picture yourself controlling urges to steal

Other forms of therapy, such as psychodynamic therapy, family therapy or marriage counseling, also may be helpful.

Avoiding relapses

It's not unusual to have relapses of kleptomania. To help avoid relapses, be sure to stick to your treatment plan. If you feel urges to steal, contact your mental health provider or reach out to a trusted support group.

LIFESTYLE AND HOME REMEDIES

Kleptomania is a type of impulse control disorder — a disorder in which you can't resist the temptation or drive to perform an act that's harmful to you or someone else.

Intussusception

2016-04-09T07:29:00.001-07:00

DEFINITION

Intussusception (in-tuh-suh-SEP-shun) is a serious disorder in which part of the intestine slides into an adjacent part of the intestine. This \"telescoping\" often blocks food or fluid from passing through. Intussusception also cuts off the blood supply to the part of the intestine that's affected. Intussusception can lead to a tear in the bowel (perforation), infection and death of bowel tissue.

Intussusception is the most common cause of intestinal obstruction in children younger than 3. Intussusception is rare in adults. Most cases of adult intussusception are the result of an underlying medical condition, such as a tumor. In contrast, the cause of most cases of intussusception in children is unknown.

In children, the intestines can usually be pushed back into position with an X-ray procedure. In adults, surgery is often required to correct the problem.

SYMPTOMS

The first sign of intussusception in an otherwise healthy infant may be sudden, loud crying caused by abdominal pain. Infants who have abdominal pain may pull their knees to their chests when they cry. The pain of intussusception comes and goes, usually every 15 to 20 minutes at first. These painful episodes last longer and happen more often as time passes.

Other frequent signs and symptoms of intussusception include:

Stool mixed with blood and mucus (sometimes referred to as \"currant jelly\" stool because of its appearance)
Vomiting
A lump in the abdomen
Lethargy

Less common signs and symptoms include:

Diarrhea
Fever
Constipation

Some infants have no obvious pain, don't pass blood or have a lump in the abdomen. Some older children have pain but no other symptoms.

Adults

Because intussusception is rare in adults and symptoms of the disorder are often nonspecific, it is more challenging to identify. Abdominal pain is the most common symptom, followed by nausea and vomiting and diarrhea. A significant percentage of people have no signs and symptoms.

When to see a doctor

Intussusception requires emergency medical care. If you or your child develops the signs or symptoms listed above, seek medical help right away.

In infants, remember that signs of abdominal pain may include recurrent bouts of pulling the knees to the chest and crying.

CAUSES

Your intestine is shaped like a long tube. In intussusception, one part of your intestine — usually the small intestine — slides inside an adjacent part. This is sometimes called telescoping because it's similar to the way a collapsible telescope folds together.

In some cases, the telescoping is caused by an abnormal growth in the intestine, such as a polyp or a tumor (called a lead point). The normal wave-like contractions of the intestine grab this lead point and pull it and the lining of the intestine into the bowel ahead of it. In most cases, however, no cause can be identified for intussusception.

Children

In the vast majority of cases of intussusception in children, the cause is unknown. Because intussusception seems to occur more often in the fall and winter and because many children with the problem also have flu-like symptoms, some suspect a virus may play a role in the condition. In a few instances, a lead point is identified as the cause of the condition — most frequently Meckel's diverticulum (a pouch in the lining of the small intestine).

Adults

In adults, intussusception is usually the result of a medical condition, such as:

A tumor
Scar-like tissue in the intestine (adhesions)
Surgical scars in the small intestine or colon
Hematoma
Inflammation, such as from Crohn's disease

RISK FACTORS

Risk factors for intussusception include:

Age. Children are much more likely to develop intussusception than adults are. It's the most common cause of bowel obstruction in children between the ages of 6 months and 3 years.
Sex. Intussusception more often affects boys.
Abnormal intestinal formation at birth. A condition present at birth (congenital) in which the intestine doesn't develop correctly (malrotation) also is a risk factor for intussusception.
A prior history of intussusception.Once you've had intussusception, you're at increased risk to develop it again.
AIDS. There is some evidence of an increased incidence of intussusception in people with acquired immune deficiency syndrome.

COMPLICATIONS

Intussusception can cut off the blood supply to the affected portion of the intestine. If left untreated, lack of blood causes tissue of the intestinal wall to die. Tissue death can lead to a tear (perforation) in the intestinal wall, which can cause an infection of the lining of the abdominal cavity (peritonitis).

Peritonitis is a life-threatening condition that requires immediate medical attention. Signs and symptoms of peritonitis include:

Abdominal pain
Abdominal swelling
Fever
Thirst
Low urine output

Peritonitis may cause your child to go into shock. Signs and symptoms of shock include:

Cool, clammy skin that may be pale or gray
A weak and rapid pulse
Abnormal breathing that may be either slow and shallow or very rapid
Lackluster eyes that seem to stare blankly
Profound listlessness

A child who is in shock may be conscious or unconscious. If you suspect your child is in shock, seek emergency medical care right away.

PREPARING FOR YOUR APPOINTMENT

Emergency medical care is required to treat intussusception. You may not have much time to prepare for an appointment.

What to expect from your doctor

Your child's doctor is likely to ask you a number of questions, including:

When did your child begin experiencing abdominal pain or other symptoms?
Does your child's pain appear to be continuous — or is it occurring off and on?
Does the pain begin and end suddenly?
Has your child experienced nausea, vomiting or diarrhea?
Have you noticed any blood in your child's stool?
Have you noticed any swelling or a lump in your child's abdomen?

What you can do in the meantime

Don't give your child any over-the-counter medications to treat symptoms before the appointment.

TESTS AND DIAGNOSIS

Your or your child's doctor will start by getting a history of the symptoms of the problem. He or she may be able to feel a sausage-shaped lump in the abdomen. To confirm the diagnosis, your doctor may order:

Ultrasound or other abdominal imaging. An ultrasound, X-ray or computerized tomography (CT) scan may reveal intestinal obstruction caused by intussusception. Imaging will typically show a \"bull's eye,\" representing the intestine coiled within the intestine. Abdominal imaging also can show if the intestine has been torn (perforated).
Air or barium enema. An air or barium enema is basically a colon X-ray. During the procedure, the doctor will insert air (the preferred choice in most cases) or liquid barium into the colon through the rectum. This makes the images on the X-ray clearer. An air or barium enema will fix intussusception 90 percent of the time in children, and no further treatment is needed. A barium enema can't be used if the intestine is torn.

TREATMENTS AND DRUGS

Treatment of intussusception typically happens as a medical emergency. Emergency medical care is required to avoid severe dehydration and shock, as well as prevent infection that can occur when a portion of intestine dies due to lack of blood.

Initial care

When your child arrives at the hospital, the doctors will first stabilize his or her medical condition. This includes:

Giving your child fluids through an intravenous (IV) line
Helping the intestines decompress by putting a tube through the child's nose and into the stomach (nasogastric tube)

Correcting the intussusception

To treat the problem, your doctor may recommend:

A barium or air enema. This is both a diagnostic procedure and a treatment. If an enema works, further treatment is usually not necessary. This treatment is highly effective in children, but rarely used in adults. Intussusception recurs as often as 15 to 20 percent of the time and the treatment will have to be repeated.
Surgery. If the intestine is torn, if an enema is unsuccessful in correcting the problem or if a lead point is the cause, surgery is necessary. The surgeon will free the portion of the intestine that is trapped, clear the obstruction and, if necessary, remove any of the intestinal tissue that has died. Surgery is the main treatment for adults and for people who are acutely ill.

In some cases, intussusception may be temporary and go away without treatment.

LIFESTYLE AND HOME REMEDIES

In children, the intestines can usually be pushed back into position with an X-ray procedure. In adults, surgery is often required to correct the problem.

Ichthyosis vulgaris | skin disorder

2016-04-09T04:44:00.001-07:00

DEFINITION

Ichthyosis vulgaris (ik-thee-O-sis vul-GAY-ris) is an inherited skin disorder in which dead skin cells accumulate in thick, dry scales on your skin's surface.

The scales of ichthyosis vulgaris, sometimes called fish scale disease or fish skin disease, can be present at birth, but usually first appear during early childhood. Sometimes, mild cases of ichthyosis vulgaris go undiagnosed because they're mistaken for extremely dry skin.

Most cases of ichthyosis vulgaris are mild, but some are severe. Sometimes other skin diseases, such as the allergic skin condition eczema, are associated with ichthyosis vulgaris. No cure has been found for ichthyosis vulgaris, and treatments focus on controlling the condition.

SYMPTOMS

Ichthyosis vulgaris slows your skin's natural shedding process. This causes chronic, excessive buildup of the protein in the upper layer of the skin (keratin). Symptoms include:

Dry, scaly skin
Tile-like, small scales
Scales colored white, dirty gray or brown — with darker colored scales typically on darker skin
Flaky scalp
Deep, painful cracks in your skin

The scales usually appear on your elbows and lower legs and may be especially thick and dark over your shins. Most cases of ichthyosis vulgaris are mild, but some can be severe. The severity of symptoms may vary widely among family members who have the condition.

Symptoms usually worsen or are more pronounced in cold, dry environments and tend to improve or even resolve in warm, humid environments.

When to see a doctor

If you suspect you or your child has ichthyosis, talk to your family doctor or a dermatologist. He or she can diagnose the condition by examining the characteristic scales. Also, be sure to seek medical advice if the symptoms worsen or don't improve with self-care measures. You may need stronger medication to manage the condition.

CAUSES

Ichthyosis vulgaris is commonly caused by a genetic mutation that's inherited from one or both parents. Children who inherit a defective gene from just one parent have a milder form of the disease, while those who inherit two defective genes have a more severe form of ichthyosis vulgaris. Children with the inherited form of the disorder usually have normal skin at birth, but develop scaling and roughness during the first few years of life.

If genetic abnormalities aren't responsible for ichthyosis, it's referred to as acquired ichthyosis. This rare type often begins in adulthood. It's usually associated with other diseases, such as cancer, thyroid disease or HIV/AIDS.

RISK FACTORS

Ichthyosis vulgaris (ik-thee-O-sis vul-GAY-ris) is an inherited skin disorder in which dead skin cells accumulate in thick, dry scales on your skin's surface.

COMPLICATIONS

Some people with ichthyosis may experience:

Overheating. In rare cases, the skin thickness and scales of ichthyosis can interfere with sweating. This can inhibit cooling.
Secondary infection. Skin splitting and cracking may lead to infections.

PREPARING FOR YOUR APPOINTMENT

If the appointment is for your child, you're likely to start by seeing your child's pediatrician. If the appointment is for you, you're likely to start by seeing your primary care doctor. He or she may refer you or your child to a specialist in skin conditions (dermatologist).

Here's some information to help you prepare for the appointment.

What you can do

Write down any symptoms your child or you are experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
Write down key personal information,including any major stresses or recent life changes.
Make a list of all medications, vitamins or supplements you or your child is taking.
Write down questions to ask your doctor.

Preparing a list of questions for your doctor will help you make the most of your time together. List your questions from most important to least important. For ichthyosis vulgaris, some basic questions to ask your doctor include:

What's the most likely cause of these symptoms?
Are there other possible causes?
What kinds of tests do I or my child need?
Is the condition likely temporary or long lasting?
What treatments are available and which do you recommend?
Are there any brochures or other printed material that I can take home with me? What websites do you recommend?

What to expect from your doctor

Your doctor is likely to ask you a number of questions, including:

When did your symptoms first appear?
Have the symptoms been continuous or do they come and go?
What, if anything, seems to improve the symptoms?
What, if anything, appears to worsen the symptoms?
Does anyone in your immediate or extended family have similar skin changes?

What you can do in the meantime

To help soothe your or your child's skin:

Wash only with mild soaps that have added oils and fats. Avoid strongly scented and antibacterial soaps, which are especially harsh on dry skin.
Apply moisturizer or lubricating cream while your or your child's skin is still moist from bathing. Choose a moisturizer that contains urea or propylene glycol — chemicals that help keep your skin moist. Petroleum jelly is another good choice. Cover the treated areas with plastic wrap to keep the petroleum jelly from staining clothes and furniture.

TESTS AND DIAGNOSIS

A doctor can often make a diagnosis by examining your skin and the characteristic scales. If there's any doubt, he or she may perform other tests, such as a skin biopsy. This may be necessary to rule out other causes of dry, scaly skin.

TREATMENTS AND DRUGS

There's no known cure for ichthyosis, so the goal of treatment is to manage the condition.

Medications

Treatments may include:

Alpha hydroxy acids, such as lactic acid and glycolic acid. Treatment can include prescription creams and ointments that contain acids that help control scaling and increase skin moisture.
Retinoids. Your doctor may prescribe these vitamin A-derived medications in severe cases. They reduce the production of skin cells. Side effects from the medication may include eye and lip inflammation, bone spurs and hair loss. Retinoids may cause birth defects. Women considering retinoid therapy should be sure they are not pregnant before starting the medication — and use effective birth control while taking retinoids.

LIFESTYLE AND HOME REMEDIES

Although self-help measures won't cure ichthyosis, they may help improve the appearance and feel of damaged skin. Consider these measures to help:

Take long soaking baths to soften the skin. Then use a rough-textured sponge, such as a loofa sponge, to remove the thickened scales.
Choose mild soaps that have added oils and fats. Avoid strongly scented and antibacterial soaps, which are especially harsh on dry skin.
After showering or bathing, gently pat or blot your skin dry with a towel so that some moisture remains on the skin.
Apply moisturizer or lubricating cream while your skin is still moist from bathing. Choose a moisturizer that contains urea or propylene glycol — chemicals that help keep your skin moist. Petroleum jelly is another good choice. Cover the treated areas with plastic wrap to keep the petroleum jelly from staining clothes and furniture.
Apply an over-the-counter product that contains urea, lactic acid or a low concentration of salicylic acid twice daily. Mild acidic compounds help your skin shed its dead skin cells. Urea helps bind moisture to your skin.
Use a portable home humidifier or one attached to your furnace to add moisture to the air inside your home.

Which of the following do these programs prioritize?

2016-04-09T01:32:00.000-07:00

Ans: D

Feedback:
Organized self-care education programs emphasize health promotion, disease
prevention, management of illness, self-care, and judicious use of the professional
health care system. Prenatal care, lobbying, and Internet activities are secondary.

What is one characteristic the nurse would cite as necessary to possess to be an effective nurse

2016-04-09T01:21:00.000-07:00

Ans: A

Feedback:
To promote an effective nurse-patient relationship and positive outcomes of care,
nursing care must be culturally competent, appropriate, and sensitive to cultural
differences. Team-focused nursing and strict adherence to routine are not
characteristics needed to be an effective nurse. The ability to handle criticism is
important, but to a lesser degree than cultural competence.

Hand-foot-and-mouth disease | viral infection

2016-04-08T03:11:00.001-07:00

DEFINITION

Hand-foot-and-mouth disease — a mild, contagious viral infection common in young children — is characterized by sores in the mouth and a rash on the hands and feet. Hand-foot-and-mouth disease is most commonly caused by a coxsackievirus.

There's no specific treatment for hand-foot-and-mouth disease. You can reduce your risk of infection from hand-foot-and-mouth disease by practicing good hygiene, such as washing your hands often and thoroughly.

SYMPTOMS

Hand-foot-and-mouth disease may cause some or all of the following signs and symptoms:

Fever
Sore throat
Feeling of being unwell (malaise)
Painful, red, blister-like lesions on the tongue, gums and inside of the cheeks
A red rash, without itching but sometimes with blistering, on the palms, soles and sometimes the buttocks
Irritability in infants and toddlers
Loss of appetite

The usual period from initial infection to the onset of signs and symptoms (incubation period) is three to seven days. A fever is often the first sign of hand-foot-and-mouth disease, followed by a sore throat and sometimes a poor appetite and malaise. One or two days after the fever begins, painful sores may develop in the mouth or throat. A rash on the hands and feet and possibly on the buttocks can follow within one or two days.

When to see a doctor

Hand-foot-and-mouth disease is usually a minor illness causing only a few days of fever and relatively mild signs and symptoms. Contact your doctor, however, if mouth sores or a sore throat keep your child from drinking fluids. Contact your doctor also if after a few days, your child's signs and symptoms worsen.

CAUSES

The most common cause of hand-foot-and-mouth disease is infection with the coxsackievirus A16. The coxsackievirus belongs to a group of viruses called nonpolio enteroviruses. Other enteroviruses sometimes cause hand-foot-and-mouth disease.

Oral ingestion is the main source of coxsackievirus infection and hand-foot-and-mouth disease. The illness spreads by person-to-person contact with an infected person's:

Nasal secretions or throat discharge
Saliva
Fluid from blisters
Stool
Respiratory droplets sprayed into the air after a cough or sneeze

Common in child care setting

Hand-foot-and-mouth disease is most common in children in child care settings because of frequent diaper changes and potty training, and because little children often put their hands in their mouths.

Although your child is most contagious with hand-foot-and-mouth disease during the first week of the illness, the virus can remain in his or her body for weeks after the signs and symptoms are gone. That means your child still can infect others.

Some people, particularly adults, can pass the virus without showing any signs or symptoms of the disease.

Outbreaks of the disease are more common in summer and autumn in the United States and other temperate climates. In tropical climates, outbreaks occur year-round.

Different from foot-and-mouth disease

Hand-foot-and-mouth disease isn't related to foot-and-mouth disease (sometimes called hoof-and-mouth disease), which is an infectious viral disease found in farm animals. You can't contract hand-foot-and-mouth disease from pets or other animals, and you can't transmit it to them.

RISK FACTORS

Hand-foot-and-mouth disease primarily affects children younger than age 10. Children in child care centers are especially susceptible to outbreaks of hand-foot-and-mouth disease because the infection spreads by person-to-person contact, and young children are the most susceptible.

Children usually develop immunity to hand-foot-and-mouth disease as they get older by building antibodies after exposure to the virus that causes the disease. However, it's possible for adolescents and adults to get the disease.

COMPLICATIONS

The most common complication of hand-foot-and-mouth disease is dehydration. The illness can cause sores in the mouth and throat, making swallowing painful and difficult. Watch closely to make sure your child frequently sips fluid during the course of the illness. If dehydration is severe, intravenous (IV) fluids may be necessary.

Hand-foot-and-mouth disease is usually a minor illness causing only a few days of fever and relatively mild signs and symptoms. However, a rare and sometimes serious form of the coxsackievirus can involve the brain and cause other complications:

Viral meningitis. This is an infection and inflammation of the membranes (meninges) and cerebrospinal fluid surrounding the brain and spinal cord. Viral meningitis is usually mild and often clears on its own.
Encephalitis. This severe and potentially life-threatening disease involves brain inflammation caused by a virus. Encephalitis is rare.

PREPARING FOR YOUR APPOINTMENT

If you take your child to a doctor, make the most of your time by writing down information the doctor will need before you go, including:

Any signs and symptoms your child is experiencing
How long your child has been having signs and symptoms
Whether your child has been in child care or other environments where the disease might be spread
Any questions you have

Some questions you might want to ask your doctor include:

What's the likely cause of the symptoms?
Are there other possible causes?
Will my child need to undergo any tests?
What's the best treatment approach?
Is there a need to take medicine?
What can I do at home to make my child more comfortable?

What to expect from your doctor

Some questions the doctor may ask include:

When did symptoms first begin?
How severe are the symptoms?
Has your child recently been exposed to anyone who was sick?
Have you heard of any illnesses at your child's school or day care?
Does anything seem to improve the symptoms?
Does anything appear to worsen the symptoms?

What you can do in the meantime

To help lessen discomfort, doctors often recommend:

Getting rest
Drinking fluids — milk-based fluids may be easier to tolerate than acidic liquids, such as juice or soda
Taking over-the-counter pain relievers other than aspirin, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others), if needed, but they're not necessary for low-grade fevers
Using mouthwash or oral spray to numb pain

TESTS AND DIAGNOSIS

Your doctor will likely be able to distinguish hand-foot-and-mouth disease from other types of viral infections by evaluating:

The age of the affected person
The pattern of signs and symptoms
The appearance of the rash or sores

A throat swab or stool specimen may be taken and sent to the laboratory to determine which virus caused the illness. However, your doctor probably won't need this type of testing to diagnose hand-foot-and-mouth disease.

TREATMENTS AND DRUGS

There's no specific treatment for hand-foot-and-mouth disease. Signs and symptoms of hand-foot-and-mouth disease usually clear up in seven to 10 days.

A topical oral anesthetic may help relieve the pain of mouth sores. Over-the-counter pain medications other than aspirin, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others), may help relieve general discomfort.

LIFESTYLE AND HOME REMEDIES

Certain foods and beverages may irritate blisters on the tongue or in the mouth or throat. Try these tips to help make blister soreness less bothersome and eating and drinking more tolerable:

Suck on ice pops or ice chips
Eat ice cream or sherbet
Drink cold beverages, such as milk or ice water
Avoid acidic foods and beverages, such as citrus fruits, fruit drinks and soda
Avoid salty or spicy foods
Eat soft foods that don't require much chewing
Rinse your mouth with warm water after meals

If your child is able to rinse without swallowing, swishing the inside of his or her mouth with warm salt water may be soothing. Mix 1/2 teaspoon (2.5 milliliters) of salt with 1 cup (237 milliliters) of warm water. Have your child rinse with this solution several times a day, or as often as needed to help reduce the pain and inflammation of mouth and throat sores caused by hand-foot-and-mouth disease.

The public health nurse is presenting a health promotion class to a group of new mothers. How should the nurse best define health?

2016-04-07T19:46:00.000-07:00

Ans: D
Feedback:
The World Health Organization (WHO) defines health in the preamble to its
constitution as a state of complete physical, mental, and social well-being and not
merely the absence of disease and infirmity. The other answers are incorrect because
they are not congruent with the WHO definition of health.

Henoch-Schonlein purpura | disorder that causes inflammation and bleeding

2016-04-06T03:31:00.001-07:00

DEFINITION

Henoch-Schonlein purpura (HEN-awk SHURN-line PUR-pu-ruh) is a disorder that causes inflammation and bleeding in the small blood vessels in your skin, joints, intestines and kidneys.
The most striking feature of Henoch-Schonlein purura is a purplish rash, typically on the lower legs and buttocks. Henoch-Schonlein purpura can also cause abdominal pain and aching joints. Rarely serious kidney damage can occur.
Although Henoch-Schonlein purpura can affect anyone, it's most common in children between the ages of 2 and 6. Henoch-Schonlein purpura usually improves on its own. Medical care is generally needed if the disorder affects the kidneys.

SYMPTOMS

There are four main characteristics of Henoch-Schonlein purpura, although not everyone with the disease develops all four. They include:

Rash (purpura). Reddish-purple spots, which look like bruises, are the most distinctive and universal sign of Henoch-Schonlein purpura. The rash develops mainly on the buttocks, legs and feet, but it can also appear on the arms, face and trunk and may be worse in areas of pressure, such as the sock line and waistline.
Swollen, sore joints (arthritis). People with Henoch-Schonlein purpura often have painful, swollen joints — mainly in the knees and ankles. Joint pain sometimes precedes the classical rash by one or two days. These symptoms subside when the disease clears and leave no lasting damage.
Gastrointestinal symptoms. Many children with Henoch-Schonlein purpura develop gastrointestinal symptoms, such as abdominal pain, nausea, vomiting or bloody stools. These symptoms sometimes occur before the rash appears.
Kidney involvement. Henoch-Schonlein purpura can also affect the kidneys. In most cases, this shows up as protein or blood in the urine, which you may not even know is there unless you have a urine test done. Usually this goes away once the illness passes, but in a few cases, kidney disease may develop and even persist.

When to see a doctor

In some cases, Henoch-Schonlein purpura causes serious problems of the bowel or kidneys. See your doctor as soon as possible if you or your child develops the distinctive rash associated with Henoch-Schonlein purpura.

CAUSES

In Henoch-Schonlein purpura, some of the body's small blood vessels become inflamed, which can cause bleeding in the skin, joints, abdomen and kidneys. Why this initial inflammation develops isn't clear, although it may be the result of an overzealous immune system responding inappropriately to certain triggers.
Nearly half the people who have Henoch-Schonlein purpura developed the disease after an upper respiratory infection, such as a cold. Infectious triggers may include chickenpox, strep throat, measles and hepatitis. Other triggers may include certain medications, food, insect bites or exposure to cold weather.

RISK FACTORS

Factors that may increase the risk of developing Henoch-Schonlein purpura include:

Age. The disease affects primarily children and young adults with the majority of cases occurring in children between 2 and 6 years of age.
Sex. Henoch-Schonlein purpura is slightly more common in boys than girls.
Race. White and Asian children are more likely to develop Henoch-Schonlein purpura than black children are.
Time of year. Henoch-Schonlein purpura strikes mainly in autumn, winter and spring but rarely in summer.

COMPLICATIONS

For most people, symptoms improve within a month, leaving no lasting problems. Recurrences are fairly common, however.
Complications associated with Henoch-Schonlein purpura include:

Kidney damage. The most serious complication of Henoch-Schonlein purpura is kidney damage. Occasionally the damage is severe enough that dialysis or a kidney transplant may be needed.
Bowel obstruction. In rare cases, Henoch-Schonlein purpura can cause intussusception — a condition in which a section of the bowel folds into itself like a telescope, which prevents matter from moving through the bowel.

PREPARING FOR YOUR APPOINTMENT

You'll likely see your family doctor or your child's pediatrician for this condition, although you may be referred to a kidney specialist (nephrologist) if kidney complications develop. Here's some information that may help you get ready for your appointment and what to expect from your doctor.
Before your appointment, you may want to write a list of answers to the following questions:

When did the symptoms begin?
Did they come on suddenly or gradually?
Were you or was your child sick before the rash started?
What medications and supplements do you or your child take regularly?

Questions you may want to ask your doctor include:

What might be causing these symptoms?
What tests are needed to confirm the diagnosis?
Is this condition temporary or chronic?
How will I know if there's kidney damage? What if it turns up later on?
How is Henoch-Schonlein purpura treated?
What are the side effects of treatment?
Do you have any literature on this condition? Is there a website you can recommend where I can learn more?

What to expect from your doctor

Your doctor is likely to ask a number of questions, such as:

What did the rash look like when it first started?
Is the rash painful? Does it itch?
Do you or does your child have other symptoms, such as stomach pain or joint aches?

TESTS AND DIAGNOSIS

A diagnosis of Henoch-Schonlein purpura is fairly easy to make if the classic rash, joint pain and gastrointestinal symptoms are present. If some of these signs and symptoms are missing, your doctor may suggest one or more of the following tests.

Lab tests

Although no single test can confirm Henoch-Schonlein purpura, certain tests can help rule out other diseases and make a diagnosis of Henoch-Schonlein seem likely. They may include:

Blood tests. People who have Henoch-Schonlein purpura often have abnormal levels of a particular type of antibody in their blood.
Urine tests. Your urine may be tested for evidence of blood and to determine if your kidneys are still working properly.

Biopsies

If there are doubts about the rash or if other tests are inconclusive, your doctor may take a small sample of skin to be examined under a microscope. In cases of severe kidney involvement, your doctor may suggest a kidney biopsy to help guide treatment decisions.

Imaging tests

Your doctor may recommend an ultrasound to rule out other causes of abdominal pain and to check for possible complications, such as a bowel obstruction.

TREATMENTS AND DRUGS

Henoch-Schonlein purpura usually improves on its own within a month with no lasting ill effects. Bed rest, plenty of fluids and over-the-counter pain relievers may help.

Medications

The use of powerful corticosteroids, such as prednisone, in treating or preventing complications of Henoch-Schonlein purpura is controversial. They're most often used to treat severe gastrointestinal symptoms. Because these drugs can have serious side effects and their usefulness isn't clear, be sure to discuss the risks and benefits with your doctor.

Surgery

If a section of the bowel has folded in upon itself or ruptured, surgical repair will be necessary.

LIFESTYLE AND HOME REMEDIES

Children and adults with mild Henoch-Schonlein purpura should be kept comfortable while the disease runs its course. Bed rest, plenty of fluids and over-the-counter pain relievers may help.

H. pylori infection | bacteria infects of stomach

2016-04-06T03:24:00.001-07:00

DEFINITION

H. pylori infection occurs when a type of bacteria called Helicobacter pylori (H. pylori) infects your stomach. This usually happens during childhood. A common cause of peptic ulcers, H. pylori infection may be present in more than half the people in the world.
Most people don't realize they have H. pylori infection, because they never get sick from it. If you develop signs and symptoms of a peptic ulcer, your doctor will probably test you for H. pylori infection, because it can be treated with antibiotics.

SYMPTOMS

Most people with H. pylori infection will never have any signs or symptoms. It's not clear why this is, but some people may be born with more resistance to the harmful effects of H. pylori.
When signs or symptoms do occur with H. pylori infection, they may include:

An ache or burning pain in your abdomen
Abdominal pain that's worse when your stomach is empty
Nausea
Loss of appetite
Frequent burping
Bloating
Unintentional weight loss

When to see a doctor

Make an appointment with your doctor if you notice any persistent signs and symptoms that worry you. Seek immediate medical help if you experience:

Severe or persistent abdominal pain
Difficulty swallowing
Bloody or black tarry stools
Bloody or black vomit or vomit that looks like coffee grounds

CAUSES

The exact way H. pylori infects someone is still unknown. H. pylori bacteria may be passed from person to person through direct contact with saliva, vomit or fecal matter. H. pylori may also be spread through contaminated food or water.

RISK FACTORS

H. pylori is often contracted in childhood. Risk factors for H. pylori infection are related to living conditions in your childhood, such as:

Living in crowded conditions. You have a greater risk of H. pylori infection if you live in a home with many other people.
Living without a reliable supply of clean water. Having a reliable supply of clean, running water helps reduce the risk of H. pylori.
Living in a developing country. People living in developing countries, where crowded and unsanitary living conditions may be more common, have a higher risk of H. pylori infection.
Living with someone who has an H. pylori infection. If someone you live with has H. pylori, you're more likely to also have H. pylori.

COMPLICATIONS

Complications associated with H. pylori infection include:

Ulcers. H. pylori can damage the protective lining of your stomach and small intestine. This can allow stomach acid to create an open sore (ulcer). About 10 percent of people with H. pylori will develop an ulcer.
Inflammation of the stomach lining.H. pylori infection can irritate your stomach, causing inflammation (gastritis).
Stomach cancer. H. pylori infection is a strong risk factor for certain types of stomach cancer.

PREPARING FOR YOUR APPOINTMENT

See your primary care doctor if you have signs or symptoms that indicate a complication of H. pylori infection. Your doctor may test and treat you for H. pylori infection, or refer you to a specialist who treats diseases of the digestive system (gastroenterologist).
Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well-prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet. Before your appointment, you might want to write a list that answers the following questions:

When did your symptoms begin?
Does anything make them better or worse?
Have your parents or siblings ever experienced similar problems?
What medications or supplements do you take regularly?

Your time with your doctor is limited, so preparing a list of questions to ask may help you make the most of your time together. For H. pylori infection, some basic questions to ask your doctor include:

How did H. pylori infection cause the complications I'm experiencing?
Can H. pylori cause other complications?
What kinds of tests do I need?
Do these tests require any special preparation?
What treatments are available?
How will I know if the treatment worked?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask additional questions that occur to you during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may allow more time to cover other points you want to address. Your doctor may ask:

Have your symptoms been continuous or occasional?
How severe are your symptoms?
Do you take any over-the-counter pain relievers such as aspirin, ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve)?

TESTS AND DIAGNOSIS

Tests and procedures used to determine whether you have an H. pylori infection include:

Blood test. Analysis of a blood sample may reveal evidence of an active or previous H. pylori infection in your body. However, breath and stool tests are better at detecting active H. pylori infections than is a blood test.
Breath test. During a breath test, you swallow a pill, liquid or pudding that contains tagged carbon molecules. If you have an H. pylori infection, carbon is released when the solution is broken down in your stomach.
Your body absorbs the carbon and expels it when you exhale. You exhale into a bag, and your doctor uses a special device to detect the carbon molecules.
Acid-suppressing drugs known as proton pump inhibitors (PPIs), bismuth subsalicylate (Pepto-Bismol) and antibiotics can interfere with the accuracy of this test. Your doctor will ask you to stop taking those medications for a week or two weeks before you have the test. This test is available for adults and children.
Stool test. A laboratory test called a stool antigen test looks for foreign proteins (antigens) associated with H. pylori infection in your stool. As with the breath test, PPIs and bismuth subsalicylate can affect the results of this test, so your doctor will ask you to stop taking them for two weeks before the test.
Scope test. You'll be sedated for this test, known as an endoscopy exam. During the exam, your doctor threads a long flexible tube equipped with a tiny camera (endoscope) down your throat and esophagus and into your stomach and duodenum. This instrument allows your doctor to view any irregularities in your upper digestive tract and remove tissue samples (biopsy).
These samples are analyzed for H. pylori infection. This test isn't generally recommended solely to diagnose an H. pylori infection because it's more invasive than a breath or stool test, but it may be used to diagnose H. pylori ulcers or if it's needed to rule out other digestive conditions.

TREATMENTS AND DRUGS

H. pylori infections are usually treated with two varieties of antibiotics at once, to help prevent the bacteria from developing a resistance to one particular antibiotic. Your doctor also will prescribe an acid-suppressing drug, to help your stomach lining heal.
Drugs that can suppress acid include:

Proton pump inhibitors (PPIs). These drugs stop acid from being produced in the stomach. Some examples of PPIs are omeprazole (Prilosec, others), esomeprazole (Nexium, others), lansoprazole (Prevacid, others) and pantoprazole (Protonix, others).
Histamine (H-2) blockers. These medications block a substance called histamine, which triggers acid production. Examples include cimetidine (Tagamet) and ranitidine (Zantac).
Bismuth subsalicylate. More commonly known as Pepto-Bismol, this drug works by coating the ulcer and protecting from stomach acid.

Your doctor may recommend that you undergo testing for H. pylori at least four weeks after your treatment. If the tests show the treatment was unsuccessful, you may undergo another round of treatment with a different combination of antibiotic medications.

LIFESTYLE AND HOME REMEDIES

Which of the following statements related to prostatic cancer is/ are true?

2016-04-06T01:28:00.000-07:00

Correct answer: D

The majority of prostate cancers are adenocarcinomas
Family history is a risk factor for prostate cancer. A first degree relative with prostate cancer more than doubles a man's risk. Alpha-adrenergic blockers do relax smooth muscle of the bladder and prostate, but finasteride is an anti-androgen agent, not an alpha-adrenergic blocker. Prostate cancer is less commonin Asian-American and Hispanic/Latino men than in African-Americans.
Reference: Craven, Heather. Core Curriculum for Medical-Surgical Nursing. Pitman, NJ: ACADEMY OF MEDICAL SURGICAL NURSING; 4 edition (April 2009). Print. Ch 20, Pg 357.

Charcot-Marie-Tooth disease | Hereditary disorder

2016-04-05T05:47:00.001-07:00

DEFINITION

Charcot (shahr-KOH)-Marie-Tooth disease is a group of hereditary disorders that damage the nerves in your arms and legs (peripheral nerves). Charcot-Marie-Tooth is also known as hereditary motor and sensory neuropathy.

The main signs and symptoms of Charcot-Marie-Tooth disease are muscle weakness and decreased muscle size. You may also notice decreased sensation in affected areas. Foot deformities such as hammertoes and high arches are common in Charcot-Marie-Tooth disease. Symptoms usually begin in your feet and legs, but they may eventually affect your hands and arms.

Muscle weakness and loss of balance can make walking difficult. Symptoms of Charcot-Marie-Tooth disease typically appear in adolescence or early adulthood, but this condition can develop in midlife too.

SYMPTOMS

Signs and symptoms of Charcot-Marie-Tooth disease may include:

Weakness in your legs, ankles and feet
Loss of muscle bulk in legs and feet
High foot arches
Curled toes (hammertoes)
Decreased ability to run
Difficulty lifting your foot at the ankle (footdrop)
Awkward or higher than normal step (gait)
Frequent tripping or falling
Decreased sensation or a loss of feeling in your legs and feet

As Charcot-Marie-Tooth disease progresses, symptoms may not be limited to the feet and legs but may also involve the hands and arms. The severity of symptoms can vary greatly from person to person. This is true even among family members.

CAUSES

Charcot-Marie-Tooth disease is a group of related conditions all caused by inherited mutations in genes involved with the structure and function of the nerves that serve your feet, legs, hands and arms.

In some cases, these genetic mutations result in damage to the nerve itself. Other mutations damage the myelin sheath, the protective coating that surrounds the nerve. The end result, however, is the same — weaker messages traveling between your extremities and your brain.

That means some of the muscles in your feet may not receive your brain's signal to contract, so you're more likely to trip and fall. And your brain may not receive pain messages from your feet, so if you've rubbed a blister on your toe, for example, it may get infected without your realizing it.

RISK FACTORS

Charcot-Marie-Tooth disease is hereditary, so you're at higher risk of developing the disorder if anyone in your immediate family has had the disease. Other causes of neuropathies, such as diabetes, may cause symptoms of or worsen Charcot-Marie-Tooth disease.

COMPLICATIONS

Complications of Charcot-Marie-Tooth disease vary in severity from person to person, with foot abnormalities and difficulty walking generally being the most serious problems. Muscle weakness may also increase, and injury to areas of the body with decreased sensation may occur.

PREPARING FOR YOUR APPOINTMENT

You might first discuss your symptoms with your family doctor, but he or she will probably refer you to a neurologist for further evaluation.

Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to arrive well prepared. Here's some information to help you get ready for your appointment and know what to expect from your doctor.

What you can do

Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
Make a list of all medications, vitamins or supplements that you're taking.
Ask a family member or friend to come with you, if possible. Sometimes it can be difficult to remember all of the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
Write down questions to ask your doctor.

Your time with your doctor may be limited, so preparing a list of questions can help you make the most of your time together. For Charcot-Marie-Tooth disease, some basic questions to ask your doctor include:

What's the most likely cause of my symptoms?
What kinds of tests do I need? Do these tests require any special preparation?
Will this condition go away, or will I always have it?
What treatments are available, and which do you recommend for me?
What are the possible side effects for treatment?
I have other health conditions. How can I best manage these conditions together?
Do I need to follow any activity restrictions?
Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

When did you begin experiencing symptoms?
How severe are your symptoms?
Do you have symptoms all the time, or do they come and go?
Does anything seem to make your symptoms better?
Does anything make your symptoms worse?
Does anyone in your family have similar symptoms?
Have you or others in your family had genetic testing to confirm the diagnosis?

TESTS AND DIAGNOSIS

During the physical exam, your doctor may check for:

Signs of muscle weakness in your arms, legs, hands and feet
Decreased muscle bulk in your lower legs, resulting in an inverted champagne bottle appearance
Reduced reflexes
Sensory loss in your feet and hands
Foot deformities, such as high arches or hammertoes
Other orthopedic problems, such as mild scoliosis or hip dysplasia

Your doctor may also recommend the following tests, which can help provide information about the extent of your nerve damage and what may be causing it.

Nerve conduction studies. These tests measure the strength and speed of electrical signals transmitted through your nerves. Electrodes are placed on your skin and deliver small electric shocks that stimulate the nerve. Delayed or weak responses may indicate a nerve disorder such as Charcot-Marie-Tooth disease.
Electromyography (EMG). A thin needle electrode is inserted through your skin into the muscle to be tested. Electrical activity is measured as you relax and as you gently tighten the muscle. Your doctor may be able to determine the distribution of the disease by testing different muscles.
Nerve biopsy. A small piece of peripheral nerve is taken from the calf of your leg through an incision in your skin. Laboratory analysis of the nerve distinguishes Charcot-Marie-Tooth disease from other nerve disorders.
Genetic testing. These tests, which can detect the most common genetic defects known to cause Charcot-Marie-Tooth disease, are done by blood sample. Genetic testing may give people with the disorder more information for family planning. It's important to have genetic counseling before undergoing genetic testing so you know the pros and cons of testing.

TREATMENTS AND DRUGS

There's no cure for Charcot-Marie-Tooth disease. But, the disease generally progresses slowly, and the expected length of life isn't shortened by the disorder.

There are some treatments to help you manage Charcot-Marie-Tooth disease.

Medications

Some, but not all people with the disease may experience pain due to muscle cramps or nerve damage. If pain is an issue for you, prescription pain medication may help control your pain.

Therapy

Physical therapy. Physical therapy can help strengthen and stretch your muscles to prevent muscle tightening and loss. A physical therapy program usually consists of low-impact exercises and stretching techniques guided by a trained physical therapist and approved by your doctor. Started early and followed regularly, physical therapy can play an important part in delaying nerve deterioration and muscle weakness before disability occurs.
Occupational therapy. Some people with Charcot-Marie-Tooth disease may experience weakness in their arms and hands, causing difficulty with gripping and finger movement. Normal daily activities, such as fastening buttons or writing, can become difficult. Occupational therapy can help you deal with such challenges through the use of assistive devices, such as special rubber grips on doorknobs or clothing with snaps instead of buttons.
Orthopedic devices. Many people with Charcot-Marie-Tooth disease require the help of certain orthopedic devices to maintain everyday mobility and to prevent injury. Leg and ankle braces or splints can provide stability during walking and climbing stairs.
Wearing boots or high-top shoes may provide additional ankle support. Custom-made shoes or shoe inserts may improve your gait. If you have hand weakness and difficulty with gripping and holding things, thumb splints may help.

Surgery

If foot deformities are severe, corrective foot surgery may help alleviate pain and improve your ability to walk. But surgery can't improve weakness or loss of sensation.

Future treatments

Researchers are investigating a number of potential therapies that may one day treat Charcot-Marie-Tooth disease. Gene therapy might be able to fix the genetic defect that causes the disease, while other treatments are focusing on correcting the damage done by the defective genes. These potential therapies are all in the earliest stages, and aren't yet being studied in humans. However, the may offer hope for the future.

LIFESTYLE AND HOME REMEDIES

Certain tactics may prevent complications caused by Charcot-Marie-Tooth disease and improve your ability to manage the effects of the disorder.

Started early and followed regularly, at-home activities can provide protection and relief:

Stretch regularly. The goal of stretching is to improve or maintain the range of motion of your joints. Stretching improves your flexibility, balance and coordination. Stretching may also reduce your risk of injury. If you have Charcot-Marie-Tooth disease, regular stretching can prevent or reduce joint deformities that may result from uneven pulling of muscle on your bones.
Exercise daily. Exercising every day keeps your bones and muscles strong. Low-impact exercises, such as biking and swimming, are less stressful on fragile muscles and joints. By strengthening your muscles and bones, you can improve your balance and coordination, reducing your risk of falls.
Improve your stability. Muscle weakness associated with Charcot-Marie-Tooth disease may cause you to be unsteady on your feet, which can lead to falling and serious injury. Walking with a cane or a walker can increase your stability. Good lighting at night can help you avoid stumbling and falling.

Foot care is important

Because of foot deformities and loss of sensation, regular foot care is important to help relieve symptoms and to prevent complications:

Inspect your feet. Daily inspection of your feet is important to prevent calluses, ulcers, wounds and infections.
Take care of your nails. Cut your nails regularly. To avoid ingrown toenails and infections, cut straight across and avoid cutting into the nailbed edges. If you have trouble with this task, consider having your nails trimmed by a foot doctor (podiatrist).
Wear the right shoes. Use shoes that fit properly and are protective. Consider wearing boots or high-top shoes for ankle support. If you have foot deformities, such as a hammertoe, you may need to consider having shoes custom made.

Carbon monoxide poisoning | Air death

2016-04-04T18:18:00.001-07:00

DEFINITION

Carbon monoxide poisoning is an illness caused by exposure to too much carbon monoxide — a colorless, odorless and tasteless gas. Too much carbon monoxide in the air you breathe can greatly diminish your ability to absorb oxygen, leading to serious tissue damage. Carbon monoxide poisoning can lead to death.

Carbon monoxide is produced by appliances and other devices that generate combustion fumes, such as those that burn gas or other petroleum products, wood and other fuels. The danger occurs when too much carbon monoxide accumulates in a contained, poorly ventilated space.

Although the signs of carbon monoxide poisoning can be subtle, the condition is a life-threatening medical emergency. Get immediate care for anyone who may have carbon monoxide poisoning.

SYMPTOMS

Signs and symptoms of carbon monoxide poisoning may include:

Dull headache
Weakness
Dizziness
Nausea
Vomiting
Shortness of breath
Confusion
Blurred vision
Loss of consciousness

Carbon monoxide poisoning can be especially dangerous for people who are sleeping or intoxicated. The fumes may be fatal before anyone realizes there's a problem.

When to see a doctor

If you suspect you've been exposed to carbon monoxide, get into fresh air immediately and seek emergency medical care. If possible, open windows and doors on the way out of the house.

CAUSES

Carbon monoxide poisoning is caused by inhaling combustion fumes. When there's too much carbon monoxide in the air, your body replaces the oxygen in the hemoglobin of your red blood cells with carbon monoxide. This keeps life-sustaining oxygen from reaching your tissues and organs.

Various appliances fueled by wood or gas produce carbon monoxide, including:

Fuel-burning space heaters
Furnaces
Charcoal grills
Cooking ranges
Water heaters
Fireplaces
Portable generators
Wood-burning stoves
Car and truck engines

Normally the amount of carbon monoxide produced by these sources isn't cause for concern. But if appliances aren't kept in good working order or if they're used in a closed or partially closed space — such as using a charcoal grill indoors or running your car in a closed garage — the carbon monoxide can build to dangerous levels.

Smoke inhalation during a fire also can cause carbon monoxide poisoning.

RISK FACTORS

Exposure to carbon monoxide may be particularly dangerous for:

Unborn babies. Fetal blood cells take up carbon monoxide more readily than adult blood cells do. This makes unborn babies more susceptible to harm from carbon monoxide poisoning.
Children. Young children take breaths more frequently than adults, which may make them more susceptible to carbon monoxide poisoning.
Older adults. Elderly people who experience carbon monoxide poisoning may be more likely to develop brain damage.

COMPLICATIONS

Depending on the degree and length of exposure, carbon monoxide poisoning can cause:

Permanent brain damage
Damage to your heart, possibly leading to life-threatening cardiac complications years after the poisoning
Death

PREPARING FOR YOUR APPOINTMENT

If you or someone you're with develops signs or symptoms of carbon monoxide poisoning — headache, dizziness, nausea, vomiting, chest pain, confusion — get into fresh air immediately and call 911 or emergency medical help.

Hospital staff will need critical information as soon as you arrive. On the way to the hospital, try to prepare to answer questions about:

Possible sources of carbon monoxide exposure
Signs or symptoms, and when they started
Any mental impairment, including confusion and memory problems
Any loss of consciousness
Other medical conditions with which the affected person has been diagnosed, including pregnancy
Smoking habits

TESTS AND DIAGNOSIS

If you're brought to an emergency room with suspected carbon monoxide poisoning, you may begin treatment immediately. To confirm your diagnosis, the doctor may have a blood sample taken to test for carbon monoxide in your blood.

TREATMENTS AND DRUGS

Once you're at the hospital, treatment may involve:

Breathing pure oxygen. In the emergency room, you may breathe pure oxygen through a mask placed over your nose and mouth. This helps oxygen reach your organs and tissues. If you can't breathe on your own, a machine (ventilator) may do the breathing for you.
Spending time in a pressurized oxygen chamber. In some cases, hyperbaric oxygen therapy is recommended. With this therapy, you're placed in a full-body pressurized chamber. Inside the chamber, air pressure is more than twice as high as normal atmospheric pressure. This speeds the replacement of carbon monoxide with oxygen in your blood. Hyperbaric oxygen therapy may be used in cases of severe carbon monoxide poisoning. It may also be recommended for pregnant women because unborn babies are more susceptible to damage from carbon monoxide poisoning.

LIFESTYLE AND HOME REMEDIES

Carbon monoxide poisoning is an illness caused by exposure to too much carbon monoxide — a colorless, odorless and tasteless gas. Too much carbon monoxide in the air you breathe can greatly diminish your ability to absorb oxygen, leading to serious tissue damage. Carbon monoxide poisoning can lead to death.

Although the signs of carbon monoxide poisoning can be subtle, the condition is a life-threatening medical emergency. Get immediate care for anyone who may have carbon monoxide poisoning.

IELTS Advantage site revealed the 7 Things All Band 7-9 Students Have in Common

2016-04-04T18:05:00.001-07:00

I received email from ieltsadvantage.com . This site is very informative and you can get more tips here before taking IELTS. All materials are free and written by an experienced IELTS teacher. The site is updated daily with hints and tips, full lessons and sample answers. All you need to get the IELTS score you deserve. The author of this site is Christopher Pell. He is an English teacher dedicated to helping people get the IELTS scores they need. For me, the best site for Ielts takers.

below, the article I received thru my email. I just copied it.

7 Things All Band 7-9 Students Do
The following is a list of things that I have noticed that all of my students who get a Band 7, 8 or 9 in IELTS Writing Task 2 do.

1. They make their opinion clear throughout their essay. They make their opinion clear in the introduction, they support this opinion in the main body paragraphs and then they reiterate this opinion in the conclusion.
2. They plan their essays for at least 5 minutes before they start writing. Planning helps you to understand the question, think of relevant ideas and structure your essay. It also means that when you do start writing you know exactly what to write and you therefore make fewer mistakes.
3. They read and listen to English every day. Reading and listening to English every day not only improves your grammar and vocabulary, but also makes it easier to think of relevant ideas during your test.
4. They fully develop their main ideas. Your ideas should all be supported with clear explanations and specific examples. It is more important to have a couple of well developed ideas than lots of undeveloped ideas. Think quality, not quantity.
5. They understand that the true purpose of writing is clear communication. The purpose of writing is not to show the reader how great your vocabulary and grammar is, it is to clearly convey meaning. Focus on writing clearly and you will do very well.
6. They know the key to high grammar scores is accuracy.
7. They only use cohesive devices when absolutely necessary. Good writers only use cohesive devices (linking words) when they have to. Bad writers overuse them

Reference: http://ieltsadvantage.com/7-things-band-9/

Polycystic Ovary Syndrome (PCOS) | health problem that can affect a woman's

2016-04-04T10:53:00.001-07:00

What is polycystic ovary syndrome (PCOS)?

Polycystic (pah-lee-SIS-tik) ovary syndrome (PCOS) is a health problem that can affect a woman's:

Menstrual cycle
Ability to have children
Hormones
Heart
Blood vessels
Appearance

With PCOS, women typically have:

High levels of androgens. These are sometimes called male hormones, though females also make them.
Missed or irregular periods (monthly bleeding)
Many small cysts (fluid-filled sacs) in their ovaries

How many women have PCOS?

Between 1 in 10 and 1 in 20 women of childbearing age has PCOS. As many as 5 million women in the United States may be affected. It can occur in girls as young as 11 years old.

What causes PCOS?

The cause of PCOS is unknown. But most experts think that several factors, including genetics, could play a role. Women with PCOS are more likely to have a mother or sister with PCOS.

A main underlying problem with PCOS is a hormonal imbalance. In women with PCOS, the ovaries make more androgens than normal. Androgens are male hormones that females also make. High levels of these hormones affect the development and release of eggs during ovulation.

Researchers also think insulin may be linked to PCOS. Insulin is a hormone that controls the change of sugar, starches, and other food into energy for the body to use or store. Many women with PCOS have too much insulin in their bodies because they have problems using it. Excess insulin appears to increase production of androgen. High androgen levels can lead to:

Acne
Excessive hair growth
Weight gain
Problems with ovulation

What are the symptoms of PCOS?

The symptoms of PCOS can vary from woman to woman. Some of the symptoms of PCOS include:

Infertility (not able to get pregnant) because of not ovulating. In fact, PCOS is the most common cause of female infertility.
Infrequent, absent, and/or irregular menstrual periods
Hirsutism — increased hair growth on the face, chest, stomach, back, thumbs, or toes
Cysts on the ovaries
Acne, oily skin, or dandruff
Weight gain or obesity, usually with extra weight around the waist
Male-pattern baldness or thinning hair
Patches of skin on the neck, arms, breasts, or thighs that are thick and dark brown or black
Skin tags — excess flaps of skin in the armpits or neck area
Pelvic pain
Anxiety or depression
Sleep apnea — when breathing stops for short periods of time while asleep

Why do women with PCOS have trouble with their menstrual cycle and fertility?

The ovaries, where a woman’s eggs are produced, have tiny fluid-filled sacs called follicles or cysts. As the egg grows, the follicle builds up fluid. When the egg matures, the follicle breaks open, the egg is released, and the egg travels through the fallopian tube to the uterus (womb) for fertilization. This is called ovulation.

In women with PCOS, the ovary doesn't make all of the hormones it needs for an egg to fully mature. The follicles may start to grow and build up fluid but ovulation does not occur. Instead, some follicles may remain as cysts. For these reasons, ovulation does not occur and the hormone progesterone is not made. Without progesterone, a woman's menstrual cycle is irregular or absent. Plus, the ovaries make male hormones, which also prevent ovulation.

Does PCOS change at menopause?

Yes and no. PCOS affects many systems in the body. So, many symptoms may persist even though ovarian function and hormone levels change as a woman nears menopause. For instance, excessive hair growth continues, and male-pattern baldness or thinning hair gets worse after menopause. Also, the risks of complications (health problems) from PCOS, such as heart attack, stroke, and diabetes, increase as a woman gets older.

How do I know if I have PCOS?

There is no single test to diagnose PCOS. Your doctor will take the following steps to find out if you have PCOS or if something else is causing your symptoms.

Medical history. Your doctor will ask about your menstrual periods, weight changes, and other symptoms.

Physical exam. Your doctor will want to measure your blood pressure, body mass index (BMI), and waist size. He or she also will check the areas of increased hair growth. You should try to allow the natural hair to grow for a few days before the visit.

Pelvic exam. Your doctor might want to check to see if your ovaries are enlarged or swollen by the increased number of small cysts.

Blood tests. Your doctor may check the androgen hormone and glucose (sugar) levels in your blood.

Vaginal ultrasound (sonogram). Your doctor may perform a test that uses sound waves to take pictures of the pelvic area. It might be used to examine your ovaries for cysts and check the endometrium (lining of the womb). This lining may become thicker if your periods are not regular.

How is PCOS treated?

Because there is no cure for PCOS, it needs to be managed to prevent problems. Treatment goals are based on your symptoms, whether or not you want to become pregnant, and lowering your chances of getting heart disease and diabetes. Many women will need a combination of treatments to meet these goals. Some treatments for PCOS include:

Lifestyle modification. Many women with PCOS are overweight or obese, which can cause health problems. You can help manage your PCOS by eating healthy and exercising to keep your weight at a healthy level. Healthy eating tips include:

Limiting processed foods and foods with added sugars
Adding more whole-grain products, fruits, vegetables, and lean meats to your diet

This helps to lower blood glucose (sugar) levels, improve the body's use of insulin, and normalize hormone levels in your body. Even a 10 percent loss in body weight can restore a normal period and make your cycle more regular.

Birth control pills. For women who don't want to get pregnant, birth control pills can:

Control menstrual cycles
Reduce male hormone levels
Help to clear acne

Keep in mind that the menstrual cycle will become abnormal again if the pill is stopped. Women may also think about taking a pill that only has progesterone, like Provera, to control the menstrual cycle and reduce the risk of endometrial cancer. But, progesterone alone does not help reduce acne and hair growth.

Diabetes medications. The medicine metformin (Glucophage) is used to treat type 2 diabetes. It has also been found to help with PCOS symptoms, though it isn’t approved by the U.S Food and Drug Administration (FDA) for this use. Metformin affects the way insulin controls blood glucose (sugar) and lowers testosterone production. It slows the growth of abnormal hair and, after a few months of use, may help ovulation to return. Recent research has shown metformin to have other positive effects, such as decreased body mass and improved cholesterol levels. Metformin will not cause a person to become diabetic.

Fertility medications. Lack of ovulation is usually the reason for fertility problems in women with PCOS. Several medications that stimulate ovulation can help women with PCOS become pregnant. Even so, other reasons for infertility in both the woman and man should be ruled out before fertility medications are used. Also, some fertility medications increase the risk for multiple births (twins, triplets). Treatment options include:

Clomiphene (Clomid, Serophene) — the first choice therapy to stimulate ovulation for most patients.
Metformin taken with clomiphene — may be tried if clomiphene alone fails. The combination may help women with PCOS ovulate on lower doses of medication.
Gonadotropins — given as shots, but are more expensive and raise the risk of multiple births compared to clomiphene.

Another option is in vitro fertilization (IVF). IVF offers the best chance of becoming pregnant in any given cycle. It also gives doctors better control over the chance of multiple births. But, IVF is very costly.

Surgery. "Ovarian drilling" is a surgery that may increase the chance of ovulation. It’s sometimes used when a woman does not respond to fertility medicines. The doctor makes a very small cut above or below the navel (belly button) and inserts a small tool that acts like a telescope into the abdomen (stomach). This is called laparoscopy. The doctor then punctures the ovary with a small needle carrying an electric current to destroy a small portion of the ovary. This procedure carries a risk of developing scar tissue on the ovary. This surgery can lower male hormone levels and help with ovulation. But, these effects may only last a few months. This treatment doesn't help with loss of scalp hair or increased hair growth on other parts of the body.

Medicine for increased hair growth or extra male hormones. Medicines called anti-androgens may reduce hair growth and clear acne. Spironolactone (Aldactone), first used to treat high blood pressure, has been shown to reduce the impact of male hormones on hair growth in women. Finasteride (Propecia), a medicine taken by men for hair loss, has the same effect. Anti-androgens are often combined with birth control pills. These medications should not be taken if you are trying to become pregnant.

Before taking Aldactone, tell your doctor if you are pregnant or plan to become pregnant. Do not breastfeed while taking this medicine. Women who may become pregnant should not handle Propecia.

Other options include:

Vaniqa (van-ik-uh) cream to reduce facial hair
Laser hair removal or electrolysis to remove hair
Hormonal treatment to keep new hair from growing

Other treatments. Some research has shown that bariatric (weight loss) surgery may be effective in resolving PCOS in morbidly obese women. Morbid obesity means having a BMI of more than 40, or a BMI of 35 to 40 with an obesity-related disease. The drug troglitazone was shown to help women with PCOS. But, it was taken off the market because it caused liver problems. Similar drugs without the same side effect are being tested in small trials.

Researchers continue to search for new ways to treat PCOS. To learn more about current PCOS treatment studies, visitClinicalTrials.gov . Talk to your doctor about whether taking part in a clinical trial might be right for you.

How does PCOS affect a woman while pregnant?

Women with PCOS appear to have higher rates of:

Miscarriage
Gestational diabetes
Pregnancy-induced high blood pressure (preeclampsia)
Premature delivery

Babies born to women with PCOS have a higher risk of spending time in a neonatal intensive care unit or of dying before, during, or shortly after birth. Most of the time, these problems occur in multiple-birth babies (twins, triplets).

Researchers are studying whether the diabetes medicine metformin can prevent or reduce the chances of having problems while pregnant. Metformin also lowers male hormone levels and limits weight gain in women who are obese when they get pregnant.

Metformin is an FDA pregnancy category B drug. It does not appear to cause major birth defects or other problems in pregnant women. But, there have only been a few studies of metformin use in pregnant women to confirm its safety. Talk to your doctor about taking metformin if you are pregnant or are trying to become pregnant. Also, metformin is passed through breastmilk. Talk with your doctor about metformin use if you are a nursing mother.

Does PCOS put women at risk for other health problems?

Women with PCOS have greater chances of developing several serious health conditions, including life-threatening diseases. Recent studies found that:

More than 50 percent of women with PCOS will have diabetes or pre-diabetes (impaired glucose tolerance) before the age of 40.
The risk of heart attack is 4 to 7 times higher in women with PCOS than women of the same age without PCOS.
Women with PCOS are at greater risk of having high blood pressure.
Women with PCOS have high levels of LDL (bad) cholesterol and low levels of HDL (good) cholesterol.
Women with PCOS can develop sleep apnea. This is when breathing stops for short periods of time during sleep.

Women with PCOS may also develop anxiety and depression. It is important to talk to your doctor about treatment for these mental health conditions.

Women with PCOS are also at risk for endometrial cancer. Irregular menstrual periods and the lack of ovulation cause women to produce the hormone estrogen, but not the hormone progesterone. Progesterone causes the endometrium (lining of the womb) to shed each month as a menstrual period. Without progesterone, the endometrium becomes thick, which can cause heavy or irregular bleeding. Over time, this can lead to endometrial hyperplasia, when the lining grows too much, and cancer.