pediagenosis: Nervous
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Showing posts with label Nervous. Show all posts
Showing posts with label Nervous. Show all posts

Sunday, June 20, 2021

Opioid Use Disorders

Opioid Use Disorders

Opioid Use Disorders

Opioid Use Disorders


Opioid misuse, abuse, and dependence (opioid use disorders) refer to the pathologic self-administration of substances that activate central mu-opiate receptors, for the purpose of experiencing an altered mental state (euphoria or relaxation), or in the opioid-dependent individual for the purpose of avoiding opioid withdrawal. Naturally-occurring opiates (morphine, codeine) are found in Papaver somniferum poppy pods as a latex sap, opium; heroin is a semisynthetic opioid derived from opium. Prescription analgesics include semisynthetic (e.g., hydrocodone, oxycodone) and synthetic (e.g., methadone, fentanyl) opioids. Both heroin and opioid analgesics may be insufflated or injected to get “high”; other routes include smoking heroin and swallowing/chewing opioid analgesics. Routine toxicology detects only opiates (heroin metabolites), and special gas chromatograph/mass spectrometry (GC/ MS) detection is required for semisynthetic and synthetic opioid analgesics.

Treatment for Alcohol Use Disorders

Treatment for Alcohol Use Disorders

Treatment for Alcohol Use Disorders

Treatment for Alcohol Use Disorders


In the United States, alcohol use disorders had 12-month prevalence rates of 4.65% alcohol abuse and 3.81% alcohol dependence from 2001 to 2002. Self-reported drinking (2010) among those age 12 years and older indicates that 23% binge drink (more than five drinks per drinking day), and nearly 7% are heavy drinkers (binge drink on five or more days per month); yet fewer than 2% of the population needing substance use treatment receives treatment.

Alcohol Withdrawal

Alcohol Withdrawal

Alcohol Withdrawal

Alcohol Withdrawal


An alcohol withdrawal syndrome (AWS) occurs when an individual who has alcohol dependence with physiologic dependence experiences a period of reduced dosage or abstinence from drinking. AWS is life-threatening as it poses a risk for seizures, hypertensive crisis, and autonomic instability (especially in patients with comorbid hypertension or diabetes) as well as delirium tremens, leading to death if not rapidly treated. AWS must be medically managed with close monitoring in either an outpatient or inpatient setting, depending on the patient risk profile.

Alcohol Use Disorders

Alcohol Use Disorders

Alcohol Use Disorders

Alcohol Use Disorders


Alcohol use is associated with 1.8 million deaths annually; global alcohol use is increasing. Yet many who drink alcohol do not experience negative health or social consequences, and some health-care studies suggest health benefits may be associated with alcohol consumption. How can we distinguish between risky drinking and safe drinking? The National Institute on Alcohol Abuse and Alcoholism (NIAAA), dedicated to providing scientific leadership in the assessment of alcohol use and its health and social consequences, has established gender-specific guidelines based on current evidence for “low-risk” drinking. To normalize these guidelines, a “standard drink” is defined as an ethanol alcohol content of 14 grams (equivalent to 12 ounces of beer, 5 ounces of table wine, or 1.5 ounces of liquor). It is considered “low-risk” for healthy adult men under age 65 years to consume no more than 14 standard drinks per week, with up to 4 drinks per day, and for healthy adult nonpregnant women under age 65 years and healthy men and women age 65 years and older, no more than 7 standard drinks per week and up to 3 standard drinks per day.

Schizophrenia

Schizophrenia

Schizophrenia

Schizophrenia


Schizophrenia is the prototype of a psychotic disorder, with the core symptoms of delusions and hallucinations as well as disorganized speech. Some patients also display prominent psychomotor disturbances, including catatonia. Together, these florid and often dramatic symptoms are referred to as positive symptoms and contrasted with negative and cognitive symptoms, the latter being responsible for much of the disability that characterizes schizophrenia. Negative symptoms are categorized into a reduced emotional expressivity cluster (restricted or flat affect) and an avolition/apathy/ anhedonia cluster. Many schizophrenia patients struggle with cognitive impairment in the realms of working memory, attention/vigilance, verbal learning and memory, visual learning and memory, reasoning and problem solving, speed of processing, and social cognition. Schizophrenic patients can often have prominent mood symptoms; these are not inconsistent with a diagnosis of schizophrenia. However, if mood symptoms dominate the overall course of a psychotic illness, a diagnosis of schizoaffective disorder can be given. Schizophrenia is a diagnosis of exclusion; various street drug usage, medications, and medical causes of psychosis must initially be excluded before diagnosis because these can mimic the core symptoms of schizophrenia.

Conversion Disorder

Conversion Disorder

Conversion Disorder

Conversion Disorder


Conversion disorder, previously referred to as hysteria, is defined by the DSM-IV-TR as a type of somatoform disorder with a loss or distortion of a neurologic function that is (1) not explained by an organic neurologic lesion or medical disease, (2) arising in relation to some psychologic stress or conflict, and (3) not consciously produced or intentionally feigned. Despite being thought of as a psychiatric disorder, neurologists predominantly manage and diagnose conversion disorder. Diagnosis requires appropriate neurologic assessment and testing that finds the physical symptoms to be incompatible with neurologic pathophysiology and/ or internally inconsistent to fulfill the first criteria. Criteria two and three are considered more difficult to demonstrate and will be de-emphasized in the diagnostic criteria for conversion disorder in the DSM-V.

Somatization

Somatization

Somatization

Somatization


Somatization is one of six major somatoform disorders identified by the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM). Other somatoform disorders include undifferentiated somatoform disorder, conversion disorder, hypochondriasis, pain disorder associated with psychologic factors, pain disorder associated with both psychologic factors and a general medical condition. Fundamentally, somatization is a constellation of physical symptoms lacking medical explanation. The DSM-IV-TR designates eight symptom requirements for diagnosis, including four bodily pain symptoms, two gastrointestinal (GI) symptoms, one neurologic symptom, and one sexual symptom, resulting in impairment in function. However, these symptoms appear to exist along a spectrum, and the current diagnostic categorization may not accurately reflect the clinical presentation. Therefore the status and characterization of somatoform disorders are being reexamined for the soon-to-be-published DSM-V, to reclassify them under the general heading of bodily distress syndrome to encompass both psychiatric and nonpsychiatric functional disorders.

Obsessive-Compulsive Disorder

Obsessive-Compulsive Disorder

Obsessive-Compulsive Disorder

Obsessive-Compulsive Disorder


Introduction. Obsessive-compulsive disorder (OCD) is diagnosed on the basis of recurrent and intrusive thoughts, referred to as obsessions, and/or compulsive behaviors or rituals. The obsessions or compulsions are recognized by the patient, at least at some point, as excessive and unreasonable, leading to marked distress or functional impairment; they may be extremely time- consuming. These symptoms are experienced as intrusive and inappropriate and are not simply excessive worries about real-world concerns.

POSTTRAUMATIC STRESS DISORDER

POSTTRAUMATIC STRESS DISORDER

POSTTRAUMATIC STRESS DISORDER

Posttraumatic stress disorder (PTSD) is a mental disorder that develops in response to a traumatic event, such as a sexual assault, military combat, natural disaster, or a serious accident. PTSD is characterized by three clusters of symptoms: (1) reexperiencing symptoms wherein the patient relives the trauma in his or her thoughts and dreams and cannot get it out of his or her mind; (2) avoidance and numbing symptoms wherein the patient avoids people, places, and anything that reminds her or him of the trauma and shuts off his or her emotional responses; and (3) hyperarousal symptoms that involve difficulty concentrating, constantly feeling on-guard and in danger, difficulty sleeping, and irritability. To be diagnosed with PTSD, the patient must report that the traumatic event was accompanied by feelings of helplessness and horror, these symptoms must occur for at least a month, and they must interfere with the patient’s ability to function in daily life.


Posttraumatic stress disorder (PTSD) is a mental disorder that develops in response to a traumatic event, such as a sexual assault, military combat, natural disaster, or a serious accident. PTSD is characterized by three clusters of symptoms: (1) reexperiencing symptoms wherein the patient relives the trauma in his or her thoughts and dreams and cannot get it out of his or her mind; (2) avoidance and numbing symptoms wherein the patient avoids people, places, and anything that reminds her or him of the trauma and shuts off his or her emotional responses; and (3) hyperarousal symptoms that involve difficulty concentrating, constantly feeling on-guard and in danger, difficulty sleeping, and irritability. To be diagnosed with PTSD, the patient must report that the traumatic event was accompanied by feelings of helplessness and horror, these symptoms must occur for at least a month, and they must interfere with the patient’s ability to function in daily life.

PANIC DISORDER

PANIC DISORDER

PANIC DISORDER

PANIC DISORDER


Patients complaining of panic often describe a dramatic presentation, including the sudden, unexpected onset of extreme fearfulness or alarm, quickly rising to a crescendo within minutes of commencement, and accompanied by a spectrum of physical, behavioral, and cognitive symptoms. These may include the bodily sensations of choking, chest pain, trembling, flushing, and rapid heart rate, which mimic a sympathetic, “fight or flight” response. The urge to escape, to find shelter, or to seek help can be overwhelming. Panic victims may believe they are dying, losing control, or going crazy and will often seek urgent medical care. The indelible, negative impression left by a panic attack often results in persistent fear of having another attack or in marked behavioral changes. Although isolated panic attacks are relatively common, it is these persistent sequelae that define the diagnosis of panic disorder. By DSM-IV criteria, this disorder may also be accompanied by agoraphobia, characterized by the phobic avoidance of situations that may be difficult or embarrassing to escape, should a panic attack recur.

SOCIAL ANXIETY DISORDER

SOCIAL ANXIETY DISORDER

SOCIAL ANXIETY DISORDER

SOCIAL ANXIETY DISORDER


Introduction and Clinical Presentation. Social anxiety disorder (SAD), or social phobia, is characterized by persistent fear of social or performance situations in which an individual will face exposure to unfamiliar people or scrutiny by others. The individual typically fears behaving in an embarrassing or humiliating fashion, or revealing symptoms of anxiety. Exposure to these situations provokes anxiety or panic symptoms, leading the individual to avoid such situations whenever possible. Physical symptoms may include diaphoresis, tachycardia, trembling, nausea, flushing, and difficulty speaking, for example.

GENERALIZED ANXIETY DISORDER

GENERALIZED ANXIETY DISORDER

GENERALIZED ANXIETY DISORDER

GENERALIZED ANXIETY DISORDER


Generalized anxiety disorder (GAD) is characterized by excessive, uncontrollable, and often irrational worry, about everyday things that is disproportionate to the actual source of worry. To diagnose GAD, excessive worry must be present for at least 6 months, the person finds it difficult to control the worry, and the anxiety and worry are associated with three (or more) out of six symptoms. These include (1) restlessness or feeling keyed up or on edge, (2) being easily fatigued, (3) difficulty concentrating or mind going blank, (4) irritability, (5) muscle tension, and (6) sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep). As with other axis I diagnoses, the symptoms must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning and are not due to the direct physiologic effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism), and do not occur exclusively during a mood disorder, psychotic disorder, or a pervasive developmental disorder.

Wednesday, May 12, 2021

Neurochemical Disorders Affective Disorders

Neurochemical Disorders Affective Disorders


Neurochemical Disorders I: Affective Disorders
‘Affect’ refers to mood and affective disorders comprise of both a pathological lowering (depression) and elevation (mania) of mood. Bipolar affective disorder (manic-depression) refers to an oscillation between depression and mania. These conditions are not simply characterized by mood changes, however, and depression may comprise a number of characteristic features.
Both depression and mania may be accompanied by features of psychosis (delusions and hallucinations; see Chapter 58). The nature of the psychosis tends to be mood-congruent: in depression, the patient may believe that he or she is guilty of something or hear voices that are critical and unpleasant. Mania may be accompanied by grandiose delusions.

Neurochemical basis of depression

Depression
Aetiology
This is a common and mania disorder with a lifetime prevalence that has been estimated to be as high as 15%, with women affected more than men (approximately 2:1). It can occur in response to adverse circumstances (reactive depression), as well as for no apparent circumstantial reason (endogenous depression), although often the distinction between these two different types of depression is not that clear-cut. In both cases the depression probably arises through a combination of genetic and environmental factors.
Neurochemical Disorders Schizophrenia

Neurochemical Disorders Schizophrenia


Neurochemical Disorders II: Schizophrenia
Schizophrenia is a syndrome characterized by specific psychological manifestations, including auditory hallucinations, delusions, thought disorders and behavioural disturbances. It is a common disorder with a lifetime prevalence of 1% and an incidence of 2–4 new cases per year per 10 000 population. It is more common in men and typically presents early in life. Like all psychiatric disorders there is no diagnostic test for this condition, which is defined by the existence of key symptoms.
·       Positive symptoms:
      delusions: abnormal or irrational beliefs, held with great conviction and out of keeping with an individual’s sociocultural background;
      hallucinations: perceptions in the absence of stimuli.
·       Negative symptoms:
      blunting of mood, apparent apathy, lack of spontaneous speech and action;
      disordered speech.

Neurochemical Disorders II: Schizophrenia, delusions, hallucinations, The dopamine hypothesis of schizophrenia,

Aetiology
A distinction used to be made between type 1 and 2 schizophrenia but this has fallen out of fashion as it may relate more to the length of time that the individual has had the condition. The cause of schizophrenia is unknown but a number of aetiological factors have been suggested:

Monday, May 10, 2021

Neurochemical Disorders Anxiety

Neurochemical Disorders Anxiety


Neurochemical Disorders Anxiety
Anxiety is a normal emotional reaction to threatening or potentially threatening situations, and is accompanied by sympathetic overactivity. In anxiety disorders the patient experiences anxiety that is disproportionate to the stimulus, and sometimes in the absence of any obvious stimulus. There is no organic basis for anxiety disorders, the symptoms resulting from overactivity of the brain areas involved in ‘normal’ anxiety. Psychiatric disorders that occur without any known brain pathology are called neuroses.
Anxiety disorders are subdivided into four main types: generalized anxiety disorder, panic disorder, stress reactions and phobias. Many transmitters seem to be involved in the neural mechanisms of anxiety, the evidence being especially strong for γ-aminobutyric acid (GABA) and 5-hydroxytryptamine (5-HT). Because intravenous injections of cholecystokinin (CCK4) into humans cause the symptoms of panic it has been suggested that abnormalities in different transmitter systems might be involved in particular types of anxiety disorder. This remains to be seen.
Neurochemical Disorders III: Anxiety, Anxiety disorders,

There is some evidence for decreased GABA binding in the left temporal pole, an area concerned with experiencing and controlling fear and anxiety.
Neurodegenerative Disorders

Neurodegenerative Disorders


Neurodegenerative Disorders
Neurodegenerative disorders are those conditions in which the primary pathological event is a progressive loss of populations of CNS neurones over time. However, it is increasingly being recognized that most neurodegenerative disorders have an inflammatory component to them, and that inflammatory diseases of the central nervous system (CNS) (such as multiple sclerosis, see Chapter 62) will cause neuronal loss and degeneration.
Aetiology
There are a number of theories on the aetiology of neurodegenerative disorders, which may not be mutually exclusive. Of late there has been much work looking at the genetic risk factors for developing these disorders (see Chapter 63), and some common sets of genes are being found for them, e.g. genes involved with inflammation and immunity.

An infective disorder
Neuronal death with a glial reaction (gliosis) is commonly seen in infective disorders (typically viral) with inflammation in the CNS. However, in neurodegenerative disorders such a reaction is not seen, although the observation that human immunodeficiency virus (HIV) infection can cause a dementia has raised the possibility that some neurodegenerative disorders may be caused by a retroviral infection. Furthermore, the development of dementia with spongiform changes throughout the brain in response to the proliferation of abnormal prion proteins as occurs in Creutzfeldt–Jakob disease has further fuelled the debate on an infective aetiology in some neurodegenerative disorders (eg α-synuclein in PD).

Neurodegenerative Disorders, autoimmune process

An autoimmune process
Autoantibodies have been described in some neurodegenerative conditions, e.g. antibodies to calcium channels in motor neurone disease (MND). However, the absence of an inflammatory response would argue against this hypothesis, although neuronal degeneration with a minimal inflammatory infiltrate can be seen in the paraneoplastic syndromes (see Chapter 62) as well as the more recently described autoimmune disorders targeting ion channels and receptors.
Neurophysiological Disorders Epilepsy

Neurophysiological Disorders Epilepsy


Neurophysiological Disorders: Epilepsy
Definition and classification of epilepsy
Epilepsy represents a transitory disturbance of the functions of the brain that develops suddenly, ceases spontaneously and can be induced by a number of different provocations. It is the most prevalent serious neurological conditions, with a peak incidence in early childhood and in the elderly.
Patients may be classified according to whether:
·    the fit is generalized or partial (focal), i.e. remains within one small CNS site, e.g. temporal lobe;
·       there is an impairment of consciousness (if there is then it is termed complex);
·       the partial seizure causes secondary generalization.
Overall, 60–70% of all epileptics have no obvious cause for their seizures, and abouttwo-thirds of all patients stop having seizures within 2–5 years of their onset, usually in the context of taking medication.

Neurophysiological Disorders: Epilepsy, Definition and classification of epilepsy, Pathogenesis of epilepsy, Treatment of epilepsy, Mechanisms of action of anticonvulsants,

Pathogenesis of epilepsy
The aetiology of epilepsy is largely unknown, but much of the therapy used to treat this condition works by modifying either the balance between the inhibitory γ-aminobutyric acid (GABA) and excitatory glutamatergic networks within the brain or the repetitive firing potential of neurones.
Neuroimmunological Disorders

Neuroimmunological Disorders


Neuroimmunological Disorders
Central nervous system immunological network
The central nervous system (CNS) has relative immunological privilege compared with the peripheral nervous system (PNS) and most other parts of the body. The reasons for this are as follows:
Neuroimmunological Disorders, Acute disseminated encephalomyelitis, Other immunological diseases,
·   The blood–brain barrier (BBB) normally prevents most lymphocytes, macrophages and antibodies from entering the CNS (see Chapters 5 and 13).
    It has a very poorly developed lymphatic drainage system.
        There is only low level expression of major histocompatibility complex (MHC) antigens.
        There are no antigen presenting cells.

Wednesday, April 28, 2021

Neurogenetic Disorders

Neurogenetic Disorders


Neurogenetic Disorders
A large number of genetic disorders involve the nervous system, and some of these have pathology confined solely to this system. Recent advances in molecular genetics have meant that many diseases of the nervous system are being redefined by their underlying genetic defect.
Three major new developments have revolutionized the role of genetic factors in the evolution of neurological disease. First, genes encoded in the maternally inherited mitochondrial genome can cause neurological disorder; Second, a number of inherited neurological disorders have as their basis an expanded trinucleotide repeat (triplet repeat disorders); Third, the ability to use sophisticated genotyping of individual cases (exome sequencing) to find novel mutations is starting to yield new insights into diseases of the nervous system.

Neurogenetic Disorders

Disorders with gene deletions
Many different disorders within the nervous system result from the loss of a single gene or part thereof. For example, hereditary neuropathy with a liability to pressure palsies, in which the patient has a tendency to develop recurrent focal entrapment neuropathies in association with a large deletion on chromosome 17, which includes the gene coding for the peripheral myelin protein 22 (PMP 22).
Cerebrovascular Disease

Cerebrovascular Disease


Cerebrovascular Disease
Definition of stroke
A stroke or cerebrovascular accident (CVA) is typically an event of sudden onset (although it can occur over hours in some patients where a major vessel is slowly thrombosing). It is due to an interruption of blood supply to an area of the central nervous system (CNS) that causes irreversible loss of tissue at the core with a penumbra of compromised tissue around the area that may still be salvageable. If the disturbance in blood flow is temporary it causes a transient ischaemic attack or TIA. This is often a harbinger of a stroke. Stroke is common and its consequences depend on the vessel that has been occluded.

Cerebrovascular Disease

Investigation of stroke
·       History and examination
·       Computed tomography (CT)/magnetic resonance imaging (MRI)
·     Blood tests including full blood count, erythrocyte sedimentation rate, renal function, glucose and lipids
·   Electrocardiogram (ECG) which may be repeated and prolonged if a cardiac source for the stroke is suspected
Other investigation may include an ECHO cardiogram and imaging of the blood vessels and/or a CSF examination and this depends on the type of stroke (see Table 64.1).

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