Relationship of Alcohol and mania (Bipolar disorder)

Mania is a one end of bipolar affective disorder (It is characterized by shifts between mania and depression.). Mania is characterized by elevated mood, increased energy, increased spending, increased talkativeness and increased pressure of thoughts. In the severe form it can cause grandiose delusions and  auditory hallucinations.

Alcoholism and mania (Bipolar disorder) can co exist, because of the possibility of sharing common genes.

In addition, alcoholism can complicate preexisting bipolar mania. Abuse of alcohol can make the condition, difficult to treat. In addition, patients with mania is known to have social and emotional disinhibition. This make it hard to stop alcohol in a patient with bipolar disorder.

Alcohol is also known to cause or precipitate bipolar affective disorder. Therefore, alcoholism and bipolar disorder creates a viscous cycle that lower the prognosis of both conditions (Alcoholism and Bipolar disorder).

A person with both problems need to take drugs to control his/her bipolar disorder and take steps to stop alcoholism at the same time. Theses patients need lot of help from his/her family and the healthcare provider.

Health risks of stress and tips for dealing with it

Stress is defined as the human body's response to a change. Even though it is good in short term, it can cause harm to your body in long term. Stress can increase certain hormonal levels in the body. This can cause certain changes in long term which can cause heart attacks, stroke and various other problems.
Importance of stress in our current society
Even though our society increased its sophistication, our body's mechanisms are lagging behind in the Stone Age.

Our body has two main roles. They are rest and face threats (fight/flight). During rest, our body increases digestion of food, stores energy and do general housekeeping jobs. But in a threat it increases energy expenditure, increases metabolism and prepare our body to fight or run. 

In the stone stage, threats are not persistent. Once the caveman saves itself from a predator he can relax. But in the current society our body identifies normal day to day stressors as threat to its survival and switch to fight/flight mode. The difference is that our day to day stressors never end like in the Stone Age. 

In addition, our day to day stressors do not need a flight/fight response (anxiety). They need a calm mind to sort the things out. 

Our body is not prepared to maintain a fight/flight mode forever. Maintaining in that mode for longer duration would result in various diseases such as heart diseases and diabetes mellitus.

This maladaptation of physiology in current society makes stress one of the main causes of disease.

How stress increase the health risks

Stress increases adrenaline, noradrenaline and cortisol levels in the body. These hormones increase blood lipid and sugar levels. When the stress is persistent for long time, above risk factors can cause ischemic heart disease and precipitate diabetes mellitus. In addition, Stress hormones increase heart rate and power of the heart contractions. These actions could cause wear and tear of heart muscles. It could lead to heart failure and heart muscle dysfunction (cardiomyopathy). 

Stressed out heart

In addition, elevated levels of stress hormones for longer duration can cause hypertension. This could further increase the heart dysfunction.

Addition to above methods stress could lead to unhealthy coping strategies such as increased smoking, increased alcohol intake and unhealthy dietary habits (taking fast foods, salty foods).





Tips for dealing with stress

• Don't worry about things you can't control, such as the weather.
• Solve the little day to day problems. This can help you gain a feeling of control.
• Prepare to the best of your ability for events you know may be stressful, such as a job interview.
• Try to look at change as a positive challenge, not as a threat.
• Work to resolve conflicts with other people.
• Talk with a trusted friend, family member or counselor.
• Set realistic goals at home and at work. Avoid overscheduling.
• Exercise on a regular basis.
• Eat regular, well-balanced meals and get enough sleep.
• Meditate.
• Participate in something you don't find stressful, such as sports, social events or hobbies.

Long term stress affects our health badly. It can cause increase heart diseases and hypertension. However, you could control your stress levels by way of good coping strategies, meditation and exercises. 

Further reading


Stress - NIH article
Stress: How to Cope Better With Life's Challenges

Usage and side effects of Venlafaxine (Venlift, Venlamax, Vexor, Venla, Venjoy, Venfax, Vendep, Sentosa, Flavix and Dallium)

Venlafaxine is a medication prescribed for major depression and anxiety disorders. In addition, it is prescribed for chronic pain syndromes such as neuropathic pain and fibromyalgia. Commonest Indian brand names are Venlift, Venlamax, Vexor, Venla, Venjoy, Venfax, Vendep, Sentosa, Flavix and Dallium. In US it is sold as Effexor.

Its commonest side effects are dry mouth, reduced sleep and constipation. Venlafaxine XR is the extended release preparation of the Venlafaxine. Therefore, Patients usually get minimal side effects with Venlafaxine XR compared to Venlafaxine.

How Venlafaxine works?

Venlafaxine works by increasing natural neurotransmitters serotonin and noradrenalin inside certain brain areas. However, side effects are due to increased noradrenalin and serotonin levels in unwanted areas of the brain.

What are the common side effects Venlafaxine ?

Constipation, nausea, loss of appetite, diarrhea, gastritis, vomiting, and abdominal pain are most common side effects. Patients can get increased blood pressure as a side effect.  Sometimes palpitations (feeling one’s own heart beat associated with distress) can occur.

Dizziness, dry mouth, insomnia, nervousness, and headache are other common side effects. In addition, patients can complain abnormal dreams. Short term anxiety and agitation is also common.

Sexual dysfunction is another problematic side effect that can leads to poor drug compliance. Women in reproductive age, taking Venlafaxine may complain menstrual irregularities. Muscle pain and joint pain can occur with some patients. Some patients can have pupillary dilatation in their eyes. This can leads to angle closure glaucoma. However compared to other anti-depressants (SSRIs) sexual side effects such as erectile impotence and lack of desire are uncommon.

Venlafaxine (Effexor) capsules

What are the conditions the doctor should know before prescribing Venlafaxine ?

Doctors usually do not prescribe Venlafaxine , when the patient has serious cardiac rhythm abnormalities, uncontrolled hypertension, severe liver diseases, severe renal impairment and pregnancy. Before starting the drug doctor will check your blood pressure, take an electrocardiogram, and check whether you are pregnant (doctor may ask whether you missed a period).

Doctors will prescribe cautiously, when the patient has certain heart diseases. Blood pressure monitoring is essential in heart diseases. In addition the doctor must know whether the patient has epilepsy. If the patient has a bleeding disorder, the doctor should know that as well. Venlafaxine is present in breast milk, so nursing mothers should consult their doctor before taking this drug.

What are rare side effects of Venlafaxine ?

Taste abnormalities, hallucinations, urinary retention, bleeding disorders, hair loss, and hypersensitivity reactions like hives, angioedema, and photo sensitivity can occur with certain patients.

What you should know before taking this drug?

Patients should not drive or operate machinery while on the drug, until they know how this drug will affect them. In addition, Venlafaxine should not be stopped abruptly. If it is stopped suddenly then the patient may get withdrawal symptoms such as gastro intestinal disturbance, headache, tremors, sleep disturbances, and sweating.

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Causes, symptoms and treatment of Confabulation?

Image via Wikipedia

Confabulation is falsification of memory in clear consciousness in association with an organically derived amnesia. It is a falsely retrieved memory, often containing false details within its own context.

In addition confabulations are not intentionally produced. person does not know about the existence of memory deficit. Some people may act on them, confirming the belief in the false memory.

There are two type


1. Embarrassment confabulation : – This form is momentary in nature. The person tries to cover up memory gap by an ad hoc confabulated excuses.

2. Fantastic confabulation : – The patient spontaneously describes adventurous experiences of a fantastic nature.

Confabulating patients are often suggestible. That means a mere suggestion can induce a lie. For an example, if we suggest to him that he was there at a cafe during this morning (which does not happened) then he will describe the experience as " Yes i took my breakfast and it was fine".

Confabulation usually occur in Amnesic syndrome seen among alcoholic dependent patients. It is called Korsakoff's psychosis. It usually results due to thiamine deficiency that is associated with long term alcohol abuse. In addition, it can be seen among people with neurological disorders in the brain.

Treatment of Confabulation


It is usually treated with Thiamine replacement. However, established confabulation cannot be treated effectively. Only the progression can be stopped. It can be stopped by taking regular thiamine supplementation and complete abstinence of alcohol.

Summary 

It is a primarily a memory disorder and the patients is unaware of the memory deficit. This leads to filling of memory gaps by a subconscious process that leads to believing a false memory as true. Patient genuinely believe that the false memory is true.

Further reading


Wishful reality distortions in confabulation: a case report.

Originally published in 

http://mentalhealthdoc.blogspot.com/

Side effects of Vistagra

Vistagra is a medication prescribed for male erectile dysfunction. Its popular brand name is Viagra and its generic name is Sildenafil Citrate.

It is manufactured in India by Cadilla Pharmaceuticals. Therefore, side effects are almost similar between these two preparations.

Vistagra causes erection after adequate sexual stimulation. It does not causes erection when the person does not have adequate sexual stimulation. It is also not effective when the sexual problems are due to serious psychological, relationship problems or serious medical problems such as vascular disease of the genitalia.

Common Side effects of Vistagra 

1. Low blood pressure: Sudden lowering of blood pressure can cause strokes, heart attacks and blindness.
2. Seizures or fits
3. Priaprism or continuous erection of penis can result in penile fracture.
4. Nausea, Vomiting and heartburn
5. Nasal bleeding

Since Vistagra can precipitate low blood pressure it is not recommended in people with heart diseases such as recent myocardial infarction or heart attacks, heart failure and heart rhythm abnormalities. In addition, it is not recommended in people with epilepsy. In addition, if you had a episode of priaprism  then it is not recommended.

Vistagra is a medication prescribed for male erectile dysfunction. Vistagra does this by inhibiting an enzyme called PGE5 or phosphodiesterase 5. By way of this inhibition it increases the Nitrous oxide level inside the penile vascular smooth muscles. This causes relaxation of vascular smooth muscles and penile erection. But this all happens when there is a proper emotional background. Therefore, Vistagra cannot erect a penis alone without sexual feelings.

Causes, symptoms and treatment of Extrapyramidal side effects of antipsychotics

Extrapyramidal side effects are type of drug reaction that occurs due to interactions with the extrapyramidal system in our body. There are two broad categories of motor neural pathways in our body.

One is pyramidal system (Tracts originating from motor cortex and innervating skeletal muscles) and other is Extrapyramidal system (Pathways other than pyramidal system which affects motor movements).

Most antipsychotic drugs affect this extrapyramidal system due to their dopamine blocking properties. Therefore, they cause extrapyramidal side effects. Older or typical antipsychotics are notorious for this sideeffect. However, newer atypical antipsychotics can also cause them. In addition, extrapyramidal symptoms can be seen in patients with Parkinson’s diseases and Huntington’s chorea.

Extrapramidal system

Pyramidal system

What are the symptoms of extrapyramidal side effects?

There are four discreet categories of extrapyramidal side effects.

Acute dystonia occur within minutes to hours of antipsychotic medications. They include abnormal and painful movements of the neck, tongue, and body.

Usual treatment is taking anticholinergic drugs such as Benzhexol or Intra muscular benztropine. In addition, taking Intra muscular Phenergon can also alleviate these symptoms.

Akathisia is abnormal sensation of difficult in keeping the legs in one place. It is a very distressing side effect that occurs usually days to weeks after taking antipsychotic drugs.

It is treated with reduction of antipsychotic dose, beta blocker medications such as Propranolol, or diphenhydramine. Usually doctors follow a protocol in treating drug induced akathisia.

Drug induced Parkinsonism present similar to Parkinson’s disease. It includes muscle stiffness, pill rolling tremor and reduced movements (Bradykinesia). It usually occurs months after start of antipsychotic drug treatment.

It is treated with anti-cholinergic drugs mentioned such as Benzhexol.  

Tardive dyskinesia is the side effect that is most difficult to treat. It occurs usually years after treating with antipsychotic drugs. It is characterized by irregular movements of the tongue and face. It usually occurs in older women who are treated with antipsychotic drugs. It is treated usually experts and prognosis is usually poor. Following video shows tardive dyskinesia. 

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Relationship between violent behavior and mental illnesses

Most people who do not know about mental illnesses think mentally ill patients can become easily violent. But the truth is little different. Most people with mental illnesses are not violent. According to the MacArthur Violence Risk Assessment Study, “the prevalence of violence among those with a major mental disorder who did not abuse substances was indistinguishable from their non-substance abusing neighborhood controls (normal people)”.

In addition, schizophrenia shows lowest incidence of violence. Bipolar affective disorder and major depression patients are more violent than schizophrenic patients. Patients with substance abuse issues are the most violent.

Who are at risk?
According to the above study and the personal experience of this author, close relatives of the mentally ill are at most risk. Risk to general public is much less than expected. In fact incidence of violence is almost similar to non-mentally ill people.

What are the predictions of violence in mentally ill?

One of the best predictor is past violence. Past unprovoked violence carries the greatest risk. In addition, substance abuse issues increase the violence of mentally ill patients. Other factors that are thought to increase violence are command hallucinations, and severe prosecutory delusions. In addition, people with severe depression may harm their dependents. E.g. severely depressed mother may kill her young children just to save them from her imagined misery.

How to control violence in a mentally ill?

Even the risk of violence is low, they do occur and most people who deal with mentally ill patients need to know how to tackle them.
 

1. Talking to the patient calmly will alleviate most of the violence. Most people with mental illnesses become violent because they do not get their basic needs. In fact for some of the reasons even the most normal sane people could get violent. For an example, one of the patients who really got violent and try to break the door of the seclusion room became so because he could not contact his mother. Contacting his mother stopped his violence completely.

2. Even most patients can be calmed down by talking, some do need drugs. First option is oral antipsychotics with sedating properties such as Olanzapine.

3. Third option is intramuscular sedative drugs such as Olanzapine, Haloperidol and Midazolam. These drugs will quickly calm down a patient but they can cause side effects such as abnormal movements and respiratory depression (Midazolam).

In extreme rare cases patients need to be physically restrained. Usually it is to allow an intramuscular injection. When the patient is sedated physical restrain should be removed.

Sources

Violence and mental illness: an overview
Violence and Mental Illness — How Strong is the Link?

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Relationship between violent behavior and mental illnesses

Mental health problems associated with obesity

Obesity is an epidemic in developed countries. In 2004, around quarter of the population were obese in UK (Psychiatry, Volume 8, Issue 6, June 2009). This epidemic would results in huge increase in type 2 diabetes, heart disease, hypertension, sleep apnea, hyperlipidaemia, increased incidence of cancer, and joint problems.

However, mental health effects of obesity are not discussed readily most of the time. But there are many mental health issues that can be directly caused by obesity. It is generally related to increased BMI or body mass index (OBESITY SURGERY, Volume 14, Number 5, 579-588).

In obese (BMI >25 kg/m²) category, Life time prevalence of anxiety and mood disorders are 25% higher than the general population. Interestingly substance misuse is lower in this category. Doctors believe it is due to the changes in brain reward system, where obese people get satisfaction from food rather than drugs of abuse (Alcohol and Opiates).

People who seek surgery for weight loss have a very high risk of developing above psychiatric disorders. In addition, there is an increased risk of psychological problems seen among women compared to men with obesity.

Obese people tend to have impulsivity, less self-control, and obsessive perfectionist traits. This would lead them to develop psychological problems but the association is not very clear.

In addition, most studies found that psychological problems tend to improve once the weight is controlled.

Summary

According to evidence certain mental health issues can cause obesity. In addition, certain other biological problems in our brain can cause both mental health problems and obesity. In addition, obesity per se can cause mental health problems. So both conditions are interdependent to some degree.

In addition, it is surprising that people with obesity have less substance use issues (Such as alcohol, cannabis and opioids).

Sources

Elsevier, Psychiatry, Volume 8, Issue 6, June 2009, Pages 198-202