BIPOLAR DISORDERS

DOC I HAVE BIPOLAR DISORDER

Bipolar disorder is a condition in which people swings between periods of a very good or irritable mood and depression.

The exact cause is unknown, but it can occur in families of people with bipolar disorder.
Bipolar disorder affects both men and women equally.
It usually begins between ages 15 - 25.

The Types of bipolar disorder:
1.bipolar disorder type I have had at least one manic episode and periods of major depression.

2.bipolar disorder type II have never had full mania.
There are periods where there is high energy levels and impulsiveness but that is not as extreme as mania (called hypomania).
This hypomania episodes alternate with periods of depression.

3.mild form of bipolar disorder called cycloymia involves less severe mood swings alternating between hypomania and mild depression.

Triggers of a manic episode in people with bipolar disorder:
1.Life changes such as births
2.Medications such as antidepressants or corticosteroids
3.Periods of insomnia
4.Recreational drug usage

Symptoms
A.Manic phase -last from days to months:
1. Distracted easily
2.Little or no need for sleep
3.Poor judgement
4.Poor control of temper
5.Reckless behavior and poor self control
6.Binge eating, drinking, and/or drug usage
7.Sex with multiple partners (promiscuity)
8.Spending sprees
9.Very elevated mood
10.Hyperactivity
11.Increased physical energy
12.Over Talking
13.Very high self-esteem (false beliefs about self or abilities)
14.Very involved in activities
15.Upset easily (agitated or irritated)

These symptoms of mania occur usually with bipolar disorder I or Manic depression.
With bipolar disorder II, the symptoms of mania are similar but less intense.

B.Depressed phase of both types of bipolar disorder:
1.Daily poor mood or sadness
2.Problems in concentrating, remembering, or making decisions
3.Eating disorders
4.Loss of appetite and weight
5.Overeating and weight gain
6.Tiredness or lack of energy
7.Feels worthless, hopeless, or guilty
8.Loss of pleasure in activities once enjoyable
9.Loss of personal self-esteem
10.Thinking of death and suicide
11.Problem getting to sleep or sleeping too much
12.Avoiding friends or activities that were once enjoyable

There is a high tendency of suicide with bipolar disorder.
Abuse of alcohol or other substances  can make the symptoms and suicide risk worse.

Sometimes the two phases of manic attack and depression may overlap.
Manic and depressive symptoms can occur together or quickly one after the other in what is called a mixed state.

Diagnosis can be obtained from:

1.family medical history of bipolar disorder
2.history of recent mood swings and the length of time of mood swings
3.thorough examination to look for illnesses that may cause the symptoms
4.laboratory tests to check for thyroid problems or drug levels
5.consultation of family members regarding patient's behavior
6. medical history of any medical problems and  medications taken
7.Observation of behavior and mood

Note that drug usage may cause some symptoms but does not rule out bipolar affective disorder.
Drug abuse may be a symptom of bipolar disorder.

A Simple Guide to Stroke

A Simple Guide to Stroke
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What is a Stroke?
---------------------

A stroke is also known as a cerebrovascular accident(CVA).
It happens when the blood vessel to a part of the brain is blocked(due to a blood clot) or burst.
The brain cells in that part cannot get the oxygen and nutrients so they are damaged and unable to function.

What Causes Stroke?
-------------------

A stroke occurs when:

1.there is a blockage of an artery in the brain by a blood clot, piece of fat or air bubble travelling in the blood from another part of the body.
This leads to lack of supply of oxygen and nutrients to the brain cells.
As a result the brain cells died leading to loss of function of the part of the body controlled by the brain cells.

2.there is a rupture of an artery in the brain leading to internal bleeding and damage to the brain cells.
This can be caused by high blood pressure, head injury or a weak artery wall from birth(aneurym).

3.there is compression by a brain tumour or tightening of the artery wall.

What are the risk factors in Stroke:
-------------------------------------

1.High Blood pressure-
Hypertension damages the arteries of the brain by causing bleeding or blockage

2.High cholesterol-
Cholesterol deposit thickens the walls of the arteries, making them narrow and reducing blood flow.

3.Diabetes mellitus
The high blood sugar level thickens the arteries hard and make the blood thick so that less blood is able to flow through them.

4.Heart disease
People with heart disease are more likely to have poor blood flow to the brain.
Some heart disease like atrial fibrillation can throw out blood clots which can block the blood supply of the brain

5.Obesity
A BMI of 23.0kg/m² and above increases the risk of getting high blood pressure, diabetes and stroke.
6.Smoking
Tobacco smoke narrows arteries and reduces oxygen supply to the brain.

7.Drinking of Alcohol
Alcohol can cause liver and kidney damage. increase blood pressure and affect diabetes

8.Cerebral aneurysm, tumour,cancer metastasis,
These can cause blockage and bleeding in the arteries of the brain

9.Trauma or surgery of the brain
These can cause bleeding or form blood clots in the arteries of the brain

10.Stress
Repeated stress, if poorly controlled, can lead to high blood pressure.

What is a temporary Stroke or Transient ischaemic attack(TIA)?
--------------------------------------------------------------

It is a early warning sign of a stroke .
TIA occurs when blood supply to a part of the brain is temporarily cut off causing slight damage to the brain cell.

It may last seconds to up to 24 hours.

The symptoms of a TIA are often vague and temporary:

1.temporary numbness or weakness occurring suddenly in one arm or leg or on one side of the face

2.temporary difficulty in speaking or slurring of speech

3.sudden difficulty in seeing or 'blackout' in one eye

4.temporary dizziness or fainting or loss of balance

5.Temporary confusion, poor coordination or understanding

6.unexplained headaches or a change in the usual headache pattern

Early treatment of a TIA can help prevent a stroke from occurring in the future.

What are the symptoms and signs of a Stroke?
--------------------------------------------

The affected person may have:

1.sudden numbness or weakness, usually on one side of the body,often with loss of feeling

2.difficulty in speaking or understanding

3.difficulty in swallowing

4.loss of concentration and memory

5.sudden difficulty walking

6.loss of control of passing urine or passing motion

7.behaviour changes such as laughing or crying at the wrong time, feeling depressed or showing bad temper.

8.sudden severe giddiness, loss of balance and coordination

9.sudden severe headache with no known cause

10.sudden vision loss in one eye

Treatment and caring for stroke patient will be in the Simple Guide to Stroke 2.

A Simple Guide to Depression

A Simple Guide to Depression
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What is Depression?
------------------------

Depression is a very common mental ilness with an alteration of mood which exceeds normal sadness.

How common is Depression?
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Everyone has felt sad at one time or another.
It may be due to a disappointment, frustration or losing someone.
But time heals, the mood lifts and people continue to get on with their lives.
In some people, depression can be so severe that it dominates their lives, preventing them from living their lives as they used to.
Depression of this degree is a medical illness and needs treatment.

What Are The Types Of Depression?
------------------------------------------

1.Major depression is manifested by a combination of symptoms that affect our work, interests and feelings towards family and friends.
These disabling episodes can occur twice or several times in a lifetime.

2.Dysthymia is a less severe type of depression.
People with dysthymia have long-term depressive symptoms and it prevents them from functioning at an optimal level.

What Are The Causes Of Depression?
--------------------------------------------

1.hereditary or genetic factors in the transmission of depressive disorders.
In some families, major depression seems to occur generation after generation.

2.biological component in depression.
It may be associated with having too little or too much chemicals in the brain.

3. medications have mood altering properties.
Some medication act by altering the biochemical imbalances in the brain causing depression.

4. Life events such as loss of a job, retirement, divorce, death of a loved one or moving to a new house can precipitate a depressive illness.

5.Social circumstances also play a part.
If we are alone, have few or no friends, suffer from a chronic illness, then we may be more vulnerable to depression.

6. People with life threatening or long-term physical illness such as cancer, stroke, arthritis or heart disease are also more vulnerable to depression.

7. Personality may also play a part in depression. Some of us are more vulnerable than others because of the individual make-up or early life experiences.

Very often, a combination of genetic, psychological and environmental factors is involved in the onset of depression.

The good news is that whatever the cause, depression is treatable.

What are the Symptoms Of Depression?
----------------------------------------------

Certain characteristic symptoms can give you or your family a clue that you are depressed:

1.Depressed mood

2.lethargy and fatigue

3.loss of interest and enjoyment in life

4.lack of drive or motivation that makes even simple tasks or decisions difficult or impossible

5.loss of concentration

6.Loss of self confidence, avoiding people

7.Sleeplessness or excessive sleeping

8.Agitation or restlessness

9.ideas of being useless, inadequate, helpless or hopeless

10.Feeling guilty or worthless

11.Loss or gain in appetite, libido with loss or gain in weight

12.Thoughts of suicide;

These symptoms are very common in depression.
It is much better admitted to friends or relatives than to keep them hidden.

How is Depression Treated?
---------------------------------

Reassurance and support is most important in treatment of depression.

Recognition of suicide risk must be remembered when treating a depressed person.

Treatment for depression is well established.
Majority up to 90% of people with major depression have fairly good treatment outcome.

Treatment consists of
drug (antidepressant medication) and
non-drug therapy.
Usually, a combined treatment is best:
1.medication to gain relatively quick relief and
2.psychotherapy to learn more effective ways to deal with life stresses.

Antidepressant Medication
---------------------------------

All antidepressant medications are equally effective but they have different side effects.
The most often used antidepressants include tricyclics, monoamine oxidase inhibitors, lithium and selective serotonin inhibitors (SSRI).

Antidepressant medications do not begin working the day you take them but your mood will improve after one to two weeks.
However, you may notice some improvement on the first day, especially in your sleep and feeling less tense and anxious.

The medications are compatible with painkillers, antibiotics and contraceptives. However, you should avoid alcohol as the medication and alcohol combined can make you too drowsy.
Do not stop the medication once you start to feel better as you may relapse into depression again.
You should discuss this with your doctor and let him advise you when to stop.
Antidepressants like all drugs have some side effects, though these are usually mild and tend to wear off as treatment goes on.

The common side effects and their remedies are:
Dry mouth - drink more water
Constipation - eat more fruits, cereals, prunes and vegetables
Drowsiness - this will pass soon; do not drive or operate heavy machinery if feeling sedated Dizziness - rise from bed or chair slowly

Some side effects with the newer medications:
Headache - this will usually go away
Nausea and stomach discomfort - transient; take medication with food
Nervousness and insomnia - these may occur during the first few weeks, reducing the dose will usually resolve them.

Non Drug Therapy
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Psychotherapy
Psychotherapy involves talking things through with a trained counselor or therapist.
Talking to someone who can really listen and understand you without passing judgement can be a tremendous relief.
You learn how to solve problems and cope with life stresses better.

Exercise
Exercise not only improves your health but it also gives you a sense of accomplishment. Endorphins ('feel good' hormones) are released during exercise and this can elevate your mood.

Relaxation Therapy
This involves deep breathing exercises and progressive muscle relaxation.

Support Groups
Support groups offer fellowship and you get to hear first hand accounts of how others with depression, like you, have learnt to cope.
There is also a psychoeducation group which help you learn about the depressive illness and methods of coping.

Electroconvulsive Theraphy (ECT)
ECT is only indicated for those with severe depression who have not responded to treatment or are highly suicidal.
It involves giving a light general anaesthetic and an electric current is passed through the brain for a few seconds. The whole procedure takes only about 15 minutes and the patient is only aware of having gone to sleep.

How Can You Prevent Depression ?
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1.try to talk to close friends about bad news

2. Be realistic about your goals. Do not aim too high. Set priorities and do what you can.

3. Do something - get out of the house for a walk or some exercise.
While you may not be able to work, it is always good to try to keep up with some light activities such as housework.
This will help take your mind off those painful feelings.

4. Eat a good balanced diet, even though you may not feel like eating.

5. Resist the temptation to drown your sorrows with alcohol.
Alcohol can depresses the mood, so while it may give you immediate relief by making you forget your problems, this is very temporary and you may end up more depressed.
It is also bad for your liver and general physical health.

6. Remind yourself that you are suffering from depression, something that many other people have gone through, and that you will eventually come out of it, as they do

7.Remember your appointments to see the doctor , take your medicine regularly and do not be afraid to ask for help from your friends and support groups.

A Simple Guide to Constipation

What is Constipation?
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Constipation by definition is a condition which is characterised by fewer than normal bowel movement than usual.
It is accompanied by straining, incomplete evacuation and passage of hard stools.

Who gets Constipation?
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It is particularly common among the elderly and younger children.


How do you get Constipation?
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There are a few causes of constipation:

1. Insufficient fibre(fruits,vegetables) to form bulk in the stools.

2. Insufficient fluid in the diet(at least 8 glasses of water).

3. Insufficient time to go to toilet when there is the urge to pass motion.

4. Insufficient exercise to help the intestine to move especially after meals, common in
sedentary jobs and older people

5. Stress cause the constriction of the anal sphincter preventing the stools from passing.

6. Depression on the other hand depress the movement of the intestines.

7. Drugs like cough mixture containing codeine,antispasmodic, antacids may also reduce the
motility of the intestine.

8. Pregnancy in the later stage cause the womb to press against the intestine.

9. People with low thyroid hormone slows down the movement of the intestines.

10.People with piles or pelvic space occupying swelling which may press against the
intestine or rectum.

How to avoid Constipation?
--------------------------------
Avoidance of constipation include:

1. Increase in daily fibre intake to at least 15gm (eg. 1 bowl of bran cereal for breakfast),
fruits and vegetables).
Fibre increases the bulk of the stool allowing easy passage of stools through the large
intestine.

2. Drink at least 8 glasses of water a day (2 litres). Water reduces the hardness of stools.

3. Regular exercises at least 2-3 times a day especially after meals. Exercise will enhance
intestinal movement.

4. Allow a distraction free period of 15 min a day for bowel movement. The strongest
intestinal movement occurs after breakfast.

5. Do not ignore or suppress the urge to pass bowel movement. This may impair the
sensation to detect initiation of bowel movement leading to constipation.

How to treat Constipation?
--------------------------------

1.Follow the advice above.

2.Consult your family doctor to exclude any abdominal swelling which may be blocking the
passage of stools.
A colonoscopy may be needed to check the large intestines for tumours or early cancer.
Your piles may be removed during the colonoscopy if found to be obstructing passage of
stools.

3.Try Yogurt or fermented milk with lactobacillus as a method to stimulate more
production of bulk in stools.

4.Try not to take laxatives unless it is deemed necessary by your doctor.
Most doctors preferred not to use medicine in combating constipation.

5. Learn to relax the anal sphincter by doing some pelvic exercises

A Simple Guide to Osteoarthritis

A Simple Guide to Osteoarthritis

Osteoarthritis
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What is Osteoarthritis ?
----------------------------
Osteoarthritis
is a degenerative condition of the joints in the human body.
It is the most common form of arthritis.
The cartilage lining of the joint are worn down such that the underlying bone come in contact with each other.
In addition bone spurs may form and joint fluid is reduced.

This causes mechanical and chemical reactions giving rise to the symptoms of Osteoarthritis.

What causes Osteoarthritis ?
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1. Genetics
has found to have role in the predisposition of Osteoarthritis.
Genes on chromosome 2q,4 & 16 have been linked with Osteoarthritis.

2. Aging
is a risk factor of Osteoarthritis.
More than 80% of those above 65 years suffer from Osteoarthritis.

3. Excessive physical activity is a potentially correctable cause of Osteoarthritis.
Activities like long distance running and other high endurance sports may place
the joints under high stress for prolonged periods resulting in overuse injuries and
accelerated wear and tear.

4. Gender plays a role in Osteoarthritis. Osteoarthritis is more common in men for a
cohort of under 50 years and more common in women in the cohort of 50-80 years.

5.Trauma is a common cause of Osteoarthritis in the younger age groups.

What are the symptoms of Osteoarthritis?
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Most common symptom are pain and swelling:

Stiff,painful and swollen joints after a workout

Stiffness in the joints in the mornings which can last about half an hour

Loss of flexibility in one's joints

Bony lumps at the base of the thumb or on the middle of the end joints of the fingers

Pain in the joints after repeated use

Osteoarthritis is often associated with joint surgery or related injury

What are the complications of Osteoarthritis ?
-------------------------------------------------------
Osteoarthritis is the top cause of disability in older women and ranks second in older men.

Besides pain and swelling, quality of life suffers in patients with Osteoarthritis due to their loss of mobility and depression.

The loss of mobility is progressive with age.


Where does Osteoarthritis occur ?
----------------------------------------
It can affect the any joint of the body although the most commonly affected joints are the weight bearing joints:
knee
hip
ankle
spine.
Other non-weight bearing joints such as
shoulder ,
elbow,
fingers
can also be affected.

How do you treat Osteoarthritis ?
----------------------------------------
Osteoarthritis is not curable and the purpose of treatment is to:
1. improve functions and
2. reduce pain and discomfort.

Treatment of Osteoarthritis can be broadly classified into:
1. Non-interventional

a. non-pharmaceutical

Weight loss is an effective way to reduce the stress on the joints and minimise the pain
Walking sticks are useful ways to offload the stress on the affected weight bearing
joints such as hips or knee. The walking aids should be used on the opposite side.
It can be in the form of a sturdy umbrella instead of a crutch.
Hot packs are useful aids in the morning to soften a stiff arthritic joint whereas braces
and knee guards are useful supports to give some comfort to the knee.
Exercises that improve strength, agility and flexibility are useful to minimise
the disability of Osteoarthritis.
A range of motion exercises is useful to keep the joints supple and mobile .
Water based exercises are a good alternative form of aerobic workout by patients afflicted
by Osteoarthritis. The warm water especially is a good medium for joint mobility and
together with the buoyancy of water it helps to minimise the body weight impact
on the joints.

b. pharmaceutical
There are 2 main types of drugs:

1. symptom modifying drugs help to alleviate the symptoms but do not change the
natural history of the conditions.
Examples are Non-steroidal Anti-inflammatory Drugs(NSAIDs) like diclofenac.

2. disease modifying drugs such as glucosamine has been shown to slow down the
wear and tear of the cartilage but it does have the ability to grow new cartilage.
It has also being found to work better with chondroitin.

2. Interventional:

a. non-surgical

Joint aspiration is a procedure where fluid from the swollen joint is removed,
helping to decompress the tension and bring relief for a while .

Vasosupplementation is a procedure whereby a lubricant is injected into the affected
joint thus reducing the the frictional wear of the joint surfaces.
In addition the lubricant has anti inflammatory properties to reduce the inflammation in the
lining of the joints and may ease the pain for months in early osteoarthritic cases .

b.surgical

Surgical intervention is usually the last resort when all other above treatment fail and in
advanced cases:

Debridement is an arthroscopic (keyhole) procedure to clean the joint of torn cartilages,
loose pieces of bones, etc.
Its main use is to remove the worn out debris which may cause pain and can mechanically
cause friction.

High tibial Osteotomy is a procedure to correct the alignment of deformed legs which
then reduce the stress on the joint.

Prosthetic joint replacement is a procedure to replace the diseased portion of the joint
with a prosthesis or artificial joint allowing painless good range of movement.
It is more suitable for older patient because there is a shelf life to these implants.

Unicondylar joint replacement can now be performed in which part of one of
the bone of the diseased joint is removed instead of a total joint replacement which
involved removal of part of both bones of a joint.

The choice of treatment depends on the stage of the disease and whether there are associated complication.

In general non-interventional methods are more suitable at the early stage of the illness and interventional modalities are more suitable for the later stage of Osteoarthritis.