Postpartum Depression And How To Manage It

 

It is quiet common for the new mother to feel sad, worried, tired or fatigued. As many as 80 out of 100 mothers go through such feelings for a week or two after the birth of the baby. It is completely normal and they start to feel better and normal after a few weeks..

Postpartum depression is diagnosed when these symptoms are much severe and lasts longer. It can cause severe mood swings, and a mix of physical, emotional and behavioral changes.

The symptoms usually begins within the first few weeks after giving birth but sometimes may even begin earlier while being pregnant or later up to a year after birth. 

Suffering from postpartum depression does not mean that a mother does not love her baby or that she is a bad mother. It is just that she is suffering from a medical condition and needs counselling therapy and treatment. 

Symptoms may vary among different woman but a list of common symptoms include:

- Feeling low

-Lack of interest in daily activities

- Body aches and headache

-Lack of appetite

- Anxiety and irritability

- Not able to think or make proper decisions. 

- Feeling difficult to bond with the baby.

- No interest in friends and family,

What causes Postpartum Depression: Female body produces a lot of hormones during pregnancy but soon after delivery there is a sudden decrease of these hormones which causes changes in the chemical system of the brain leading to depression. 

How To Manage:

Depending on the severity and the type it can be treated with psychotherapy or antidepressant medications. 

It is important to seek medical help if symptoms of depression lasts longer than 2 weeks within 1 year of giving birth. 

-Get Support from friends and family. 

-Be open about your feelings and discuss it with your partner and your family. 

- Join support groups.

-Antidepressants may be prescribed to you by your doctor but they usually take 6-8 weeks to show improvement in symptoms. 

- Psychotherapy helps with more positive thinking approach. 

How Should Doctors Recognize and Treat their Own Metal Illness

Introduction
Doctors have a higher than average incidence of suicide and alcoholism, and so all doctors must be prepared to face (and try to prevent) these and other health risks in their professional and private lives. A doctor's  skill at looking after himself/herself has never been as good as their skill at looking after others, but when the healer is wounded, is it clear that his ability to help others will be correspondingly reduced.

Indicators of Affected Mental State
If the time comes when a doctor's mental state seriously reduces the ability to work, the doctor must be able to recognize this and take appropriate action. The following may indicate that this point is approaching:
• Drinking alcohol before ward rounds or surgeries.
• The minimizing of every contact with patients, so that the doctor does the bare minimum which will suffice.
• Inability to concentrate on the matter in hand. The thoughts are entirely taken up with the workload ahead.
• Irritability (defined as disagreeing with >1 nurse in 24 hours time period).
• Inability to take time off without feeling guilty.
• Feelings of excessive shame or anger when reviewing past mistakes.
• Emotional exhaustion—for example knowing that you should be feeling pleased or cross with yourself or others, but on consulting your heart you draw a blank.
• Prospective studies suggest that introversion, masochism, and isolation are important risk factors for doctors’ impairment.

The Mental State Examination

This assesses state of mind at the time of interview with the patient. A true description of mental states entails valid knowledge about current emotions plus their reactions to those emotions.

Take notes under the following headings.

• Appearance and behavior: see for signs of self-neglect; slowness, anxiety, or suspiciousness.

• Mode of speech: Speech rate, eg gabbling (pressure of speech), or slow/retarded. Note content.

• Mood: Note thoughts about harming self or others. Gauge your own response to the patient. The
laughter and grand ideas of manic patients are contagious, as to a lesser extent is the expression of thoughts from a depressed person.

• Beliefs: Eg about himself, his own body, about other people and the future. Note abnormal beliefs
(delusions) eg that thoughts are overheard, and ideas (eg persecutory, grandiose).

• Unusual experiences or hallucinations: “Sometimes when people are low they have unusual
experiences; have you heard anything unusual recently?” Note modality, eg visual.

• Orientation: In time, place, and person. What year? What season? What month/day of week? Is
it morning or afternoon? What is your name?

• Short-term memory: Recall a name & address 5 minutes after learning it. Ensure he really has learned it before waiting for the 5 minutes to elapse.

• Concentration: Months of the year backwards.

• Patient’s insight and degree of your rapport.

• Long-term memory: Current affairs recall. Who is the monarch/head of state? This tests other functions, not just memory

Understanding Hallucinations And Delusions

While dealing with psychiatry patients it is important to understand what having odd ideas mean and to  decide if a patient has delusions, hallucinations or a major thought disorder , because if present the helps in making a proper diagnosis and then a good treatment plan.

Patients may be reluctant to reveal odd ideas.
Ask gently:
“Have you ever had any thoughts which might now seem odd; perhaps that there is a conspiracy
against you, or that you are controlled by outside voices or the radio?”

Hallucination: is defined as a perception in the absence of external stimulus and these may be visual, auditory, tactile etc involving almost any of the five senses.
There are many different causes. It could be due to a mental illness like in schizophrenia or a nervous system disorder like Parkinson's disease. Tactile or visual hallucinations (without auditory hallucinations) suggest an organic disorder (e.g alcohol withdrawal).

Hypnagogic hallucinations and hypnopompic hallucinations are considered normal phenomena. Hypnagogic hallucinations can occur as one is falling asleep and hypnopompic hallucinations occur when one is waking up.

A pseudo-hallucination is one in which the person knows the stimulus is in the mind (e.g a voice heard within him- or herself, rather than over the left shoulder). They are more common, and does not indicate a mental illness, but they may be a sign that a genuine hallucination is waning.

Few treatments are available for hallucinations. However, for those hallucinations caused by mental disease, a psychologist or psychiatrist should treat the underlying medical illness.

Delusions are firm beliefs that do not change, even when a person is presented with conflicting evidence. If the belief arrives fully formed, and with no antecedent events or experiences to account for it, it is said to be primary, and is suggestive of schizophrenia

Oppositional Defiant Disorder

Definition: Oppositional defiant disorder (ODD) is a condition in which a child displays an ongoing pattern of uncooperative, hostile, resistant and an annoying behavior towards people in authority. 

In order to be diagnosed the behavior must be present for at least 6 months.

Symptoms: It is difficult to differentiate between a normal but an emotional child with a child with an oppositional defiant disorder. It is not unusual for children to argue, disobey or talk back to their parents, teachers or other adults, but when such a behavior gets too annoying to disrupt the child’s daily life and activities, lasts longer than 6 months and is excessive for the child’s age than it becomes a psychological disorder known as Oppositional defiant disorder. 

ODD is characterized by frequent occurrence of at least four of the following behaviors:

• losing temper
• arguing with adults.
• actively defying or refusing to comply with the request or rules of the adults.
• deliberately doing things that will annoy others
• getting angry
• showing violent behavior.
• blaming others on his/her own mistakes
• being touch and easily annoyed by others.
• unwillingness to compromise.
• Acting aggressive towards peers
• Have academic problems.

Related Mental health issues: A child with oppositional defiant disorder may have associated other mental health issues like anxiety, depression and/or attention deficit hyperactivity disorder. The symptoms of theses conditions may overlap and sometimes it is difficult to diagnose as one particular disorder.

Hyperventilation - Causes And Management

Hyperventilation is breathing which occurs more deeply and/or more rapidly than normal.

Pathophysiology: CO 2 is ‘blown off ’, so that pCO 2 decreases.. Hyperventilation may be primary (‘psychogenic’) or secondary. A classical secondary cause is DKA — Kussmaul’s respiration represents respiratory compensation for a metabolic acidosis.

Secondary causes of hyperventilation
• Metabolic acidosis (eg DKA, uraemia, sepsis, hepatic failure).
• Poisoning (eg aspirin, methanol, CO, cyanide, ethylene glycol).
• Pain/hypoxia.
• Hypovolaemia.
• Respiratory disorders (eg PE, asthma, pneumothorax).

Primary (psychogenic or inappropriate) hyperventilation
Typically, the patient is agitated and distressed with a past history of panic attacks or episodes of hyperventilation. They may complain of dizziness, circumoral paraesthesia, carpopedal spasm, and occasionally sharp or stabbing chest pain. Initial examination reveals tachypnoea with equal
air entry over both lung fields, and no wheeze or evidence of airway obstruction.

Factitious Disorder - A Brief Discussion

Definition.
A disorder characterized by the conscious production of signs and symptoms of both medical and mental disorders. The main objective is to assume the sick role and eventually hospitalization. Usually diagnosed with physical or psychological symptoms or both.

Called Factitious Disorder By Proxy if the signs and symptoms are faked for another person, as in
mother and child.

Etiology.
Seen more commonly in men and in hospital and health care workers. As children, many of the patients suffered abuse that resulted in frequent hospitalizations, thus their need to assume the sick role.

Physical and Psychiatric Presenting Symptoms.
• May have a gridiron abdomen from the multiple surgeries
• Typically demand treatment when in the hospital
• If tests return negative, they tend to accuse doctors and threaten litigation.
• Become angry when confronted.

Treatment.
Usually involves management rather than cure. Must be aware of counter-transference when the physician suspects factitious disorder.

Bulimia nervosa

Introduction

The essential features of bulimia nervosa include eating binges followed by feelings of guilt, humiliation, and self-deprecation. These feelings cause the patient to engage in self-induced vomiting, the use of laxatives or diuretics, following a strict diet, or fasting to overcome the effects of the binges. Electrolyte imbalances (including metabolic alkalosis, hypochloremia, and hypokalemia) and dehydration can occur, increasing the risk of physical complications.
Bulimia nervosa usually begins in adolescence or early adulthood and can occur simultaneously with anorexia nervosa. It affects nine women for every man affected. Nearly 2% of adult women meet the diagnostic criteria for bulimia nervosa; 5% to 15% have some symptoms of the disorder.

Causes
Bulimia nervosa has no known cause, but psychosocial factors may contribute to its development, including family disturbance or conflict, sexual abuse, maladaptive learned behavior, struggle for control or self-identity, cultural overemphasis on physical appearance, and parental obesity.

Signs and symptoms
The history of a patient with bulimia nervosa is marked by episodes of binge eating that may occur up to several times per day. The patient commonly reports a binge-eating episode during which she continues eating until abdominal pain, sleep, or the presence of another person interrupts it. The preferred food usually is sweet, soft, and high in calories and carbohydrate content.
The bulimic patient may appear thin and emaciated. Typically, however, although her weight frequently fluctuates, it usually stays within normal limits through the use of diuretics, laxatives, vomiting, and exercise. So, unlike the anorexic patient, the bulimic patient can usually hide her eating disorder.

Anorexia nervosa

Introduction

The key feature of anorexia nervosa is self-imposed starvation resulting from a distorted body image and an intense and irrational fear of gaining weight, even when the patient is obviously emaciated. An anorexic patient is preoccupied with her body size, describes herself as “fat,” and commonly expresses dissatisfaction with a particular aspect of her physical appearance.
Although the term anorexia suggests that the patient’s weight loss is associated with a loss of appetite, this is rare. Anorexia nervosa and bulimia nervosa can occur simultaneously. With anorexia nervosa, the refusal to eat may be accompanied by compulsive exercising, self-induced vomiting, or abuse of laxatives or diuretics.

Incidence
Anorexia occurs in 5% to 10% of the population; about 95% of those affected are women. This disorder occurs primarily in adolescents and young adults but may also affect older women. The occurrence among males is rising.
Although the prognosis varies, it improves if the patient is diagnosed early or if she wants to overcome the disorder and seeks help voluntarily. Mortality ranges from 5% to 15%—the highest mortality associated with a psychiatric disturbance. One-third of these deaths can be attributed to suicide.

Causes
No one knows what causes anorexia nervosa. Researchers in neuroendocrinology are seeking a physiologic cause but have found nothing definite. Clearly, social attitudes that equate slimness with beauty play some role in provoking this disorder; family factors also are implicated. Most theorists believe that refusing to eat is a subconscious effort to exert personal control over one’s life.

Signs and symptoms
The patient’s history usually reveals a 25% or greater weight loss for no organic reason, coupled with a morbid dread of being fat and a compulsion to be thin. Such a patient tends to be angry and ritualistic. 

She may report amenorrhea, infertility, loss of libido, fatigue, sleep alterations, intolerance to cold, and constipation.

Hypotension and bradycardia may be present. 

Management Of Schizophrenia

This disorder is characterized by disturbances (for at least 6 months) in thought content and form, perception, affect, sense of self, volition, interpersonal relationships, and psychomotor behavior.
Treatment
With schizophrenia, treatment focuses on meeting the physical and psychosocial needs of the patient, based on his previous level of adjustment and his response to various interventions. 

Treatment may combine drug therapy, long-term psychotherapy for the patient and his family, psychosocial rehabilitation, vocational counseling, and the use of community resources.

Antipsychotics
The primary treatment for more than 30 years, antipsychotics (also called neuroleptic drugs) appear to work by blocking postsynaptic dopamine receptors. These drugs reduce the incidence of psychotic symptoms, such as hallucinations and delusions, and relieve anxiety and agitation.
Other psychiatric drugs, such as antidepressants and anxiolytics, may control associated signs and symptoms.
Certain antipsychotics are associated with numerous adverse reactions, some of which are irreversible. Most experts agree that patients who are withdrawn, isolated, or apathetic show little improvement after antipsychotic treatment.
Some antipsychotics are depot formulations that are implanted I.M. once or twice a week to once a month; this method allows gradual release of the drug.
Clozapine, which differs chemically from other antipsychotics, may be prescribed for severely ill patients who fail to respond to standard treatment. It effectively controls a wider range of psychotic signs and symptoms without the usual adverse effects. However, clozapine can cause drowsiness, sedation, excessive salivation, tachycardia, dizziness, seizures, and agranulocytosis.
A potentially fatal blood disorder, agranulocytosis is characterized by a low white blood cell count and pronounced neutropenia. Routine blood monitoring is essential to detect the estimated 1% to 2% of all patients taking clozapine who develop agranulocytosis. If caught in the early stages, this disorder is reversible.

Obsessive-compulsive disorder

Obsessive thoughts and compulsive behaviors represent recurring efforts to control overwhelming anxiety, guilt, or unacceptable impulses that persistently enter the consciousness.

The word obsession refers to a recurrent idea, thought, impulse, or image that is intrusive and inappropriate and causes marked anxiety or distress.

A compulsion is a ritualistic, repetitive, and involuntary defensive behavior. Performing a compulsive behavior reduces the patient’s anxiety and increases the probability that the behavior will recur. Compulsions are commonly associated with obsessions.

Patients with obsessive-compulsive disorder are prone to abuse psychoactive substances, such as alcohol and anxiolytics, in an attempt to relieve their anxiety. In addition, other anxiety disorders and major depression commonly coexist with obsessive-compulsive disorder.
Obsessive-compulsive disorder is typically a chronic condition with remissions and flare-ups. Mild forms of the disorder are relatively common in the population at large.

Causes
The cause of obsessive-compulsive disorder is unknown. Some studies suggest the possibility of brain lesions, but the most useful research and clinical studies base an explanation on psychological theories. Several studies show brain abnormalities, such as decreased caudal size and decreased white matter, but results are inconsistent and remain under investigation. In addition, major depression, organic brain syndrome, and schizophrenia may contribute to the onset of obsessive-compulsive disorder.

Delusional Disorders

According to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition – Text Revision. (DSM-IV-TR), delusional disorders are marked by nonbizarre false beliefs with a plausible basis in reality. Formerly referred to as paranoid disorders, delusional disorders involve erotomanic, grandiose, jealous, somatic, or persecutory themes. Some patients experience several types of delusions, whereas others experience unspecified delusions with no dominant theme.

Delusional disorders commonly begin in middle or late adulthood, usually between the ages of 40 and 55, but they can occur at a younger age. These uncommon illnesses affect less than 1% of the population; the incidence is about equal in men and women.
Typically chronic, these disorders commonly interfere with social and marital relationships but seldom impair intellectual or occupational functioning significantly.

Causes
Delusional disorders of later life strongly suggest a hereditary predisposition. At least one study has linked the development of delusional disorders to inferiority feelings in the family.
Some researchers suggest that delusional disorders are the product of specific early childhood experiences with an authoritarian family structure. Others hold that anyone with a sensitive personality is particularly vulnerable to developing a delusional disorder.

Certain medical conditions—head injury, chronic alcoholism, and deafness—and aging are known to increase the risk for delusional disorders. Predisposing factors linked to aging include isolation, lack of stimulating interpersonal relationships, physical illness, and impaired hearing and vision.
Severe stress (such as a move to a foreign country) may also precipitate a delusional disorder.

Signs and symptoms

Aside from behavior related to the patient’s delusions, the psychiatric history of a delusional patient may be unremarkable. This helps distinguish it from disorders that result in behavior more dissociated from reality such as paranoid schizophrenia.
The delusional patient is likely to report problems with social and marital relationships, including depression or sexual dysfunction. He may describe a life marked by social isolation or hostility. He may deny feeling lonely, relentlessly criticizing, or placing unreasonable demands on others.
Gathering accurate information from a delusional patient may prove difficult. He may deny his feelings, disregard the circumstances that led to his hospitalization, and refuse treatment.
However, his responses and behavior during the assessment interview provide clues that can help to identify his disorder. Family members may confirm observations—for example, by reporting that the patient is chronically jealous or suspicious.

Summary of Autistic disorders

A severe, pervasive developmental disorder, autistic disorder is marked by unresponsiveness to social contact, gross deficits in intelligence and language development, ritualistic and compulsive behaviors, restricted capacity for developmentally appropriate activities and interests, and bizarre responses to the environment. Autistic disorder may be complicated by epileptic seizures, depression and, during periods of stress, catatonic phenomena.

Age of Presentation
Autism usually becomes apparent before the child reaches age 30 months, but in some children, the actual onset is difficult to determine. Occasionally, autistic disorder isn’t recognized until the child enters school. It affects three to four times more boys than girls, usually the firstborn boy. The prognosis is poor; most patients require a structured environment throughout life.

Causes
Autistic disorder is thought to result from a combination of psychological, physiologic, and sociological factors. The parents of an autistic child may appear distant and unaffectionate. However, because autistic children are unresponsive or respond with rigid, screaming resistance to touch and attention, parental remoteness may be merely a frustrated, helpless reaction to this disorder, not its cause.
Some autistic children show abnormal but nonspecific EEG findings that suggest brain dysfunction, possibly resulting from trauma, disease, or a structural abnormality. Autistic disorder also has been associated with maternal rubella, untreated phenylketonuria, tuberous sclerosis, anoxia during birth, encephalitis, infantile spasms, and fragile syndrome X.

Signs and symptoms
Typical features of infantile autistic disorder include unresponsiveness to people, language impairment, lack of imaginative play, bizarre behavior patterns, and abnormal reactions to sensory stimuli.

Drug Abuse and Dependence

Definition

The National Institute on Drug Abuse defines drug abuse and dependence as the use of a legal or an illegal drug that causes physical, mental, emotional, or social harm. 

Examples of abused drugs include narcotics, stimulants, depressants, anxiolytics, and hallucinogens.

Chronic drug abuse, especially I.V. use, can lead to life-threatening complications, such as cardiac and respiratory arrest, intracranial hemorrhage, acquired immunodeficiency syndrome, tetanus, subacute infective endocarditis, hepatitis, vasculitis, septicemia, thrombophlebitis, pulmonary emboli, gangrene, malnutrition and GI disturbances, respiratory infections, musculoskeletal dysfunction, trauma, depression, increased risk of suicide, and psychosis. Materials used to “cut” street drugs can also cause toxic or allergic reactions.

Drug abuse can occur at any age. Experimentation with drugs commonly begins in adolescence or even earlier. Drug abuse commonly leads to addiction, which may involve physical or psychological dependence or both. The most dangerous form of abuse occurs when users mix several drugs simultaneously—including alcohol.

Causes
Drug abuse commonly results from a combination of low self-esteem, peer pressure, inadequate coping skills, and curiosity. There is also evidence of familial patterns of addiction.
Most people who are predisposed to drug abuse have few mental or emotional resources against stress, an overdependence on others, and a low tolerance for frustration. Taking the drug gives them pleasure by relieving tension, abolishing loneliness, allowing them to achieve a temporarily peaceful or euphoric state, or simply relieving boredom.
Drug dependence may follow experimentation with drugs in response to peer pressure. It may also follow the use of drugs to relieve physical pain, but this is uncommon.

Signs and symptoms
Indications of acute intoxication vary, depending on the drug.
Friends, family members, or law enforcement officials may bring the patient to the hospital because of respiratory depression, unconsciousness, acute injury, or a psychiatric crisis.

Introduction to Alcoholism

A chronic disorder, alcoholism is usually described as an uncontrolled intake of alcoholic beverages that interferes with physical and mental health, social and family relationships, and occupational responsibilities. Alcoholism cuts across all social and economic groups, involves both sexes, and occurs at all stages of the life cycle, beginning as early as elementary school age. About 20% of patients, even in affluent areas, have alcoholism. Lifetime risk for dependence is 10% to 15% for men and 5% for women.

Causes
Numerous biological, psychological, and sociocultural factors appear to be involved in alcohol addiction. An offspring of one alcoholic parent is seven to eight times more likely to become an alcoholic than is a peer without an alcoholic parent. Biological factors include genetic and biochemical abnormalities, nutritional deficiencies, endocrine imbalances, and allergic responses.
Psychological factors include the urge to drink alcohol to reduce anxiety or symptoms of mental illness; the desire to avoid responsibility in family, social, and work relationships; and the need to bolster self-esteem.
Sociocultural factors include the availability of alcoholic beverages, peer pressure, an excessively stressful lifestyle, and social attitudes that approve of frequent drinking.

Signs and symptoms
Because people with alcohol dependence may hide or deny their addiction and may temporarily manage to maintain a functional life, assessing a patient for alcoholism can be difficult. However, there are various physical and psychosocial symptoms that can facilitate assessment.
The patient’s history may suggest a need for daily or episodic alcohol use to maintain adequate functioning, an inability to discontinue or reduce alcohol intake, episodes of anesthesia or amnesia (blackouts) during intoxication, episodes of violence during intoxication, or interference with social and familial relationships and occupational responsibilities.
Many minor complaints that the patient may have may also be alcohol related. He may mention malaise, dyspepsia, mood swings, depression, or more infections. Note any evidence of an unusually high tolerance for sedatives and narcotics.

Alzheimer’s Disease

Also known as primary degenerative dementia, Alzheimer’s disease accounts for more than half of all dementias. An estimated 5% of people over age 65 have a severe form of this disease, and 12% suffer from mild to moderate dementia. Because this is a primary progressive dementia, the prognosis is poor.

Causes
Several factors contribute to the progression of Alzheimer’s disease. They include neurochemical factors, such as deficiencies in acetylcholine (a neurotransmitter), somatostatin, substance P, and norepinephrine; environmental factors, such as aluminum and manganese; viral factors, such as slow-growing central nervous system viruses; trauma; and genetic immunologic factors.
The brain tissue of a patient with Alzheimer’s disease typically shows cortical atrophy, the hallmark features being neurofibrillary tangles, neuritic plaques, and granulovascular degeneration.

Signs and symptoms
Onset is insidious. Initially, the patient experiences almost imperceptible changes, such as forgetfulness, recent memory loss, difficulty learning and remembering new information, deterioration in personal hygiene and appearance, and an inability to concentrate. Gradually, tasks that require abstract thinking and activities that require judgment become more difficult. Progressive and severe deterioration in memory, language, and motor function results in a loss of coordination and an inability to write or speak.
Personality changes (restlessness, irritability) and nocturnal awakenings are common. Eventually, the patient becomes disoriented, and emotional lability and physical and intellectual disability progress. The patient becomes more susceptible to infection and accidents. Secondary to loss of the cough reflex, pulmonary diseases such as pneumonia may result in death.

Brief Summary of Somatization disorder

Introduction

When multiple recurrent signs and symptoms of several years’ duration suggest that physical disorders exist without a verifiable disease or pathophysiologic condition to account for them, somatization disorder is present.
The typical patient with somatization disorder usually undergoes repeated medical examinations and diagnostic testing that—unlike the symptoms themselves—can be potentially dangerous or debilitating. However, unlike the hypochondriac, she isn’t preoccupied with the belief that she has a specific disease.
Somatization disorder usually is chronic, with exacerbations during times of stress.
Signs and symptoms usually begin in adolescence; rarely, when the patient is in her 20s. This disorder primarily affects women; it’s seldom diagnosed in men.

Causes
Both genetic and environmental factors contribute to the development of somatization disorder.

Signs and symptoms
A patient with somatization disorder presents physical complaints in a dramatic, vague, or exaggerated way, often as part of a complicated medical history in which many medical diagnoses have been considered.
An important clue to this disorder is a history of multiple medical evaluations by different physicians at different institutions—sometimes simultaneously—without significant findings. The patient usually appears anxious and depressed.

Common physical complaints include:

• conversion or pseudoneurologic signs and symptoms (for example, paralysis or blindness)
• GI discomfort (abdominal pain, nausea, or vomiting)
• female reproductive difficulties (such as painful menstruation) or male reproductive difficulties (such as erectile dysfunction)
• psychosexual problems (such as sexual indifference)
• chronic pain (such as back pain)
• cardiopulmonary symptoms (chest pain, dizziness, or palpitations).

Personality Disorders

Defined as individual traits that reflect chronic, inflexible, and maladaptive patterns of behavior, personality disorders cause social discomfort and impair social and occupational functioning. Although no statistics document the number of cases of personality disorder, these disorders are known to be widespread. Most patients with a personality disorder don’t receive treatment; when they do, they’re typically managed as outpatients.

According to the classification system of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition – Text Revision, personality disorders fall on Axis II. Knowing the features of personality disorders helps provide a more complete picture of the patient and a more accurate diagnosis. For example, many features characteristic of personality disorders are apparent during an episode of another mental disorder (such as a major depressive episode in a patient with compulsive personality features).

Personality disorders typically begin before or during adolescence and early adulthood and persist throughout adult life. The prognosis varies.

Etiology
Only recently have personality disorders been categorized in detail, and research continues to identify their causes. Various theories attempt to explain the origin of personality disorders.
Biological theories hold that these disorders may stem from chromosomal and neuronal abnormalities or head trauma.
Social theories hold that the disorders reflect learned responses, having much to do with reinforcement, modeling, and aversive stimuli as contributing factors.
Psychodynamic theories hold that personality disorders reflect deficiencies in ego and superego development and are related to poor mother-child relationships that are characterized by unresponsiveness, overprotectiveness, or early separation.

Major Depression - Causes, Symptoms And Disgnosis

Introduction

Also known as unipolar disorder, major depression is a syndrome of persistently sad, dysphoric mood accompanied by disturbances in sleep and appetite, lethargy, and an inability to experience pleasure (anhedonia). Major depression occurs in 3% to 5% of adults, affecting all racial, ethnic, and socioeconomic groups. It affects both sexes but is more common in wo

About half of all depressed patients experience a single episode and recover completely; the rest have at least one recurrence. Major depression can profoundly alter social, family, and occupational functioning.

However, suicide is the most serious complication of major depression, resulting when the patient’s feelings of worthlessness, guilt, and hopelessness are so overwhelming that he no longer considers life worth living. Nearly twice as many women as men attempt suicide, but men are far more likely to succeed.

Causes
The multiple causes of depression aren’t completely understood. Current research suggests possible genetic, familial, biochemical, physical, psychological, and social causes.

Psychological factors
Such causes may include feelings of helplessness and vulnerability, anger, hopelessness and pessimism, and low self-esteem; they may be related to abnormal character and behavior patterns and troubled personal relationships.
In many patients, the history identifies a specific personal loss or severe stressor that probably interacts with the person’s predisposition to provoke major depression.

Medical conditionsDepression may be secondary to a specific medical condition—for example, metabolic disturbances, such as hypoxia and hypercalcemia; endocrine disorders, such as diabetes and Cushing’s disease; neurologic diseases, such as Parkinson’s and Alzheimer’s disease; and cancer, especially of the pancreas.
Other medical conditions that may underlie depression include viral and bacterial infections, such as influenza and pneumonia; cardiovascular disorders such as heart failure; pulmonary disorders such as chronic obstructive pulmonary disease; musculoskeletal disorders such as degenerative arthritis; GI disorders such as irritable bowel syndrome; genitourinary problems such as incontinence; collagen vascular diseases such as lupus; and anemias.

Tic disorders

Introduction

Including Tourette syndrome, chronic motor or vocal tic disorder, and transient tic disorder, tic disorders are similar pathophysiologically but differ in severity and prognosis. All tic disorders, commonly known simply as tics, are involuntary, spasmodic, recurrent, and purposeless motor movements or vocalizations. These disorders are classified as motor or vocal and as simple or complex.
Tics may begin as early as age 2, with average onset being age 7. All tic disorders are three times more common in boys than in girls. Transient tics usually are self-limiting, but Tourette syndrome follows a chronic course with remissions and exacerbations.

Causes
Although their exact cause is unknown, tic disorders occur more frequently in certain families, suggesting a genetic cause. Tics commonly develop when a child experiences overwhelming anxiety, usually associated with normal maturation. Tics may be precipitated or exacerbated by the use of phenothiazines or central nervous system stimulants or by head trauma.

Signs and symptoms
Assessment findings vary according to the type of tic disorder. 

Inspection, coupled with the patient’s history, may reveal the specific motor or vocal patterns that characterize the tic, as well as the frequency, complexity, and precipitating factors. The patient or his family may report that the tics occur sporadically many times a day.

Note whether certain situations exacerbate the tics. All tic disorders may be exacerbated by stress, and they usually diminish markedly during sleep. The patient also may report that they occur during activities that require concentration, such as reading or sewing.

Determine whether the patient can control the tics. Most patients can, with conscious effort, control them for short periods.