What is a Primary Survey

The Primary Survey is the initial patient assessment, intended to rapidly and systematically identify and treat any immediately life-threatening problems. It follows the ABC format familiar from other courses, but extends this into more detail. Assessment and treatment proceed simultaneously – as a problem is identified,appropriate action should be taken before moving on ...

What is a Mental Health

Concepts of mental health include subjective well-being, perceived self-efficacy, autonomy, competence, intergenerational dependence and recognition of the ability to realize one’s intellectual and emotional potential. It has also been defined as a state of well-being whereby individuals recognize their abilities, are able to cope with the normal stresses of life, work productively and fruitfully, ...

26 November 2009

Children can develop Bipolar Disorder

children with bipolar disorderBoth children and adolescents can develop bipolar disorder. It is more likely to affect the children of parents who have the illness. Unlike many adults with bipolar disorder, whose episodes tend to be more clearly defined, children and young adolescents with the illness often experience very fast mood swings between depression and mania many times within a day.6 Children with mania are more likely to be irritable and prone to destructive tantrums than to be overly happy and elated. Mixed symptoms also are common in youths with bipolar disorder. Older adolescents who develop the illness may have more classic, adult-type episodes and
symptoms. Bipolar disorder in children and adolescents can be hard to tell apart from other problems that may occur in these age groups. For example, while irritability and aggressiveness can indicate bipolar disorder, they also can be symptoms of attention deficit hyperactivity disorder, conduct disorder, oppositional defiant disorder, or other types of mental disorders more common among adults such as major depression or schizophrenia. Drug abuse also may lead to such symptoms. For any illness, however, effective treatment depends on appropriate diagnosis. Children or adolescents with emotional and behavioral symptoms should be carefully evaluated by a mental health professional. Any child or adolescent who has suicidal feelings, talks about suicide, or attempts suicide should be taken seriously and should receive immediate help from a mental health specialist.
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21 November 2009

2012 Movie

a2012Centuries ago, the Mayans left us their calendar, with a clear end date and all that it implies. Since then, astrologists have discovered it, numerologists have fund patterns that predict it, geologists say the earth is overdue for it, and even government scientists cannot deny the cataclysm of epic proportions that awaits the earth in 2012. A prophecy that began with the Mayans has now been well-chronicled, discussed, taken apart and examined. By 2012, we’ll know we were warned..
The paragraph above is the prologue of the film that is currently the world community controversy, including in Indonesia. Surprised to hear rumors that in the year 2012 will be a major natural disaster, very likely is the end of the world. Plus I live in Indonesia as is often the case when natural disasters such as tsunamis, earthquakes, landslides, floods and mudflow. The last is a big earthquake in Padang, West Sumatra. Makes me shudder if the prediction is true. How will I die? What about my family? Friends? Do not want to separate or to see loved ones die! Indeed, I cannot see it! And I'm really not ready to die for it! Many things should I prepare to die, one of which is compliance in accordance with the religious worship which I profess. The main key when I was ready to die. Maybe you will think like me.
When the world community feeling annoyed with the problem, once again Hollywood made a sensation by launching a controversial film. In the film, describes how the end of the world (read: disaster) happens. Visual effects are incredible, to be all looks real! And able to make people want to know about the world, want to feel the sensation of movie made in'Collumbia Pictures'. Reportedly able to reach the first position on the movie box office the first time in release. No doubt 'Collumbia Pictures' benefit greatly from this film
Want to know about the show, I finally decided to buy the DVD version of the film. Here's a brief explanation of the contents of the film in 2012, according to my version
Described in the year 2009, a scientist named DR. Adrian found a natural phenomenon that makes it so worried about something that will happen in 2012 so he must notify the council of government. Then council members immediately notify all necessary authorities to immediately hold a meeting to create some anticipation. The decision was made to build 3 ships for rescue action. With the help of donors, the project finally was completed in a short time, of course, wealthy donors, and get tickets for the ship to escape. How the world communities respond to these issues? Anyone cares to do a demo to the government to immediately take action, some do not care, some do not even know about this problem. Jackson is one of indifference, which he was only thinking about his job. He worked as a personal driver Yuri, a boss of Russia.
Jackson rescue action against his family and then going on. Very lucky, rescued from the earthquake, ground cracks, buildings collapsed, lava, finally boarded the plane and a little more secure when flying. All feel sad at losing; do not want to separate or to see loved ones die. After a struggle, eventually him and his family can be boarded ships and survived of the help of friend. At the end of the story, the earth is formed into a new continent
Character of the actor when playing this movie is different, it is human nature, many are thinking about himself, but there are also other people who care. I conclude from the plot of this movie is less interesting, impressed all be arranged with the money. Rich people have better luck. For its visual effects, very awesome. My opinion after watching this movie, this movie just for profit. 2012 rumors, only to increase sales of the film is not it? About the existence of solar storms can be learned. More experts asked more appropriate solution. The signs of the end of the world (according to what I heard on the basis of religion) would not be predicted at any time, date, year, hours it will happen. Only visible signs of secondary. A simple example, we do not know God. I will not talk much, I'm sure you are more critical in thinking than I am. So, you are more likely to believe in a god destiny or a human prediction? What do you think?
READ MORE - 2012 Movie

19 November 2009

Glimpse of the RSSM

RSSM HospitalIn the year 1916, Shortens plan to build a 'Krankzinnigengesticht'.(Psychiatric Hospital) in central Java with a capacity of 1400 beds. Magelang defined as a location by the Dutch government. Hospital referred to as 'krankzinnigengesticht Kramat', after independence, its name became 'Magelang Mental Hospital'.

In the development Magelang Mental Hospital into vertical Hospital's Department of Health in accordance with the Minister of Health certificate of RI Item: 135/MenKes/SK/IV/1978 RS. Soul Magelang is mental hospital as a class A Psychiatric Hospital Education. Presidential Decree No.38/1991 on ‘Swadana’ Unit, a unit of the hospital services that can move quickly in providing services to the community by using funds obtained from operational income. Mental hospitals and certificate Magelang appointed Minister of Health PNBP User Agency in order to facilitate the task in order to provide services to the community.
Being a Government Agency by applying under Pattern Dep.Kes.RI Financial Management General Services Agency (PPK BLU) based on the decision of the Minister of Finance No.278/KMK.05/2007 dated June 21, 2007 and the decision of Minister of Health No.756/Men.Kes / SK/VI/2007 dated 26 June 2007. Bed capacity of the current 800 beds to the number of buildings consisting of 2.7 ha-patient ward 26 units, 1 unit of drug, Outpatient and emergency room each - 1 units respectively. Prof.dr.Soeroyo Hospital (RSSM Magelang) or abbreviated as a core business of public service is supported.

from Rumah sakit Jiwa Prof. Dr. Soeroyo (history)
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17 November 2009

Bipolar disorder causes

bipolar disorder causesBipolar disorder causes dramatic mood swings&from overly ‘high’ and/or irritable to sad and hopeless, and then back again, often with periods of normal mood in between. Severe changes in energy and behavior go along with these changes in mood. The periods o highs and lows are called episodes of mania and depression.
Signs and symptoms of mania (or a manic episode) include:
  • Increased energy, activity, and restlessness
  • Excessively ‘high’, overly good, euphoric mood
  • Extreme irritability
  • Racing thoughts and talking very fast, jumping from one idea to another
  • Distractibility, can t concentrate well
  • Little sleep needed
  • Unrealistic beliefs in one s abilities and powers
  • Poor judgment
  • Spending sprees
  • A lasting period of behavior that is different from usual
  • Increased sexual drive
  • Abuse of drugs, particularly cocaine, alcohol, and sleeping medications
  • Provocative, intrusive, or aggressive behavior
  • Denial that anything is wrong
A manic episode is diagnosed if elevated mood occurs with 3 or more of the other symptoms most of the day, nearly every day, for 1 week or longer. If the mood is irritable, 4 additional symptoms must be present.
Signs and symptoms of depression (or a depressive episode) include:
  • Lasting sad, anxious, or empty mood
  • Feelings of hopelessness or pessimism
  • Feelings of guilt, worthlessness, or helplessness
  • Loss of interest or pleasure in activities once enjoyed, including sex
  • Decreased energy, a feeling of fatigue or of being ‘slowed down’
  • Difficulty concentrating, remembering, making decisions
  • Restlessness or irritability
  • Sleeping too much, or can t sleep
  • Change in appetite and/or unintended weight loss or gain
  • Chronic pain or other persistent bodily symptoms that are not caused by physical illness or injury
  • Thoughts of death or suicide, or suicide attempts
A depressive episode is diagnosed if 5 or more of these symptoms last most of the day, nearly every day, for a period of 2 weeks or longer.

A mild to moderate level of mania is called hypomania. Hypomania may feel good to the person who experiences it and may even be associated with good functioning and enhanced productivity. Thus even when family and friends learn to recognize the mood swings as possible bipolar disorder, the person may deny that anything is wrong. Without proper treatment, however, hypomania can become severe mania in some people or can switch into depression. Sometimes, severe episodes of mania or depression include symptoms of psychosis (or psychotic symptoms). Common psychotic symptoms are hallucinations (hearing, seeing, or otherwise sensing the presence of things not actually there) and delusions (false, strongly held beliefs not influenced by logical reasoning or explained by a person s usual cultural concepts). Psychotic symptoms in bipolar disorder tend to reflect the extreme mood state at the time. For example, delusions of grandiosity, such as believing one is the President or has special powers or wealth, may occur during mania; delusions of guilt or worthlessness, such as believing that one is ruined and penniless or has committed some terrible crime, may appear during depression.
People with bipolar disorder who have these symptoms are sometimes incorrectly diagnosed as having schizophrenia, another severe mental illness. It may be helpful to think of the various mood states in bipolar disorder as a spectrum or continuous range. At one end is severe depression, above which is moderate depression and then mild low mood, which many people call ‘the blues’ when it is short lived but is termed ‘dysthymia’ when it is chronic. Then there is normal or balanced mood, above which comes hypomania (mild to moderate mania), and then severe mania. In some people, however, symptoms of mania and depression may occur together in what is called a mixed bipolar state. Symptoms of a mixed state often include agitation, trouble sleeping, significant change in appetite, psychosis, and suicidal thinking. A person may have a very sad, hopeless mood while at the same time feeling extremely energized.
Bipolar disorder may appear to be a problem other than mental illness & for instance, alcohol or drug abuse, poor school or work performance, or strained interpersonal relationships. Such problems in fact may be signs of an underlying mood disorder.

Kay Redfield Jamison, Ph.D., An Unquiet Mind, 1995, p. 6.
READ MORE - Bipolar disorder causes

16 November 2009

Bipolar Disorder

Bipolar Disorder'mental illnes'Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in a persons mood, energy, and ability to function. Different from the normal ups and downs that everyone goes through, the symptoms of bipolar disorder are severe. They can result in damaged relationships, poor job or school performance, and even suicide. But there is good news: bipolar disorder can be treated, and people with this illness can lead full and productive lives.

Bipolar definition
Bipolar, or manic-depressive disorder, is a mood disorder that causes radical emotional changes and mood swings, from manic highs to depressive lows. The majority of bipolar individuals experience alternating episodes of mania and depression.

Bipolar disorder typically develops in late adolescence or early adulthood. However, some people have their first symptoms during childhood, and some develop them late in life. It is often not recognized as an illness, and people may suffer for years before it is properly diagnosed and treated. Like diabetes or heart disease, bipolar disorder is along-term illness that must be carefully managed throughout a person s life.
Manic-depression distorts moods and thoughts, incites dreadful
behaviors, destroys the basis of rational thought, and too often erodes
the desire and will to live. It is an illness that is biological in its origins,
yet one that feels psychological in the experience of it; an illness that is
unique in conferring advantage and pleasure, yet one that brings in its
wake almost unendurable suffering and, not infrequently, suicide.
“I am fortunate that I have not died from my illness, fortunate in
having received the best medical care available, and fortunate in having
the friends, colleagues, and family that I do.”
(more detailed article will appear in the next post)
Kay Redfield Jamison, Ph.D., An Unquiet Mind, 1995, p. 6.
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12 November 2009

Dementia and Alzheimer Disease

Alzheimer Disease'mental healthWhat is dementia?
First, dementia is not part of the normal aging process. Although forms of dementia are common among the senior population, it is not a natural aspect of aging. As we age, we usually have a decline in the efficiency of accessing our memory. This is very common. Consider our brain as “library of information”. When we are young, our library is only partially filled. As we go forward in life our “library” fills up. In our senior years, our librarian must search through many floors of files to be able to recall information. This process just takes time. Thus, our memory efficiency will decline. The second component of memory is accuracy. Memory accuracy is the key point of concern with dementia-related illness. Let’s consider the following example: I am driving to an appointment. I have not visited the address for awhile. I forget the name of the location’s street address. Sound familiar? This is efficiency memory loss. I do not despair because I carry my Palm Pilot everywhere. Now let’s suppose that one cannot find one’s way home from a frequently visited location. This situation represents an accuracy issue.
Dementia is a brain disorder that affects a person’s ability to carry out daily activities. Alzheimer’s disease
is the most common form of dementia. This disease involves the parts of the brain that control thought, language and memory. According to the National Institute of Aging, scientists still do not know what causes AD and there is no cure.
The Alzheimer’s Association (1996) reported: the risk of AD increases exponentially with age, doubling each decade after age 65. With life expectancies increasing significantly, the number of cases could double every 20 years. Twenty years ago, AD was not commonly mentioned in the press. This is because people were on average not living as long and death took place before the AD had a chance to develop.
10 Warning Signs of AD (Alzheimer’s Association):
  1. Memory loss that effects job skills or performance
  2. Difficulty performing familiar tasks
  3. Forgetting simple words or using inappropriate ones
  4. Getting lost
  5. Poor or decreased judgment
  6. Problems with abstract thinking, such as adding numbers
  7. Misplacing things or putting them in odd places
  8. Rapid changes in mood or behavior, often for no obvious reason
  9. Dramatic personality changes, either sudden or gradual
  10. Loss of initiative or disinterest in one’s usual pursuits
Caring for most persons with AD is physically and emotionally demanding. The rate of progression various from person to person – but progression of AD is usually slow and steady. The Alzheimer’s Association reports that from the time of onset, the lifetime of a person with AD can range form 3-20 years.

John B. Linvill, Jr., CSA
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10 November 2009

Symptoms of Schizophrenia

Symptoms of SchizophreniaInterspersed between the acute periods are various stages of convalescence during which patients frequently experience "negative symptoms". These are subtractions from the normal repertoire of feelings such as loss of interest, loss of energy, loss of warmth, loss of humor. In general, these do not respond to medical interventions but require more difficult psychological assistance. (Note: Since this note was written, clozapine, resperidone and other drugs have been introduced which can help with negative symptoms.)
Hallucinations are false perceptions, inaccuracies that affect our senses & cause us to hear, see, taste, touch or smell what others do not. In the acute phases of schizophrenia, patients are likely to insist they are hearing voices that no one else can hear. Sometimes they hear noises, clicks or non-word sounds. On occasion they are disturbed by seeing, smelling or feeling things that others do not.
Descriptions of these perceptions differ. Sometimes they are experienced as very forceful & apparently important thoughts. Frequently they seem to come from outside the self & are heard as conversations between other people, or commands, or compliments (or insults) addressed to the person. Sometimes the voices are reassuring, at other times menacing. Often the remarks heard are not addressed to the person but seem to be concerned with them in an unclear (but perhaps derogatory) way. Individuals who experience this describe it "like a tape playing in my head". The experience is so real that many schizophrenics are convinced someone has implanted a broadcasting device in their bodies. Or they come to believe in a supernatural explanation for the strange sensation. It is so real to the person that it cannot be dismissed as imagination. During periods of convalescence, patients are in control of their "voices"; they can often summon & dismiss them at will. Or they may learn to ignore them, or treat them as benign accompaniments of everyday living. But during acute periods, the hallucinations, usually the same ones over & over, take control & the patient feels victimized, powerless, at the mercy of a "foreign presence".
Patients themselves, & those close to them, must recognize hallucinations as symptoms of illness. Discussions about their objective truth or plausibility are not valuable. The experience is true & very vivid & has to be accepted as such. Attempts to "set the person straight" result in resistance, tension, & bad feelings. It is, however, helpful to clarify that others do not hear, see, smell, or feel what the patient is experiencing. This helps to identify it as a special experience of the patient whether he can or can not accept it as a symptom of the illness. At least everyone can agree that something is happening.
Hallucinations respond to a lessening of stress & an increase of antipsychotic medication. Keeping busy is important as it provides helpful distraction. Competing stimuli can sometimes "drown out" the voices. Encourage the patient to discuss when the hallucinations occur & what they say with his therapist. This can clarify the nature of the stress that tends to bring them on. Another useful strategy is to point out to the patient that he has some control over the hallucinations. Often, unconsciously, the patient has developed the habit of of listening for his voices, as if he were a passive recipient. Directing his mind to other interests, & helping him recognize he need not wait for incoming voices, can be surprisingly effective. These are techniques that the patient develops for himself over time & that require a fair amount of trial & error. Encouragement to persevere, not to give up, to discuss things with the therapist & reassurance that the family & close friends understand, are important. Constant talking about hallucinations can be exasperating but it is understandable that the patient is preoccupied with such extraordinary events. Chronic hallucinations must be accepted as part of everyday life & are not usually sufficient reason to excuse participation in activities or household chores.
Delusions are false beliefs or misinterpretations of events & their significance. For instance, a person may get accidentally bumped in the subway & may conclude that this is a Government plot to harass him. He may be awakened by noise from his neighbors apartment & may decide this is a deliberate attempt to interrupt his sleep. Everyone tends to personalize & misinterpret events, especially during times of stress or fatigue. What is characteristic of the schizophrenic however, especially during an acute period, is that the conviction is fixed & alternate explanations for the events experienced are not even considered. Usually attempts at reasoning or discussion about possible other meanings of the bumping or the noise in the night can only lead to the further conviction that the reasoner must be in on the plot, too. Arguing with a delusion only leads to further mistrust or anger. The beliefs are tenaciously held, against all reason, & they are characteristically not shared beliefs. They are held only by the person himself & by no one else.
Families & friends must first realize that delusions are a result of illness & not stubbornness or stupidity. Although fixed delusions can be irritating, emotional reactions should be avoided, as should taunts or threats. There is almost always something about the delusional belief that can be empathized with. For instance: "Getting bumped in subways is very annoying. It must make you feel as if no on cares, no one pays attention, that you're not important enough to get an apology or an 'excuse me'." (Presumably the belief that one is at the center of a government plot must derive, at least in part, from the fear that one is really very unimportant or worthless.) Or: "Getting awakened at night is terrible. It's so hard to get back to sleep later. It saps you of all your strength. If you feel your neighbor is not your friend, it is important to be strong & healthy." (This kind of reasoning may persuade a person to seek medical attention &/or an increase in his medicine in order to be strong & fend off annoyances by others. It works better than saying, "You're deluded, you had better see the psychiatrist."
Another approach is to help cut down the stimuli that lead to delusion formation. If crowded subways bring on experiences that lead to persecutory ideas, avoid them. An emergence of delusional ideas, whether persecutory or grandiose (thinking one is special) usually means there is too much activity or emotion, perhaps too many people around. Example: "I think I am Jesus." Unhelpful response: "That's totally irrational. You're crazy." Helpful Response: "I guess you feel really special & different today. Maybe it's all the excitement around here. Let's try a very low key routine for the next few days." When well on medication, if the person persists in talking about left over delusions, a helpful response would be, "That's how you see things. I have explained that I don't agree--we will have to agree to disagree." (This acknowledges his view yet stops pointless discussion.)
Talking Nonsense
This generally occurs when a person is in the active phase of his illness. It can re-emerge sometimes when medications are too low or stress is too high. What the patient says becomes incomprehensible to those around him either because sentences are unconnected to each other, or else because there seems to be no point to the stories told, or else because topics seem to switch with great frequency. Words may take on special meanings in schizophrenia either because they trigger private associations or because attention is paid to individual sounds rather than hole words. For instance "psychiatry" may sound like "sigh Kaya tree" & the topic may switch suddenly from a discussion of psychiatry to a discussion about mystical trees. Certain words may be avoided because they sound harsh or evil. Sometimes intonations are changed for similar reasons. Sometimes language is used as an incantation to ward off threats. Difficulty making sense to others is a symptom of the acute phase of the illness. It is almost impossible to communicate with patients when they are in this phase & it is very frustrating to family.
Try to communicate non-verbally. Sometimes communication through writing works, as thoughts tend to be more organized in writing. Do not force yourself to listen & understand; it will usually lead to headache & irritation. When talking to others, however, do not speak as if the patient were absent. Do not tease or mimic him. Most people use one side of their brain for language & the other side for art or music or movement. If the language side is disturbed, it might be a good idea to concentrate on the other side & encourage patients to draw, sing, or play an instrument, to exercise or dance. These are other ways of communicating which might prove to be effective.
Like other positive symptoms, thought disturbances respond to a reduction of stress & an increase in antipsychotic medication. Preoccupations These are fixed ideas, not necessarily false (like delusions) but overvalued. They take on extraordinary importance & take up an inordinate amount of thought time. One idea often returns & returns. Frequently it is a worry about doing the right thing or doing it well or in time. Characteristically, the worry grows & becomes unrealistic. A common sequence of events is for the worry to take up so much of a person's time that the "right thing" does not get done & its not being done is then attributed to the bad motives of others. Or it may be rationalized as God's wish. OR, frequently, the person may decide he's physically unable to carry out the task.
Example of unrealistic explanation: "I can't get up because I'm paralyzed." "I'm supposed to stay in bed today because it's the Lord's day." "If I get up, I'll get hurt." These kinds of explanations sound odd to others but to the schizophrenic they seem warranted. They do not understand why others see them merely as "excuses". To them they explain the facts better than any other explanation. Sometimes these preoccupations have a mystifying character to them. They seem to require puzzling over & decoding.
The schizophrenic spends much time in this kind of puzzling activity & that is why he thinks he has solved mysteries that others haven't, since they spent no time at it. When lost in thought, schizophrenics do not want to be distracted. They feel they have important work to do to try & come to the bottom of the puzzle & they do not appreciate offers of conversation or shared activities at those times. Preoccupations are usually seen in the active phase of the illness but may continue into the convalescent stage. They may take the form of daydreaming.
They must not be allowed to control the life of the patient or the life of those around him. Distraction is helpful as is a structure or daily routine that does not permit too much time for sitting & thinking. The necessities of life: sleep, good food, exercise, fresh air, cleanliness, health & social interactions must be maintained. Preoccupations must not be allowed to interfere. Increased meds may be required.
Violent or Aggressive Behavior.
This is not really a symptom of schizophrenia but when it does occur, it tends to occur in conjunction with hallucinations, delusions, preoccupations & jumbled thoughts. It, too, is triggered by stress & abates when antipsychotic medication is taken in appropriate amounts. Violent behavior is much more frequent in mental disorders that have nothing in common with schizophrenia. It is described here mainly because patients & families are so frightened of it & it leads to so much dread & worry. It is most common in young men. It can be precipitated by psychological or chemical stimulants.
Violence against others is often a result of misinterpretation of their intent & a resultant feeling of being cornered. A person in the acute stage of schizophrenia may exaggerate other's irritation & misread it as fury. He may see ridicule in what is meant as jest. He senses himself in danger when he is not & may strike out under those circumstances. Violence against the self is more common & is discussed under depression. In an attempt to prevent violence, try to avoid blame, ridicule, confrontation, teasing, or insult.
Allow your schizophrenic relative privacy & psychological distance. Should violence erupt, however, do not allow yourself to be intimidated by it. Take whatever measures are necessary for the safety of everyone concerned. This may require firmness or help from friends & neighbors. It may require summoning the police. Let the patient's therapist know if violence erupts at home. Ask the therapist for pointers on how to help the patient develop self-control. In addition, always maintain an up-to-date list of helpful community resources
(See "Important Phone Numbers" and "Preparing for an Emergency" enc. Ask for "Directory of Mental Health Services" for your borough from the AMI/FAMI office-ed) You may find through experience that the patient responds best to certain friends when he is frightened, distressed & potentially violent. Call upon these friends in times of crisis. The best way to prevent dangerous moments is to anticipate them & be prepared with an effective plan of action, should they occur.
Although violence is not common is schizophrenia, it may become a pattern with some schizophrenics. If so, discuss appropriate living arrangements & appropriate anticipatory & preventive measures with the therapist. Restlessness Restlessness, anxiety, tension & agitation are words describing similar states. None of these are positive symptoms of schizophrenia but, like aggressive behavior, they tend to occur in conjunction with the positive symptoms. They may result from fear & apprehension, as a response to the frightening aspects of hallucinations & delusions. If this is so, they require quiet, calm reassurance. Patients who are so anxious about what is happening to them need to have someone near to provide explanation & stability. The reduction of stress & the introduction of medicines will reduce anxiety as well.
Restlessness that begins after the patient is started on medication may be a secondary effect of the drugs. This kind of restlessness usually appears as a shaking of the legs & a need to pace the floor. Patients may be seen to move from one foot to the other or, when sitting, shake their legs up & down on the ball of the foot. At the dinner table, this constant motion may cause the whole table to shake.
Another commonly observed movement is tremor. This is a rhythmic contraction of muscles, usually seen in the extremities. The tremor is usually not particularly bothersome to the patient unless he plays the piano or uses the typewriter. The restlessness, however, is very uncomfortable. The patient has some control over it, can stop it for a few moments at a time but it comes back the instant he lets his attention waiver. It can be quite agonizing for some patients & needs to be reported to the doctor who can change the dose of antipsychotic drugs or add side-effect medicine which will make this restlessness disappear. The same procedures will reduce the tremor that is secondary to the medicine.
After many years of antipsychotic drug use, some patients develop other kinds of movement disorders, usually jerky movements around the mouth & extremities. These are not usually uncomfortable but can be unsightly. The prescribing doctor must be made aware of them & will adjust the dose of the drugs accordingly. These movements are more difficult to control. They may, in fact, become worse for a time after the drug dose is lowered. In most cases the movements gradually wane if the drugs can be discontinued for a prolonged period but that is sometimes risky because the patient may become acutely ill again.
Restlessness & tension, whether psychological or secondary to drugs, is made worse by stimulants (coffee, tea, cola drinks, chocolate, cold tablets). Sedative medication helps but should only be used with the advice of the prescribing doctor. Understanding helps. Do not criticize the patient for pacing. Instead, try accompanying him for a walk, encourage exercise, jogging & bicycle riding. If the pacing becomes unbearable in the house, suggest other areas, outside the home, where the patient might walk about without disturbing others.

READ MORE - Symptoms of Schizophrenia

07 November 2009

Unsecured Business Loan

Unsecured Business LoanWhat do you do to build a business? You how to create your brilliant ideas in your business that will build? But how to obtain venture capital to realize your brilliant idea, while you are currently experiencing financial crises that you feel is impossible to start a business! Have you ever thought, unsecured business loan? This solution…

Unsecured business loan is the right solution right now when you will build a business in the global crisis hit the economy. How not, you can more easily develop plans for your business. You can choose a variety of offers from this service companies. One example of when you will be using unsecured business loans to small-scale. We called Unsecured Small Business Loans. on program loans unsecured small business you have two options for the new business loans and loans for existing businesses.

If you are interested, it never hurts to try. Unsecured business loans is an attractive offer, you can more easily plan your business will begin. If you want to learn more, you can visit this site. ‘Do not wait for an opportunity but it creates the opportunity to always be successful’. What do you think?
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06 November 2009

What is Schizophrenia?

What is Schizophrenia?Schizophrenia is a chronic, severe, and disabling mental illness that affects approximately 1 out of every 100 people in the world’s population. The first symptoms of schizophrenia are typically seen in late adolescence or early adulthood, although they occasionally develop after the age of 30. A variety of different symptoms may occur when the illness first develops, including social isolation, unusual thinking or speech, having beliefs that seem strange and peculiar to others, seeing things that are not visible to others, and hearing voices when none are present. These symptoms often make it difficult for a person with schizophrenia to maintain interpersonal relationships, care for personal needs, work, and live independently.

How Long Does Schizophrenia Last?
For most people, schizophrenia is an episodic illness in which symptoms appear and subside at varying degrees of intensity over the course of one’s lifetime. The frequency and severity of schizophrenia symptoms vary from person to person; some patients have only one or a few episodes ofthe illness while others experience symptoms continuously.
How Do People Talk About Different Aspects of Schizophrenia?
Since each person’s experience with schizophrenia is different, certain terms help others understand the severity of one’s illness and the length of time one has been sick (the duration of one’s illness). Subchronic refers to the time during which a person first begins to show signs of the schizophrenia on a somewhat regular basis. This phase typically lasts from 6 months to no more 2 years in duration. Chronic schizophrenia refers to an illness that has been present for at least 2 years. Acute schizophrenia refers to the reemergence or intensification of psychotic symptoms in a person who previously had no symptoms or whose symptoms had not changed for a significant amount of time.
Other terms are used to describe the degree to which schizophrenia has developed across a person’s life. There are three basic phases to the illness. Overlapping symptoms in each of these phases make them hard to distinguish clearly, but they offer a general understanding of whether the illness is just developing or has been cycling through subchronic, chronic, and acute phases for some time. The first phase is called the prodromal or pre-illness phase. This phase involves a clear deterioration of functioning: social withdrawal, inappropriate affect (emotional responses to different situations), or increased impairment in personal grooming and hygiene. The second phase is called the active phase. In this phase, there have been continuous signs of disturbance for at least 6 months and occupational, social, academic, and personal functioning is considerably below the highest level of functioning before the illness began. During the active phase, people with schizophrenia experience difficulty telling the difference between reality and fantasy, frequently termed psychosis. Other symptoms that appear in the active phase (described in more detail below) are delusions, hallucinations, thought disturbances, or inappropriate affect. The third or residual phase follows the active phase and is indicated by a persistence of at least two of the symptoms experienced during the pre-illness phase. It is not uncommon for patients in the residual stage to experience periods when the prominent psychotic symptoms seen in the active phase reemerge for a brief period of time and then subside.
What Are the Main Symptoms of Schizophrenia?
Delusions are false beliefs that are not based in reality. These false beliefs commonly contain themes of persecution and grandeur. An example of a delusion is a belief that others are trying to harm or control the person to steal information vital to national security.
Hallucinations are false perceptions (seeing, hearing, smelling, tasting, and feeling) not experienced by others. Smelling the odor of rotting flesh and hearing voices in an empty room when there are no voices or odors are examples of hallucinations.
Thought disturbances are incidences in which the person is unable to concentrate, to “think straight or coherently,” or to slow down racing thoughts. An example of a thought disturbance is when a person speaks in randomly connected thoughts using words that do not exist.
Inappropriate affect refers to showing an emotion that is inconsistent with the person’s speech or thoughts. For example, the person may say that he or she fears being persecuted by the devil and then laugh. Sometimes a person with schizophrenia may exhibit a blunted or flat affect, which is a severe reduction in emotional expressiveness. Examples are the use of a non-changing tone of voice with few facial expressions.
No laboratory tests exist to determine a diagnosis of schizophrenia. Like other mental and emotional disorders, a diagnosis of schizophrenia is made solely on the basis of the person’s behavior, thoughts, and feelings. Through careful observation and interviewing, competently trained psychiatrists, psychologists, nurses, social workers, and therapists can detect major disturbances in a person’s functioning, including the presence of psychotic symptoms. However, before a diagnosis of schizophrenia is made, medical factors such as a brain tumor or the effects of substance abuse are ruled out.
Myths About Schizophrenia
Despite common belief and usage of the term by the popular press, schizophrenia is not the same as the relatively rare disorder known as split personality (multiple personality: a Dr. Jekyll and Mr. Hyde switch in character). People also tend to equate schizophrenia with “insanity” or “madness.” These are not psychiatric terms but are popular descriptions for strange, irrational behavior. Most people suffering from schizophrenia are not violent, although an occasional individual will have violent outbursts. There is also concern among some families that they might be the cause of schizophrenia. No conclusive scientific evidence exists that a family’s actions cause schizophrenia. There is abundant evidence, however, that families may be able to help improve the outcome of the illness.
Causes of Schizophrenia
There are a number of factors that may cause schizophrenia. Some of these factors are genetic (inherited from the person’s biological parents), some are biological (stemming from abnormalities in a person’s body), and some are psychosocial (caused by the environment in which one was raised and in which one lives currently).
Structural abnormalities of the brain, biochemical deficiencies, or an imbalance of brain chemicals called neurotransmitters are considered potential biological causes of schizophrenia. The degree to which each factor causes schizophrenia, as opposed to being caused by schizophrenia, remains unclear. Studies show that if a close relative suffers from schizophrenia there is a 1 in 10 chance that another immediate family member may also experience the disorder, suggesting that there are genetic components of the disease as well.
Environmental stress also appears to be an important factor in the development of schizophrenia. Personal and family events such as an adolescent’s leaving home, a young adult’s entrance into a new career or peer group, a death in the family, or the breakup of a significant relationship are some of the stressors that may precede the onset of schizophrenia.
These stressors demand adaptive changes from the individual and challenge the individual’s current coping and competence. Growing evidence exists that an individual’s inability to cope with and handle certain stressors combines with structural, genetic, and biochemical vulnerabilities to result in schizophrenia.
Treatment Modalities
Although some individuals will always be subject to varied degrees of recurring symptoms of schizophrenia, studies show encouraging evidence that most people suffering from schizophrenia can be trained and supported to live productive, noninstitutionalized lives. There is no one best treatment for schizophrenia; a combination of treatment and support programs seems to provide the best way to help a person with schizophrenia maintain the highest degree of health and independence.
Antipsychotic medications have greatly improved the outlook for the person with schizophrenia. These drugs do not “cure” schizophrenia but typically reduce the intensity and frequency of the psychotic symptoms and usually allow the person to function more effectively and appropriately. Another beneficial aspect of drug therapy is that it may help to reduce such symptoms as poor concentration and social isolation. However, medications are only a necessary first step.
Psychiatric rehabilitation is a second important step that is often provided by day treatment centers and community support programs. Psychiatric rehabilitation enables the individual to acquire personal and instrumental skills as well as environmental supports which will enable the person to fulfill the demands of various living, learning, and working environments.
Family Support
Since many persons with schizophrenia live with their families, it is important for the family to have a clear understanding of the illness. Many psychiatric rehabilitation programs include the family in their work to reduce the family’s stress and help make the family setting a more supportive environment for the person with schizophrenia. These programs also help families learn about the different kinds of outpatient and family support services that are available in the community.
Self-help groups are one such resource. Although they are usually not led by professional therapists, these groups are often helpful because members—usually family members of persons with schizophrenia—provide continuing support for each other. These groups have also become effective in advocating for needed research and treatment programs.
READ MORE - What is Schizophrenia?

03 November 2009

Pediatric Patient (EAM 4)

Pediatric Patient
The Pediatric patient- the principles of airway management in children are the same as in the adult. Confusion and error occur when we try to think about the pediatric airway as “different” than the adult airway. It is just not so! It is true that the dosages of medications are different, we just need to remember the doses in milligrams per kilogram or look them up. The anatomy is slightly different with larynx being somewhat anterior and superior to that of the adult and surgical airways are not recommended in children (The anatomy of the adult larynx is actually more variable than the child’s). With these two exceptions the pediatric airway should be approached in exactly the same way as the adult airway. Medications used for children to facilitate intubation and the need for alternative airway techniques in the case of a failed airway are no different than in the adult.

One concern in the pediatric airway is that the functional residual capacity is lower in the child and pre-oxygenation will not “buy” you as much time to intubate. With good pre-oxygenation in the adult, an adult can remain apneic for up to 5 minutes without significant oxygen desaturation. The child may desaturate in 1 minute or less. This is easily overcome by applying Sellick’s maneuver and briefly bagging the patient. During intubation, atropine is almost universally used in children during the pre-treatment phase (3 minutes before intubation) to blunt the bradycardia and hypotension that occurs when the larynx is manipulated. Also, a defasciculating dose of a nondepolorizer is almost never needed in children.
The Trauma Patient- The debate over which technique for intubation is safest in the cervical spine injured patient has been raging. Blind nasotracheal intubation was commonly used in the 1980’s but has fallen out of favor because of the high complication rate, high miss rate, stimulation of intracranial pressure and lack of protection of the C-spine. Recently, there is evidence indicating that with properly performed rapid sequence intubation and orotracheal intubation with in-line stabilization, there is little hazard to the patient. Since this affords the best opportunity to intubate with the least risk of a failed airway, RSI with in-line traction stabilization is now being recommended even in the presence of a cervical spine injury. Alternatively, if the patient has a proven C-spine injury and an incomplete neurologic deficit and does not need urgent intubation, then fiberoptic assisted orotracheal or nasotracheal intubation can be performed by those with experience in this technique in a more leisurely fashion. The choice of which neuromuscular blocking agent to use for RSI is also controversial. Most emergency physicians prefer succinylcholine over the longer acting nondepolarizing agents. This is ultimately safer in a failed airway or a “can’t intubate-can’t ventilate” situation as the neuromuscular blockade will last only a few minutes. The principal disadvantage of succinylcholine in trauma is its propensity to cause profound hyperkalemia in some situations. This occurs in burns, crush injuries and denervation processes like stroke or paralysis. However, the hyperkalemic effect does not occur for days to a week after injury and should not be a problem in the acutely injured patient.
Succinylcholine will also increase intracranial pressure, which is a concern in many traumatized patients. This can be mitigated by the use of a small dose of a competitive neuromuscular blocking agent in the pretreatment phase- for example 1 mg of Norcuron© 3 minutes before the succinylcholine. Lidocaine should also be used in head injured patients to protect from the rise in BP associated with tracheal stimulation. In the patient with a distorted airway either from facial fractures or a neck hematoma, the “wait and see” approach will only guarantee a more difficult airway in the future. Most authors now recommend an aggressive approach to the distorted airway with early intubation before the situation becomes more dangerous. Waiting for the nearly obstructed airway to become completely obstructed can be disastrous. The distorted airway always disquiets us, as it should. This is one case where the intubationist should plan ahead and have several options before beginning. Although RSI is not contraindicated, the optimal approach will probably be an awake intubation with the patient protecting his/her own airway as long as possible. A combined approach is sometimes also a good option. A little sedation can be used for a quick look for the glottis. If the glottis can be visualized, RSI can proceed. If the glottis can not be visualized, another approach must be entertained or a surgical airway anticipated.
The Patient with Increased Intracranial Pressure- Increased intracranial pressure presents a direct threat to the viability of the brain. Many of the techniques used in airway management may further increase pressure thus compounding the problem. The use of a laryngoscope to visualize the larynx causes a release of catecholamines causing increased BP and pulse- both of which are deleterious to the patient with increased ICP. There may also be a direct increase in ICP not related to tracheal stimulation of unknown etiology. The ICP will also be increased by the use of succinylcholine as a paralyzing agent. Although RSI remains the technique of choice in patients with increased ICP and succinylcholine remains the drug of choice, there are several special considerations. Several pharmacologic agents mitigate against this increased ICP. The administration of fentanyl, a synthetic opioid, can blunt the affect of the catecholamine release as will a beta blocker (not often used). Fentanyl could and should be used in almost all patients with an increased ICP but may cause transient hypotension and premature apnea in some patients at 3 micrograms/kg dose in the pretreatment phase. Lidocaine in a dose of 1.5 mg/kg will blunt the reflex response to intubation and should also be used in the patient with elevated ICP in the pretreatment phase. The increase in ICP related to succinylcholine is temporally related to the muscle fasciculations and can be avoided by use of a competitive neuromuscular blocking agent at 1/10th the paralyzing dose in the pretreatment phase. Since ketamine increases cerebral blood flow, this agent should be avoided in the patient with increased ICP.
The Patient with Asthma or COPD- Always remember that if the patient can’t breath secondary to reactive airway disease, you might not be able to breath for them either! These patients can be extremely difficult to ventilate and be hemodynamically unstable. First and foremost there should be aggressive therapy to “break” their asthma or COPD attack. Use of multiple standard agents as well as Heliox®, magnesium, anticholinergic agents, and BiPAP and less standard methods may be attempted before intubation. Asthma is a unique situation in which one MUST intubate the patient on the first try because often the patient can not be successfully bagged because of the high airway pressures. If the patient needs intubation, RSI is the best choice. However, the patient should be left in the sitting position until after the paralyzing medication, succinylcholine, is administered. Although succinylcholine is known to release histamine, this effect does not appear to be clinically significant. All patients with reactive airway disease should receive lidocaine in the pretreatment phase to attenuate the respiratory response to airway manipulation. Ketamine is the induction agent of choice as it has a direct effect on relaxation of bronchial smooth muscles and should be given just prior to succinylcholine.

Advanced Emergency Airway Management Walls RM, Luten RC, Murphy ME, Schneider RE. 1997

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02 November 2009

Patients Under Spontaneous Breathing

Patients Under Spontaneous Breathing
One of the most frequent interventions in an intensive care setting is fluid replacement. Recent trials emphasize that excessive volume, given unnecessarily, may be harmful to the patient, and that assessment of volume responsiveness is fundamental for intensivists. Volume responsiveness may be defined as increased systolic volume (SV) with consequent increased cardiac output (CO) from an established volume infusion which would provide better oxygen supply to the tissue. However, this response to volume testing will only take place when both ventricles operate in the ascending phase of the Frank-Starling curve, i.e., in a preload dependence status. In the last decade, with improved knowledge and practical application of physiology and heart-lung interaction, along with critical patient monitoring techniques, new volume responsiveness assessment methods were described, called dynamic methods.

Described as such are pulse pressure variation (PPV), systolic pressure variation (SPV), systolic volume variation (SVV), in addition to techniques using echocardiography to evaluate superior and inferior vena cava collapsibility. The dynamic evaluation methods have good accuracy to predict fluid responsiveness, with much higher predictive values than static measurements. However, an important limitation of these methods is that indexes and measurements were validated for specific groups of patients under sedation and volume controlled mechanical ventilation, with no respiratory effort and no arrhythmias. Other studies that tried to reproduce these results in different settings, did not reach the same results. In spontaneous breathing patients, or in those under mechanical ventilation with respiratory effort, fluid responsiveness assessment still requires additional studies, as the current intensive care trend is to maintain the patient with the mildest sedation and weaning from mechanical ventilation as soon as possible. This review aims to summarize the main evidences on fluid responsiveness assessment in the spontaneous breathing patient, didactically dividing the static measurement studies from those with dynamic methods.

Magder S, Georgiadis G, Cheong T. Respiratory variations in right atrial pressure predict the response to fluid challenge. J Crit Care. 1992;7(2):76-85.
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