5
June
2008
Bipolar disorder involves mania. 2 types: bipolar disorder I and II. Focus on I: episodes of sustained mania and usually depressive episodes. bipolar disorder is often undetected and a person is treated for depression instead. 1% prevalence. Probably genetic component to this disorder. Men and women are equally affected, and usually onset age 15-30.
Mania has 5 criteria per American Psychiatric Association 1) at least 1 week of abnormally and persistently elevated, expansive, or irritable mood. 2) During this time of mood disturbance, 3 of the following (4 if mood is only irritable): a) inflated self-esteem or grandiosity b) decreased need for sleep c) more talkative than usual or pressure to keep talking d) flight of ideas or subjective experience that thoughts are racing e) distractibility f) increase in goal-directed activity g) excessive involvement in pleasurable activities that have a high potential for painful consequences 3) The symptoms don’t meet criteria for mixed episode 4) The mood disturbance a) is sufficiently severe to cause marked impairment in occupational functioning, usual social activities, or relationships with others, b) necessitates hospitalization to prevent harm to self or others, or c) has psychotic features. 5) The symptoms are not due to the direct physiological effects of a substance (eg, a drug of abuse, a medication, or other treatment) or a general medical condition (eg, hyperthyroidism).
drjohnhong 
Psych 
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27
February
2008
Hyperhidrosis: excessive sweating. I am going to focus on the hands, feet, and armpits because that is embarrassing and emotionally distressing to people who have it. It is thought less than 1% of the population suffers from this.
The cause? For most there is not a disease causing it. Those with growth hormone excess (acromegaly) have sweating hands and feet. Medications can cause it – there are a lot, in particular some NSAIDs, BP meds, migraine meds, antidepressants, and narcotics. Stimulants in particular can cause sweaty hands and feet because the sympathetic nervous system causes the sweat glands to secrete perspiration.
Interesting: doesn’t occur when asleep. Episodes occur usually during stress or excitement. Of course heat can cause the sweating as well.
drjohnhong Psych, Dermatology Comments (0) » |
5
December
2007
Depression in Men: for some reason it seems women are the focus of depression and not men. True 8-10% of women have major depression vs. 3-5% of men. But for men, they are less likely to discuss it or have it treated. It is thought depression affects our country so much: $83 billion a year due to functional disability and mortality. Lifetime prevalence of depression is thought to be 17.9% in white and 10.4% in blacks. Peaks in the ages 30-39. Now this is for major depression and doesn’t include minor depression or dysthymia.
Depressed older men in particular who aren’t married are more likely to commit suicide than women (probably 4x higher). Depression is a strong risk factor for all-cause mortality, and probably plays a role in illness.
Major depression: 5 of 9 symptoms for 2 weeks for the majority of each day. 2 of the symptoms must include depressed mood or anhedonia (loss of interest or pleasure). Change in sleep (sleep more or less), loss of energy, change in weight or appetite, change in psychomotor activity (usually less agile and less physically active). Poor concentration, suicidal thoughts or thinking about death, poor self esteem (feeling worthless or guilty)
Minor depression and dysthymic disorder have symptoms described in major depression but don’t fully meet criteria.
What is depressed mood? Some people say it is a feeling of sadness. Others just feel “blah”. Irritability and short-temper can be a sign of depressed mood. With anhedonia, a person doesn’t want to go out and do the things normally enjoyed. It just isn’t as fun or meaningful.
Early morning awakening can occur with depression, so about 4 hours after falling asleep, they are up for the rest of the night. If there is anxiety, falling asleep can take a long time. Some people “hibernate” and will sleep all day.
Anorexia can occur or the opposite: eating too much.
Bipolar disorder needs to be ruled out because treatment is different. Also other psychiatric and medical conditions need to be checked because they can affects a person’s mood.
Treatment: talk to your doctor. Psychotherapy and antidepressants are very effective.
drjohnhong Men issues, Psych Comments (0) » |
17
October
2007
Obsessive-Compulsive Disorder (OCD) affects 2-3% of Americans, and usually starts around age 10 or 21. OCD means having anxiety-provoking intrusive thoughts and repetitive behaviors. The intrusive thoughts are unwelcomed and can interfere with a person’s day. Obsessions include aggressive thoughts and impulses, fear someone will be harmed, or fears of germs or dirt. Compulsions are repetitive behaviors like washing hands over and over, checking to make sure the door is locked over and over, or counting things like the tiles on the floor. The compulsive behavior is to overcome the fears.
OCD symptoms overlap some other mental disorders. Trichotillomania is a type of compulsive behavior of hair pulling, so it can lead to bald spots on the head, eye browns, arms, etc. Skin picking and nail-biting can lead to infections. Hypocondriasis is the belief of having a specific disease. Other OCD related disorders include gambling addiction, kleptomania, sexual compulsions, autism, Tourette’s Syndrome, Body dysmorphic disorder, and anorexia nervosa.
Obsession: the person realizes that they are obsessing and that they aren’t hallucinating or in psychosis. But they have a hard time getting rid of the senseless, intrusive thoughts. Many obsessive thoughts have a theme: a small oversight will be disastrous, fear of contamination, desire to put things in order nice and neat, aggressive impulses like hurting someone, and sexual thoughts.
Compulsions: a behavior is done over and over to cool down the obsession. Some people count, others arrange things into a neat order, wash hands, pick skin, pull hair, others touch (like David Sedaris wrote in one of his books about touching people’s heads).
Quality of life is often hurt by OCD – in particular interpersonal relationships. There is shame and distress over the OCD and many patients won’t seek help due to the shame.
One study followed 144 OCD patients for 40 years. 2/3 had some improvement in OCD within 10 years, 1/5 no longer had OCD. However, 1/5 who recovered relapsed.
Treatment: it is difficult. For those with mild to moderate OCD, cognitive-behavioral therapy and medications can help. SSRIs or Clomipramine are drugs of choice.
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