kidney stone

What is a kidney stone?

A kidney stone is a hard, crystalline mineral material formed within the kidney or urinary tract. Kidney stones are a common cause of blood in the urine (hematuria) and often severe pain in the abdomen, flank, or groin. Kidney stones are sometimes called renal calculi.

The condition of having kidney stones is termed nephrolithiasis. Having stones at any location in the urinary tract is referred to as urolithiasis, and the term ureterolithiasis is used to refer to stones located in the ureters.

causes kidney stones

Kidney stones form when there is a decrease in urine volume and/or an excess of stone-forming substances in the urine. The most common type of kidney stone contains calcium in combination with either oxalate or phosphate. About 75% of kidney stones are calcium stones. Other chemical compounds that can form stones in the urinary tract include uric acid, magnesium ammonium phosphate (which forms struvite stones; see below), and the amino acid cystine.

Dehydration from reduced fluid intake or strenuous exercise without adequate fluid replacement increases the risk of kidney stones. Obstruction to the flow of urine can also lead to stone formation. In this regard, climate may be a risk factor for kidney stone development, since residents of hot and dry areas are more likely to become dehydrated and susceptible to stone formation.

Kidney stones can also result from infection in the urinary tract; these are known as struvite or infection stones. Metabolic abnormalities, including inherited disorders of metabolism, can alter the composition of the urine and increase an individual's risk of stone formation.

A number of different medical conditions can lead to an increased risk for developing kidney stones:

• Gout results in chronically increased amount of uric acid in the blood and urine and can lead to the formation of uric acid stones.
• Hypercalciuria (high calcium in the urine), another inherited condition, causes stones in more than half of cases. In this condition, too much calcium is absorbed from food and excreted into the urine, where it may form calcium phosphate or calcium oxalate stones.
• Other conditions associated with an increased risk of kidney stones include hyperparathyroidism, kidney diseases such as renal tubular acidosis, and other inherited metabolic conditions, including cystinuriaand hyperoxaluria.
• Chronic diseases such as diabetes and high blood pressure(hypertension) are also associated with an increased risk of developing kidney stones.
• People with inflammatory bowel disease are also more likely to develop kidney stones.
• Those who have undergone intestinal bypass or ostomy surgeryare also at increased risk for kidney stones.
• Some medications also raise the risk of kidney stones. These medications include some diuretics, calcium-containing antacids, and the protease inhibitor indinavir (Crixivan), a drug used to treat HIV infection.
• Dietary factors and practices may increase the risk of stone formation in susceptible individuals. In particular, inadequate fluid intake predisposes to dehydration, which is a major risk factor for stone formation. Other dietary practices that may increase an individual's risk of forming kidney stones include a high intake of animal protein, a high-salt diet, excessive sugar consumption, excessive vitamin D supplementation, and possible excessive intake of oxalate-containing foods such as spinach. Interestingly, low levels of dietary calcium intake may alter the calcium-oxalate balance and result in the increased excretion of oxalate and a propensity to form oxalate stones.

kidney stones symptoms and signs

While some kidney stones may not produce symptoms (known as "silent" stones), people who have kidney stones often report the sudden onset of excruciating, cramping pain in their low back and/or side, groin, or abdomen. Changes in body position do not relieve this pain. The abdominal, groin, and/or back pain typically waxes and wanes in severity, characteristic of colicky pain (the pain is sometimes referred to as renal colic). It may be so severe that it is often accompanied by nausea and vomiting. The pain has been described by many as the worst pain of their lives, even worse than the pain of childbirth or broken bones. Kidney stones also characteristically cause blood in the urine. If infection is present in the urinary tract along with the stones, there may be fever and chills. Sometimes, symptoms such as difficulty urinating, urinary urgency, penile pain, or testicular pain may occur due to kidney stones.

kidney stones diagnosed

The diagnosis of kidney stones is suspected when the typical pattern of symptoms is noted and when other possible causes of the abdominal or flank pain are excluded. Imaging tests are usually done to confirm the diagnosis. A helical CT scan without contrast material is the most common test to detect stones or obstruction within the urinary tract. Formerly, an intravenous pyelogram (IVP; an X-ray of the abdomen along with the administration of contrast dye into the bloodstream) was the test most commonly used to detect urinary tract stones, but this test has a greater risk of complications, takes longer, and involves higher radiation exposure than the non-contrasted helical CT scan. Helical CT scans have been shown to be a significantly more effective diagnostic tool than the IVP in the diagnosis of kidney or urinary tract stones.

What is the treatment for kidney stones? How long does it take to pass a kidney stone?

Most kidney stones eventually pass through the urinary tract on their own within 48 hours, with ample fluid intake. Ketorolac (Toradol), an injectable anti-inflammatory drug, and narcotics may be used for pain control when over-the-counter pain control medications are not effective. Intravenous pain medications can be given when nausea and vomiting are present.

Although there are no proven home remedies to dissolve kidney stones, home treatment may be considered for patients who have a known history of kidney stones. Since most kidney stones, given time, will pass through the ureter to the bladder on their own, treatment is directed toward control of symptoms. Home care in this case includes the consumption of plenty of fluids.Ibuprofen (Advil) may be used as an anti-inflammatory medication if there is no contraindication to its use. If further pain medication is needed, stronger narcotic pain medications may be recommended.

There are several factors which influence the ability to pass a stone. These include the size of the person, prior stone passage, prostate enlargement, pregnancy, and the size of the stone. A 4 mm stone has an 80% chance of passage while a 5 mm stone has a 20% chance. Stones larger than 9 mm-10 mm rarely pass without specific treatment.

Some medications have been used to increase the passage rates of kidney stones. These include calcium channel blockers such as nifedipine (Adalat, Procardia, Afeditab, Nifediac) and alpha blockers such as tamsulosin(Flomax). These drugs may be prescribed to some people who have stones that do not rapidly pass through the urinary tract.

For kidney stones that do not pass on their own, a procedure called lithotripsy is often used. In this procedure, shock waves are used to break up a large stone into smaller pieces that can then pass through the urinary system.

Surgical techniques have also been developed to remove kidney stones when other treatment methods are not effective. This may be done through a small incision in the skin (percutaneous nephrolithotomy) or through an instrument known as an ureteroscope passed through the urethra and bladder up into the ureter.

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aseptic necrosis

What is aseptic necrosis?

Aseptic necrosis is a bone condition that results from poor blood supply to an area of bone, causing localized bone death. This is a serious condition because the dead areas of bone do not function normally, are weakened, and can collapse. Aseptic necrosis is also referred to as avascular necrosis or osteonecrosis.

causes aseptic necrosis

Aseptic necrosis can be caused by trauma and damage to the blood vessels that supply bone its oxygen. Other causes of poor blood circulation to the bone include a blockage by air or fat (embolism) that obstructs the blood flow through the blood vessels, abnormally thick blood (hypercoagulable state), atherosclerosis (hardening of the arteries), or inflammation of the blood vessel walls (vasculitis). Steroid medications (cortisone, such as prednisone[Deltasone, Liquid Pred] andmethylprednisolone [Medrol, Depo-Medrol]) are the most common medications to cause aseptic necrosis. Typical bones affected by steroids include the femur bone of the hip, the humerus bone of the shoulder, and the tibia bone of the knee, sometimes in combinations and frequently affecting both sides of the body (bilateral). Aseptic necrosis of the jawbone has been associated with the use of medications (bisphosphonates) used to treat high blood calcium levels from cancer.

symptoms of aseptic necrosis

Aseptic necrosis begins as a painless bone abnormality. It can remain painless. The involved bone often later develops pain, especially with use. For example, if a hip joint develops avascular necrosis in the ball of the hip joint, pain can be noted, especially upon weight-bearing. As the ball of the hip joint collapses from the degeneration of the bone from aseptic necrosis, pain in the groin can be felt with hip rotation and pain can sometimes be noted with rest after weight-bearing.

aseptic necrosis diagnosed

The diagnosis of aseptic necrosis can often, but not always, be made with plain film X-rays. By the time changes are apparent by plain film X-ray testing there has been substantial damage to the bone affected. Bone changes visible on plain film X-ray are, therefore, considered a later-stage finding. Earlier signs of avascular necrosis can be detected with an MRI scan image or suggested by a nuclear bone scan image.

treatment for aseptic necrosis

The treatment of aseptic necrosis is critically dependent on the stage of the condition. Early aseptic necrosis (before X-ray image changes are evident) can be treated with a surgical operation called a core decompression. This procedure involves removing a core of bone from the involved area and sometimes grafting new bone into the area. This allows new blood supply to form, preserving the bone. Weight-bearing or impact of the involved joint is restricted.

Later stages of aseptic necrosis (when X-ray image changes are apparent) typically lead to seriously damaged bone and joints, requiring joint replacement surgery.

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phobia

What is a phobia? What are the different kinds of phobias?

A phobia is defined as the unrelenting fear of a situation, activity, or thing that causes one to want to avoid it. The three types of phobias are social phobia (fear of public speaking, meeting new people, or other social situations), agoraphobia (fear of being outside), and specific phobias (fear of particular items or situations).

Phobias are largely underreported, probably because many phobia sufferers find ways to avoid the situations of which they are phobic. Therefore, statistics that estimate how many people suffer from phobias vary widely, but at minimum, phobias afflict more than 6 million people in the United States, with the average age of developing a phobia being about 10 years of age. Other facts about phobias include that these illnesses are not unusual and are thought to affect up to 28 out of every 100 people, and in all western countries, phobias strike 7%-13% of the population. Women tend to be twice as likely to suffer from a phobia compared to men.

Some of the most common phobias include fears of public speaking or other social situations (social phobia or social anxiety disorder), open spaces (agoraphobia), closed-in spaces (claustrophobia), clowns (coulrophobia), flying (aerophobia), blood, animals (zoophobia), commitment (commitment phobia), driving, spiders (arachnophobia), needles (aichmophobia), snakes (ophidiophobia), math, heights (acrophobia or altophobia), germs (mysophobia), and having dental work done (dentophobia). Fears of midgets, haunted houses, helmets, pickles, and feet are just a few unusual fears/phobias and may be considered weird or strange by some but can be just as debilitating as those phobias that are more common. Agoraphobia often coexists with panic disorder.

causes and risk factors for phobias

While there is no one specific known cause for phobias, it is thought that phobias run in families, are influenced by culture and how one is parented, and can be triggered by a number of different life events. Immediate family members of people with phobias are about three times more likely to also suffer from a phobia than those who do not have such a family history. People whose parents either were overly protective or were distant in raising them may be at more risk of developing phobias. Phobia sufferers have been found to be more likely to manage stress by avoiding the stressful situation and by having difficulty minimizing the intensity of the fearful situation. Another possible contributor to the development of phobias is classical conditioning. As it relates to phobias, in classical conditioning, a person responds to something frightening by generalizing the fear of that specific object or situation to more generalized objects or situations. For example, an individual may respond to a real threat by one dog to a fear of all dogs.

signs and symptoms of phobias

Symptoms of phobias often involve having apanic attack -- in that they include feelings of panic, dread, or terror, despite recognition that those feelings are excessive in relationship to any realdanger -- as well as physical symptoms like shaking, sweating, trouble thinking clearly, nausea, rapid heart beat, trouble breathing, and an overwhelming desire to escape the situation that is causing the phobic reaction. Also, extreme measures are sometimes taken to avoid or escape the situation.

treatment for phobias

Helping those who suffer from phobias is thought to be most effective whenpsychotherapy and medications that are specific to the treatment of phobia are both used. One form of psychotherapy involves the supportive and gradual exposure of the individual with phobias to circumstances that are increasingly close to the one they are phobic about (desensitization). These situations can either consist of actual or computer-generated anxiety-provoking stimuli.

Cognitive behavioral therapy (CBT) has been found to significantly decrease phobic symptoms by helping the phobia sufferer change his or her way of thinking. CBT uses three techniques to accomplish this goal:

• Didactic component: This phase involves educating the individual about phobias and treatment and helps to set up positive expectations for therapy and promote the cooperation of the person with a phobia.
• Cognitive component: It helps to identify the thoughts and assumptions that influence the person's behavior, particularly those that may predispose him or her to being phobic.
• Behavioral component: This employs behavior-modifying techniques to teach the individual with a phobia more effective strategies for dealing with problems.

Selective serotonin reuptake inhibitor (SSRI) medications are often used to treat phobias, particularly when desensitization and CBT are inadequately effective. These medications affect levels of serotonin in the brain. Examples of these medications include fluoxetine (Prozac), sertraline(Zoloft), paroxetine (Paxil), fluvoxamine (Luvox), citalopram (Celexa), andescitalopram (Lexapro). The possible side effects of these medications can vary greatly from person to person and depend on which medication is being used. Common side effects of this group of medications include dry mouth, sexual dysfunction, nausea, tremors, trouble sleeping, blurred vision,constipation or soft stools, and dizziness. In very rare cases, some people have been thought to become more acutely more anxious or depressed once on the medication, even trying to or completing suicide or homicide. Children and teens are thought to be particularly vulnerable to this rare possibility.

Phobias are also sometimes treated using beta-blocker medications, which decrease the physical symptoms associated with panic by blocking the effects that adrenaline has on the body. An example of a beta blocker ispropranolol. These disorders are also sometimes treated with drugs in a medication class known as benzodiazepines. This class of medications causes relaxation but is used with caution these days to treat anxiety due to the possibility of addiction and the risk of overdose, especially if taken when alcohol is also being consumed. Examples of medications from that group include diazepam (Valium), alprazolam (Xanax), lorazepam (Ativan), andclonazepam (Klonopin).

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antisocial personality disorder

antisocial personality disorder symptoms and signs

To understand antisocial personality disorder (ASPD or APD), it is necessary to learn what having any personality disorder involves. As defined by the Diagnostic and Statistical Manual for Mental Disorders(DSM-IV-TR, 2000), a personality disorder (PD) is a persistent pattern of thoughts, feelings, and behaviors that is significantly different from what is considered normal within the person's own culture.

Professionals group personality disorders based on a commonality of symptoms.

Cluster A personality disorders are those that include symptoms of social isolation, and/or odd, eccentric behavior. These disorders include

• paranoid personality disorder,
• schizotypal personality disorder,
• schizoid personality disorder.

Cluster B personality disorders are those that include symptoms of dramatic or erratic behaviors (counter-social behaviors). These personality disorders include

• antisocial personality disorder,
• borderline personality disorder,
• histrionic personality disorder,
• narcissistic personality disorder.

Cluster C personality disorders are dominated by difficulties with anxiety and inhibited behavior. These disorders are referred to as and include

• avoidant personality disorder,
• dependent personality disorder,
• obsessive compulsive personality disorder (OCD).

Antisocial personality disorder is specifically a pervasive pattern of disregarding and violating the rights of others. Diagnostic criteria for this disorder state that this pattern must include at least three of the following specific signs and symptoms:

• Lack of conforming to laws, as evidenced by repeatedly committing crimes
• Repeated deceitfulness in relationships with others, such as telling lies, using false names, or conning others for profit or pleasure
• Failure to think or plan ahead (impulsivity)
• Tendency to irritability, anger, and aggressiveness, as shown by repeatedly assaulting others or getting into frequent physical fights
• Disregard for personal safety or the safety of others
• Persistent lack of taking responsibility, such as failing to establish a pattern of good work habits or keeping financial obligations
• A lack of feeling guilty about wrong-doing

Other important characteristics of this disorder include that it is not diagnosed in children (individuals younger than 18 years of age), but the affected person must have shown symptoms of this diagnosis at least since 15 years of age. Additionally, it cannot be diagnosed if the person only shows symptoms of antisocial personality disorder at the same time they are suffering from schizophrenia or when having a manic episode. This disorder tends to occur in about 1% of women and 3% of men in the United States. Antisocial personality symptoms in women tend to include self-harm and more of the other symptoms of borderline personality disorder (BPD) than in men.

causes and risk factors of antisocial personality disorder

One of the most frequently asked questions about antisocial personality disorder by both professionals and laypeople is whether or not it is genetic. Many wonder if it is hereditary, just as much as hair, eye, or skin color; if this were the case, children of antisocial people would be highly expected to become antisocial themselves, whether or not they live with the antisocial parent. Fortunately, human beings are just not that simple. Like all personality disorders, and most mental disorders, antisocial personality disorder tends to be the result of a combination of biologic/genetic and environmental factors.

Although there are no clear biological causes for this disorder, research on the possible biologic risk factors for developing antisocial personality disorder indicates that, in those with antisocial personality disorder, the part of the brain that is primarily responsible for learning from one's mistakes and for responding to sad and fearful facial expressions (the amygdala) tends to be smaller and respond less robustly to the happy, sad, or fearful facial expressions of others. That lack of response may have something to do with the lack of empathy that antisocial individuals tend to have with the feelings, rights, and suffering of others. While some individuals may be more vulnerable to developing antisocial personality disorder as a result of their particular genetic background, that is thought to be a factor only when the person is also exposed to life events such as abuse or neglect that tend to put the person at risk for development of the disorder. Similarly, while there are some theories about the role of premenstrual syndrome (PMS) and other hormonal fluctuations in the development of antisocial personality disorder, the disorder can, so far, not be explained as the direct result of such abnormalities.

Other conditions that are thought to be risk factors for antisocial personality disorder include substance abuse, attention deficit hyperactivity disorder (ADHD), reading disorder, or conduct disorder, which is diagnosed in children. People who experience a temporary or permanent brain dysfunction, also called organic brain damage, are at risk for developing violent or otherwise criminal behaviors. Theories regarding the life experiences that increase the risk for developing antisocial symptoms in teenagers and adults provide important clues for its prevention. Examples of such life experiences include a history of prenatal drug exposure or malnutrition, childhood physical, sexual, or emotional abuse; neglect; deprivation or abandonment; associating with peers who engage in antisocial behavior; or a parent who is either antisocial or alcoholic.

antisocial personality disorder diagnosed

There is no specific definitive test, such as a blood test, that can accurately assess whether a person has antisocial personality disorder. Practitioners conduct a mental-health interview that gathers information to look for the presence of the symptoms previously described. Due to the use of a mental-health interview in making the diagnosis and the fact that this disorder can be quite resistant to treatment, it is important that the mental-health professional know to assess the symptoms in the context of the individual's culture so the person is not assessed as having antisocial personality disorder when he or she does not. Unfortunately, research shows that many practitioners lack the knowledge, experience, and sometimes the willingness to factor cultural context into their assessments.

treatments for antisocial personality disorder

Another very common question asked is, can antisocial personality disorder be cured? While it can be quite resistant to change, research shows there are a number of effective treatments for this disorder. For example, teenagers who receive therapy that helps them change the thinking that leads to their maladaptive behavior (cognitive behavioral therapy) have been found to experience a significant decrease the incidence of engaging in repeat antisocial behaviors.

On the other hand, attempting to treat antisocial personality disorder like other conditions is not often effective. For example, programs that have tried to use a purely reflective (insight-oriented) approach to treating depression or eating disorders in people with antisocial personality disorder often worsen rather than improve outcomes in those individuals. In those cases, a combination of firm but fair programming that emphasizes teaching individuals with antisocial personality disorder the skills that can be used to live independently and productively within the rules and limits of society has been the more effective treatment for this condition.

While medications do not directly treat the behaviors that characterize antisocial personality disorder, they can be useful in addressing conditions that co-occur with this condition. Specifically, depressed or anxious individuals who also have antisocial personality disorder may benefit fromantidepressants, and those who exhibit impulsive anger may improve when given mood stabilizers.

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anxiety

 the different types of anxiety

Anxiety can range from the constructive kind that elevates performance as with performance anxiety, to disorders of anxiety, in that the individual suffers from a level of fear, angst, or dread that interferes with his or her ability to function. The most common anxiety disorders are specific phobias. Other anxiety disorders include social anxiety disorder, panic disorder, generalized anxiety disorder, obsessive compulsive disorder, and posttraumatic stress disorder.

anxiety symptoms and signs

Common symptoms and signs of anxiety can include

• restlessness or feeling edgy,
• becoming tired easily,
• trouble concentrating,
• feeling as if the mind is going "blank,"
• irritability,
• muscle tension,
• sleep problems (trouble falling or staying asleep or having sleep that is not restful).

Anxiety that is associated with specific (specific or simple phobia) or social fears (social phobia) may also result in avoidance of certain situations or an elevation to the level of panic symptoms. In addition to the more general symptoms of anxiety previously described, worry that is associated with a traumatic event (posttraumatic stress disorder) may also result in the following symptoms:

• Avoidance of people, places, or situations that are reminiscent of the traumatic event
• Re-experiencing the trauma in repeated nightmares or flashbacks
• Difficulty trusting others
• Excessive attention to staying safe or keeping loved ones safe (for example, hypervigilance)
• A tendency to startle easily
• A sense of a bleak or foreshortened future

When anxiety intensifies to the level of becoming a panic attack, signs and symptoms can include

• palpitations;
• chest pain, chest tightness, feeling like one is having a heart attack;
• shortness of breath or trouble breathing;
• sweating of the palms;
• nausea or other stomach upset;
• trembling or shaking;
• feeling dizzy, unsteady, lightheaded, or faint;
• derealization (feelings of unreality) or depersonalization (feeling detached from oneself);
• fear of losing control or going insane;
• numbness or tingling sensations;
• chills or hot flashes;
• feeling like one is choking;
• a sense of impending doom;
• feeling like one is dying.

treatment for anxiety

There are a variety of treatments available for controlling anxiety, including several effective medications and specific forms of psychotherapy. In terms of medications,buspirone (Buspar) is known to be quite effective for treating GAD. However, it seems to be less effective in managing many other disorders that often co-occur (are comorbid) with GAD. Therefore, specific members of the selective serotonin reuptake inhibitor (SSRI) and the selective serotonin and norepinephrine reuptake inhibitor (SSNRI) drug classes, which are also approved by the U.S. Food and Drug Administration (FDA) for effective treatment of GAD, are prescribed more often. Examples of SSRI medications includefluoxetine (Prozac), sertraline (Zoloft),paroxetine (Paxil), citalopram (Celexa), andescitalopram (Lexapro). Examples of SNRI medications are duloxetine (Cymbalta) andvenlafaxine (Effexor). Although buproprion (Wellbutrin) is primarily known to primarily treat depression, preliminary research suggests that it may also be helpful in the treatment of anxiety.

Benzodiazepine medications likeclonazepam (Klonopin) and lorazepam(Ativan) are more useful in stopping severe anxiety symptoms, like those that occur in panic disorder or in posttraumatic stress disorder rather than the ongoing worry that is usually associated with GAD. Althoughalprazolam (Xanax) is often used to treatpanic attacks, its short duration of action can sometimes result in having to take it several times per day. Medications from the beta-blocker family (for example,propranolol [Inderal]) are sometimes used to provide rapid relief of the physical symptoms associated with a panic attack. Some individuals who suffer from severe panic attacks may benefit from treatment with neurontin (Gabapentin), which was initially developed to treat seizures, or may benefit from a neuroleptic medication like risperidone (Risperdal), olanzapine(Zyprexa), quetiapine (Seroquel), or aripiprazole (Abilify). Zolpidem (Ambien) has been found helpful in treating the insomnia that can often be a symptom of anxiety.

Before SSRIs and SSNRIs became available, medications from the group known as the tricyclic antidepressants (TCAs) were often used to address panic disorder. Although TCAs have been found to be equally effective in treating panic attacks, SSRIs and SSNRIs have been proven to be safer and better tolerated. Therefore TCAs are used much less often than they used to be. When used in the appropriate person with close monitoring, these medications can be quite effective as part of treatment for panic disorder.

For individuals who may be wondering how to avoid panic attacks using treatment without prescribed medications, natural remedies may be an option. While treatment like hypnosis and herbal supplements that containkava have been found to be helpful for some people with some anxiety disorders, the research data are still considered to be too limited for many physicians to recommend treatment with other natural remedies like valerianor passionflower. Also, care should be taken when taking any dietary supplements, since dietary supplements and "natural" remedies are not regulated in terms of quality, content, or effectiveness.

The psychotherapy component of treatment for anxiety disorders is at least as important as the medication treatment. In fact, research shows that psychotherapy alone or the combination of medication and psychotherapy treatment are more effective than medication alone in overcoming anxiety for both adults and children. It has also been found to be potentially effective for people with autism in addition to anxiety. The most common type of therapy used to treat anxiety is cognitive behavioral therapy (CBT). This form of therapy seeks to help those with an anxiety disorder identify and decrease the irrational thoughts and behaviors that reinforce anxiety symptoms and can be administered either individually, in group therapy, and even in partner-assisted therapy. CBT that seeks to help the anxiety sufferer decrease the tendency to pay excessive attention to potential threats has also been found to be helpful.

Behavioral techniques that are often used to decrease anxiety include relaxation techniques and gradually increasing exposure to situations that may have previously precipitated anxiety in the individual. Helping the anxiety sufferer to understand and how to handle the emotional forces that may have contributed to developing symptoms (anxiety-focused psychodynamic psychotherapy) has also been found to be effective in teaching an individual with panic disorder how to prevent an anxiety attack or to decrease or stop a panic attack once it starts.

Often, a combination of psychotherapy and medications produces good results. Improvement is usually noticed in a fairly short period of time, about two to three months. Thus, appropriate treatment for anxiety can prevent symptoms or at least substantially reduce their severity and frequency, bringing significant relief to many people with anxiety. There are also self-care measures that people with anxiety can do to help make treatment more effective. Since substances like caffeine, alcohol, and illicit drugs can worsen anxiety, those things should be avoided. Other tips to prevent or manage anxiety symptoms include engaging in aerobic exercise and stress-management techniques like deep breathing, massage therapy, and yoga, since these self-help activities have also been found to help decrease the frequency and severity of symptoms. Although many people breathe into a paper bag when afflicted by the hyperventilation that can be associated with panic, the benefit received may be the result of the individual believing it will remedy the symptoms (placebo effect). Also, breathing into a paper bag when one is having trouble breathing can make matters worse when the hyperventilation is the result of conditions of oxygen deprivation, like anasthma attack or a heart attack.

People with an anxiety disorder may also need treatment for other emotional problems. Depression has often been associated with anxiety, as have alcohol and drug abuse. Recent research also suggests that suicideattempts are more frequent in people with an anxiety disorder. Fortunately, these problems associated with panic disorder can be overcome effectively, just like panic disorder itself. Sadly, many people with anxiety do not seek or receive treatment.

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anorexia nervosa

What is anorexia nervosa?

Anorexia nervosa, commonly referred to simply as anorexia, is one type of eating disorder. More importantly, it is also a psychological disorder. Anorexia is a condition that goes beyond concern aboutobesity or out-of-control dieting. A person with anorexia often initially begins dieting to lose weight. Over time, the weight lossbecomes a sign of mastery and control. The drive to become thinner is actually secondary to concerns about control and/or fears relating to one's body. The individual continues the ongoing cycle of restrictive eating, often accompanied by other behaviors such as excessive exercising or the overuse of diet pills to induce loss of appetite, and/or diuretics, laxatives, or enemas in order to reduce body weight, often to a point close to starvation in order to feel a sense of control over his or her body. This cycle becomes an obsession and, in this way, is similar to an addiction.

causes anorexia nervosa

At this time, no definite cause of anorexia nervosa has been determined. However, research within the medical and psychological fields continues to explore possible causes.

Studies suggest that a genetic (inherited) component may play a more significant role in determining a person's susceptibility to anorexia than was previously thought. Researchers are currently attempting to identify the particular gene or genes that might affect a person's tendency to develop this disorder, and preliminary studies suggest that a gene located at chromosome 1p seems to be involved in determining a person's susceptibility to anorexia nervosa.

Other evidence had pinpointed a dysfunction in the part of the brain called the hypothalamus (which regulates certain metabolic processes), as contributing to the development of anorexia. Other studies have suggested that imbalances in neurotransmitter (brain chemicals involved in signaling and regulatory processes) levels in the brain may occur in people suffering from anorexia.

Feeding problems as an infant, a general history of under-eating, and maternal depressive symptoms tend to be risk factors for developing anorexia. Other personal characteristics that can predispose an individual to the development of anorexia include a high level of negative feelings and perfectionism. For many individuals with anorexia, the destructive cycle begins with the pressure to be thin and attractive. A poor self-image compounds the problem. People who suffer from any eating disorder are more likely to have been the victim of childhood abuse.

While some professionals remain of the opinion that family discord and high demands from parents can put a person at risk for developing this disorder, the increasing evidence against the idea that families cause anorexia has mounted to such an extent that professional mental health organizations no longer ascribe to that theory. Possible factors that protect against the development of anorexia include high maternal body mass index (BMI) as well as personal high self-esteem.

anorexia nervosa diagnosed

Anorexia nervosa can be a difficult disorder to diagnose, since individuals with anorexia often attempt to hide the disorder. Denial and secrecy frequently accompany other symptoms. It is unusual for an individual with anorexia to seek professional help because the individual typically does not accept that she or he has a problem (denial). In many cases, the actual diagnosis is not made until medical complications have developed. The individual is often brought to the attention of a professional by family members only after marked weight loss has occurred. When anorexics finally come to the attention of the health care professional, they often lack insight into their problem despite being severely malnourished and may be unreliable in terms of providing accurate information. Therefore, it is often necessary to obtain information from parents, a spouse, or other family members in order to evaluate the degree of weight loss and extent of the disorder. Health professionals will sometimes administer questionnaires for anorexia as part of screening for the disorder.

Warning signs of developing anorexia or one of the other eating disorders include excessive interest in dieting or thinness. One example of such interest includes a movement called "thinspiration," which promotes extreme thinness as a lifestyle choice rather than as a symptom of illness. There are a variety of web sites that attempt to inspire others toward extreme thinness by featuring information on achieving that goal, photos of famous, extremely thin celebrities, and testimonials, as well as before and after pictures of individuals who ascribe to extreme thinness.

The actual criteria for anorexia nervosa are found in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR).

There are four basic criteria for the diagnosis of anorexia nervosa that are characteristic:

1. The refusal to maintain body weight at or above a minimally normal weight for age and height (maintaining a body weight less than 85% of the expected weight)
2. An intense fear of gaining weight or becoming fat, even though the person is underweight
3. Self-perception that is grossly distorted, excessive emphasis on body weight in self-assessment, and weight loss that is either minimized or not acknowledged completely
4. In women who have already begun their menstrual cycle, at least three consecutive periods are missed (amenorrhea), or menstrual periods occur only after a hormone is administered.

The DSM-IV-TR further identifies two subtypes of anorexia nervosa. In thebinge-eating/purging type, the individual regularly engages in binge eating or purging behavior which involves self-induced vomiting or the misuse of laxatives, diuretics, or enemas during the current episode of anorexia. In the restricting type, the individual severely restricts food intake but does not regularly engage in the behaviors seen in the binge-eating type.

In order to diagnose anorexia, the health care professional distinguishes this illness from being a symptom of an underlying medical disorder or of another eating disorder. As a symptom of a medical disorder, the term anorexia (in general, rather than anorexia nervosa, the condition discussed in this article) describes the considerable weight loss that may be the result of serious illness that may afflict terminally ill patients who are receivinghospice care.

Unlike the binge-eating/purging type of anorexia nervosa, bulimia nervosa does not result in weight reduction below the minimal normal weight. Bulimia nervosa is characterized by episodes of eating significantly excessive amounts of food that the individual feels they cannot stop themselves from engaging in (binges), alternating with episodes of attempts to counteract the binges using inappropriate behaviors (purging) like self-induced vomiting, misuse of medications, fasting, and/or excessive exercising. Most individuals with an eating disorder do not fit neatly into either the diagnosis of anorexia or bulimia and are therefore classified as suffering from eating disorder, not otherwise specified (EDNOS). For example, people with binge-eating disorder experience episodes of binge eating but do not regularly engage in purging or restricting behaviors.

anorexia symptoms and signs (psychological and behavioral)

Anorexia can have dangerous psychological and behavioral effects on all aspects of an individual's life and can affect other family members as well.

• The individual can become seriously underweight, which can lead todepression and social withdrawal.
• The individual can become irritable and easily upset and have difficulty interacting with others.
• Sleep can become disrupted and lead to fatigue during the day.
• Attention and concentration can decrease.
• Most individuals with anorexia become obsessed with food and thoughts of food. They think about it constantly and become compulsive about their food choices or eating rituals. They may collect recipes, cut their food into tiny pieces, prepare elaborate calorie-laden meals for other people, or hoard food. Additionally, they may exhibit other obsessions and/or compulsions related to food, weight, or body shape that meet the diagnostic criteria for anobsessive compulsive disorder.
• Other psychiatric problems are also common in people with anorexia nervosa, including affective (mood) disorders, anxiety disorders, and personality disorders.
• Generally, individuals with anorexia are compliant in every other aspect of their life except for their relationship with food. Sometimes, they are overly compliant, to the extent that they lack adequate self-perception. They are often eager to please and strive for perfection. They usually do well in school and may often overextend themselves in a variety of activities. The families of anorexics often appear to be "perfect." Physical appearances are important to the anorexia sufferer. Performance in other areas is stressed as well, and they are often high achievers in many areas.
• While control and perfection are critical issues for individuals with anorexia, aspects of their life other than their eating habits are often found to be out of control as well. Many have, or have had at some point in their lives, addictions to alcohol, drugs, or gambling. Compulsions involving sex, exercising, housework, and shopping are not uncommon. In particular, people with anorexia often exercisecompulsively to speed the weight-loss process.
• Symptoms of anorexia in men tend to co-occur with other psychological problems and more commonly follow a period of being overweight than in women. Men with anorexia also tend to be more likely to have a distorted body image.
• Compared to symptoms in men, symptoms of anorexia in women tend to more frequently include a general displeasure with their body and a possibly stronger desire to be thin. Women with anorexia also tend to experience more perfectionism and cooperativeness.

In addition to the mental effects of anorexia, physical effects of this disorder in children and teens include a number of issues that are associated with the growth and development inherent in this age group. Examples of symptoms and signs of anorexia in childhood and adolescence can include a slowing of the natural increase in height or a slowed increase in development of other body functions.

All of these features can negatively affect one's daily activities. Diminished interest in previously preferred activities can result. Some individuals also have symptoms that meet the diagnostic criteria for a major depressive disorder.

treatment for anorexia nervosa

Anorexia may be treated in an outpatient setting, or hospitalization may be necessary. For an individual with severe weight loss that has impaired organ function, hospital treatment must initially focus on correction of malnutrition, and intravenous feeding or tube feeding that goes past the mouth may be required. A gain of between 1 to 3 pounds per week is a safe and attainable goal when malnutrition must be corrected. Sometimes weight gain is achieved using schedules for eating, decreased physical activity, and increased social activity, either on an inpatient or outpatient basis. For individuals who have suffered from anorexia for several years, the goals of treatment may need to be achieved more slowly in order to prevent the anorexia sufferer from relapsing as a result of being overwhelmed by treatment.

The overall treatment of anorexia, however, must focus on more than weight gain. There are a variety of treatment approaches dependent upon the resources available to the individual. Because of increasing insurance restrictions, many patients find that a short hospitalization followed by participation in a day treatment program is an effective alternative to longer inpatient programs. Most individuals, however, initially seek outpatient treatment involving psychological as well as medical intervention. It is common to engage a multidisciplinary treatment team consisting of a medical care professional, a dietician or nutritionist, and a mental health care professional.

Different kinds of psychological therapy have been employed to treat people with anorexia. Individual therapy, cognitive behavior therapy, group therapy, and family therapy have all been successful in the treatment of anorexia. In adolescents, research shows that the Maudsley model of family therapy can be particularly effective in treating this disorder in this population. In contrast to many past approaches to treatment, the Maudsley model approaches the family of the individual with anorexia as part of the solution rather than part of the reason their loved one has the disorder. With ongoing specific guidance from the professional mental health team, this approach has the family actively help their loved one eat in a more healthy manner.

Any appropriate treatment approach addresses underlying issues of control, perfectionism, and self-perception. Family dynamics are explored. Nutritional education provides a healthy alternative to weight management for the patient. Group counseling or support groups may assist the individual in the recovery process. The ultimate goal of treatment should be for the individual to accept herself/himself and lead a physically and emotionally healthy life.

While no medications have been identified that can definitively reduce the compulsion to starve oneself, olanzapine (Zyprexa, Zydis), risperidone(Risperdal), and quetiapine (Seroquel) are medications that are also used as mood stabilizers and to treat schizophrenia that may be useful in treating anorexia. These medications may also help increase weight and to manage some of the emotional symptoms like anxiety and depression that can accompany anorexia. Some of the selective serotonin reuptake inhibitor (SSRI) antidepressant drugs, like fluoxetine (Prozac), sertraline (Zoloft),paroxetine (Paxil), citalopram (Celexa), and escitalopram (Lexapro), have been shown to be helpful in weight maintenance after weight has been gained, as well as having beneficial effects on the mood and anxiety symptoms that may be associated with the condition.

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