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

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?

Link of this post
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

Effects of lithum on developing fetus

Lithium is a drug that is used in Bipolar affective disorder and resistant depression. However, it is a rather toxic molecule to the human body. But it is safe within certain dose range.

There are several documented cases of birth defects caused by Lithium in humans. They include Epstein anomaly. It is a heart anomaly that can become a severe problem in later life.

In addition, high doses of lithium can cause several abnormalities in the rat fetus. They include high incidence of cleft palate, growth retardation, brain liquification and pulpy brain, hepatomegaly and digital abnormalities. However, incidence in humans are not available because of the obvious reasons.

But stopping lithium during pregnancy can cause severe relapse of bipolar disorder. Which can result in more damages to the fetus and the mother. So doctors weigh risks and benefits of continuing lithium during pregnancy. Sometimes your doctor may decide to continue lithium with the aforementioned risks. In addition, there are very few safer bipolar maintenance therapy options available to the doctors. Some doctors may change the drug regimen to anti-psychotic medications with mood stabilizing properties such as seroquel/zyprexa.

Sources

Teratogenic effects of lithium and ethanol in the developing fetus.

Why is alcohol addictive?

Alcohol is a rather unusual substance and people consume it since the beginning of the human civilization. However, scientists say if Alcohol was found today, it would be certainly a banned substance (FDA would have definitely banned it).

Properties of Alcohol

Alcohol is a simple molecule, but it shows some remarkable properties and actions on neuroreceptors that cause addiction.
1. Alcohol acts on GABA type A receptor via benzodiazepine site. Therefore, alcohol has the actions of Vallium or Xanax
2. Alcohol acts on opioid receptors in the brain: - This causes euphoria and effects of heroin. But in a less intense way.
3. Alcohol acts on the dopamine system of the brain: - This is similar to Cocaine.
4. Alcohol in larger doses acts as a general anesthetic

Image via Wikipedia

5. Alcohol has some properties of SSRI or selective serotonin reuptake inhibitors: Therefore it causes increased energy and alleviates depression but for a greater cost.

What is the brain reward system?

Knowledge about the brain’s reward system is necessary to understand why alcohol is so addictive.
In human brain there is a reward system in place to motivate us. It activates when you eat, have sex, and achieve something. It makes you feel good. In addition, human brain learns about these rewards and attaches memories surrounding these events. This helps us to pursuit our goals.

Problem with alcohol is that it activates the brains reward system artificially and it is much more intense than the natural rewards. Then the brain pathologically learns about alcohol and its surroundings (sight of a bar, friends who drinks and surrounding circumstances).

Since alcohol activates reward system, addicted person will ignore natural ways to get his pleasures resulting in loss of employment, loss of academic performance and relationship problems.

In addition, when he sees a bar or meets a friend who took alcohol with him causes activation of the memories of the reward system that make him seek alcohol. It is a strong desire and most people cannot control it, even they decided to get rid of alcohol.

What is Alcohol withdrawal?

Since alcohol has many pharmacological actions on the brain’s neuroreceptors, human brain adapts to long term alcohol intake by way of changing its own chemistry. Then there would be a new equilibrium between alcohol and anti-alcohol chemistry in the brain. Therefore, when alcohol is suddenly withdrawn these anti – alcohol forces become unopposed and causes severe withdrawal reaction. This withdrawal reaction makes the addicted person to take alcohol.

Sometimes the withdrawal reaction is so strong it can even kill the person, if withdrawal is tried without medical help.


Therefore, it is highly advisable to take medical help when long term alcohol user is stopping alcohol.

How chronic insomnia is treated with sedative hypnotics–New guidelines

According to the stahl’s essentials of psychopharmacology 3rd edition, There is a place for long term use of sedative hypnotics in chronic insomnia. Sedative hypnotic is a drug that causes depression of central nervous system activity which causes sleep.

The old guidelines recommend short term use of sedative hypnotics, improve sleep hygiene and treat the underlying cause for insomnia. It does not appreciate chronic insomnia as a disease entity on its own.

In addition, most of the older sedative hypnotics such as benzodiazepines (Vallium, Dalmane) and barbiturates are comparatively long acting. These long acting compounds tend to cause sleepiness in the following day and falls/hip fractures in the elderly. In addition, they tend to cause withdrawal symptoms and dependence.

New thinking on insomnia and sedative hypnotic use

Now most experts think chronic insomnia is a disorder by itself and there is a need for long term treatment. In addition, hypnotics such as Zaleplon, Zolpidem and Zopiclone extremely short acting. Therefore they do not show any sleepiness in the following day.

In addition, long term studies conducted on eszopiclone shows little or no tolerance (need to take increasing amount of drug to get the same effect) and withdrawal symptoms (Stahl, 3rd).

Following hypnotics have shown marked promise and have no restrictions in the long term use. However, some of them may cause sleepiness in the next day morning.

1. Zolpidem CR (Ambien continuous release)
2. Trazadone (Desyrel)
3. Quatiapine (Seroquel)

Warning
This drug related blog post is for information only. YOU MUST CONSULT YOUR DOCTOR BEFORE TAKING THESE DRUGS.


Sources
Essential psychopharmacology Stahl, 3rd edition

Diagnostic features of Alcohol dependence

According to the ICD – 10 criteria developed by the WHO, Alcohol dependence is defined as “A cluster of physiological, behavioural, and cognitive phenomena due to alcohol use takes on a much higher priority for a given individual than other behaviours that once had greater value”.


It means that alcohol taking behavior takes over the persons other behaviors like working, socializing and other entertainments.




Diagnostic guidelines


1. Strong desire and sense of compulsion to take alcohol
2. Difficulty in controlling alcohol taking behavior.
3. Symptoms of withdrawal like tremors, sweating, increased heart rate, nausea, vomiting and hallucinations, once alcohol is stopped.
4. Tolerance to alcohol, meaning that increase in the amount of alcohol needed to get the same effect. This will result in progressive increase in the amount of alcohol intake.
5. Progressive neglect of alternate pleasure activities. Previous hobbies are stopped to take on alcohol.
6. Persistent use of alcohol despite clear evidence of mental, physical and social harm.

If three or more of above features are present in an individual then alcohol dependence syndrome can be diagnosed.

Since most people are secretive about their alcohol habits, it is difficult to elicit above features. Sometimes doctors need to take comprehensive history from persons family/friends to diagnose Alcohol dependence syndrome.

What is a severe depressive episode?

According to the WHO ICD – 10 criteria (Alternative to the DSM IV of the American psychiatric association), Depression is diagnosed, when the following features are present for more than 2 weeks.

Three Major symptoms of a Depressive episode

1. Depressed mood persisting throughout the day and varies little from day to day and it is usually unresponsive to the circumstances.

2. Loss of interest, enjoyment of the normally pleasurable activities.

3. Reduced energy which leads to increased tiredness (fatigability) and reduced activity.

Seven other minor symptoms of depressive episode

1. Reduced concentration and attention leading to forgetfulness and other mental functions

2. Reduced self esteem and self confidence

3. Ideas of guilt and worthlessness (e.g. believing that a person is a worthless person not suitable for the society)

4. bleak and pessimistic ideas of the future

5. Ideas of self harm and suicide

6. Sleep problems

7. Loss of appetite for food

How severe depressive episode is diagnosed ?

Depressed man -
Vincent van gough
image via Wikipedia

To diagnose severe depressive episode All three major criteria must be present and at least four of the minor criteria must also be present. In addition, person’s work performance, day to day activities should be completely disrupted.
When the person has delusions and hallucinations then the diagnosis is changed to severe depressive episode with psychotic features.

If the person has one or more depressive episodes in the past then the diagnosis should be changed to Recurrent depression current episode Severe depression.

If the person has one or more hypomanic or manic features then the diagnosis should be chaned to bipolar disorder current episode severe depression.

This diagnosis is comparable to the major depressive episode in DSM IV.
Patients with severe depressive episode should be managed in a psychiatric unit.

Further reading

1. ICD – 10