Schizophrenia

The first frank episode of psychosis happened when I was around 16, and I suddenly started walking home from school in the middle of the day. I began to feel the houses were getting weird; they were sending me messages: “You are special. You are especially bad. Now walk. Cries and whispers.” There were also some warning signs in college but I didn’t really “officially” break down until graduate school at Oxford.

Schizophrenia was originally known as dementia praecox describing a syndrome that involved an early,  gradual onset yet a progressive deterioration of brain function.  In 1950 Bleuler introduce the term schizophrenia which translates to "split mind" to refer to a split between thought process and emotions or disorganization in thought and behavior.

Keep in mind that this kind of "split mind"is not the same as dissociation reactions of fugue, amnesia, or multiple personality; in these conditions mentioned above the split is between different states of conscious instead of the between thought and emotion.

Even though most cases have an onset in the late teens to mid-thirties, schizophrenia can be diagnosed at any age; yet men tend to show symptoms at an earlier age than women allowing the men to have better outcomes in the end.  Unlike men that show more negative symptoms, women are more likely to suffer from paranoid delusions, mood symptoms, and hallucinations.  Risk of suicide has also increased, up to 40% attempt suicide but about 10% of the schizophrenics have suicide completion.  

There are different subtypes of schizophrenia:

• Paranoid Type
• In this type there are hallucinations or delusions and involve persecution.  Delusions of grandiose or persecution also associated with anger or jealousy.  These individuals have a later onset of symptoms and a better clinical prognosis but may be at greater risk  for suicidal or violent behavior.
• Disorganized Type
• The features consist of incoherent speech, hallucinations, some delusional beliefs, inappropriate responses frequently involving silly laughter, and stereotyped mannerisms and grimaces.  This type of schizophrenia tends to have an earlier onset while the overall disorganization and impairment are severe and it being chronic without significant remissions.
• Catatonic Type
• The most common feature in this type are psychomotor disturbances involving rigid immobility, excessive motor activity, echolalia, echopraxia, and unresponsiveness to environmental stimuli, for long periods of time.  There may be a presence of waxy flexibility, purposeless movements that may appear aggressive and may result in self-injury or injuries to others.  They are extremely negative; they may remain mute or resist all instructions or attempts to be moved.
• Undifferentiated Type
• This type of schizophrenia meets the criteria for schizophrenia but not the criteria for paranoid, disorganized, or catatonic subtypes.  This subtype reflects the fact that schizophrenic symptoms do not conform to the other subtypes mentioned.
• Residual Type
• This residual type is applied to people who have previously experienced episodes of schizophrenia but who at present show no symptoms or psychotic features like, delusions, hallucinations, or disorganized speech or behavior.  At times residual schizophrenia happens between periods of full blown psychotic symptoms and periods of remission but keep in mind that in some cases the residual state can persist for years.  

Unfortunately individuals with schizophrenia have more than twice the death rate than those without the disorder; while almost half of individuals with schizophrenia will suffer from a substance use disorder, like alcohol, marijuana, or others.  But on the brighter side research does show that individuals who suffer from schizophrenia have a better quality of life if their family members are more supportive and less critical.

Split Mind

Have you ever had those moments that you are being watched or that you are being followed and you start to walk faster and your heart rate increases, but you suddenly get a hold of yourself and kind of chuckle because you realize how stupid those thoughts were.  How could anyone just be watching you or following you  for no apparent reason, so you just throw those kinds of thoughts to the back burner and never think about ever again.
But what if these two thoughts never went away, you just could not seem to let go of these thoughts, but now not only are you being followed or being watched but they have put something in your cereal so that you can ingest it and now they are in you.
As awkward as this might sound there is people out there that suffer with these kinds of thoughts that have become their reality known as, Schizophrenia.
Schizophrenia originally known as dementia praecox but later in 1911 introduced as schizophrenia by Eugen Bleuler a Greek term referred to as "split mind" meaning that there is a split between the emotional and intellectual aspect of experience.
Throughout history people who suffered from schizophrenia were thought to be possessed by demons and were feared and many times locked up forever.  Even though research has advanced in educating and helping the public to better understand schizophrenia it is still easier for the average person to deal with the idea of cancer than to try and understand the strange behavior, hallucinations, or erratic ideas of someone with schizophrenia.
Many people have the misconception that people with schizophrenia are more violent, and so when friends and family learn about their diagnosis they are shocked and afraid.

Onset
Schizophrenia occurs in early adulthood, usually early 20s.  During this time the person may seem without goals in life, unmotivated, becoming very eccentric, isolating themselves from family and friends.

Signs

• Social withdrawal
• Irrational, bizarre or odd statements or beliefs
• Increase paranoia - questioning other's motives 
• Becoming more emotionless 
• Hostility or suspicious
• Drugs or alcohol use
• Inappropriate laughter
• Insomnia or excessive sleeping

Causes

It is not know what causes schizophrenia but it is believe to be a combination of genetics and environment.
Brain chemicals play a big role in schizophrenia such as neurotransmitters of dopamine and glutamate; neuroimaging studies have shown the differences in brain structure and central nervous system of people with schizophrenia.

Risk Factors

• Having a family history of schizophrenia
• Exposure to viruses, toxins, malnutrition while in womb (1st & 2nd trimester)
• Stressful life circumstances
• Older paternal age
• Usage of psychoactive drugs during adolescence and young adulthood

Treatment

Because schizophrenia is a chronic condition it requires lifelong treatment, even if and when symptoms subside; antipsychotic medications are most common for treating schizophrenia.

• Atypical antipsychotics…these are the newer medications with lower risk and debilitating side effects.
• Abilify
• Clozaril, Fazaclo
• Zyprexa
• Invega
• Seroquel
• Risperdal

• Conventional or Typical, Antipsychotic…produce frequent and potentially significant neurological side effects such as tardive dyskinesia.
• Chlorpomazine
• Fluphenazine
• Haldol
• Perphenazine

Conclusion
It can take several weeks to see improvement but the goal is to effectively control signs and symptoms at the lowest possible dosage.  Different medications, different dosage, and or combinations may be given to achieve the desired result; other medication such as andtidepressants or anti anxiety medication may also be helpful.

Fearless

What would it be like to be fearless?  Would it be a good thing or would it be a daily tragedy?  Unfortunately their is a rare genetic disorder known as Urbach-Wiethe Disease.  

What exactly is Urbach-Wiethe Disease??

Also known as Lipoid proteinosis of Urbach and Wiethe; a rare congenital lipoid disease where lipids, carbohydrate and proteins are deposited into the blood vessel wall and other tissues.  It was first seen in 1929 by Erich Urbach and Camillo Wiethe.

Symptoms

The symptoms vary from person to person these are few:

• Inability to cry
• Itchy eyes
• Skin ulcers
• Hoarseness
• Mucosal ulcers
• Mucosal plaque 
• Increased blood phospholipids
• Increase urinary tyrosind
• Vocal cord growths
• Large tongue
• Skin plaque
• Macrocheilia
• Skin bumps
• Skin nodules
• Mental retardation
• Indurated skin plaque

Causes

It is caused by a mutation in the extracellular matrix protein 1 gene, ECM1; but unlike the dermatological symptoms it is caused by a build up of a hyaline material in the dermis and thickening of the basement membranes in the skin, it is seen on the eyelids where beaded papules developed.  Some people may just be carriers of the disease and show no symptoms.

Diagnosis

It may be diagnosed by the dermatological manifestation, especially the noticeable beaded papules on the eyelids, staining of hyaline and testing the antibodies for EMC1.

Treatment

Unfortunately there is no cure but many of the symptoms may be treatable by using oral dimethyl sulfoxide, intralesional heparin, etretinate, anti-seizure medication, and having a tracheostomy if needed.

Prognosis

Patients with this form of disease may have longevity as long as their symptoms are properly treated and cared for such as the thickening mucosa.  But will eventually require a tracheostomy or carbon dioxide laser surgery to keep the patient safe and comfortable. 

Meet the woman without fear……...

Sleep Apnea

Many of us are very fortunate to be able fall asleep with no interruptions but have you ever thought of what it would be like to fall asleep and suddenly waking up to a choking episode?  This is what is known as sleep apnea…….and what is sleep apnea…….what are the symptoms and treatments?

Sleep Apnea

A sleeping disorder that interrupts sleep due to shallow breathing or breathing suddenly stops lasting ten to twenty seconds constantly during sleep causing the person to wake up 20 to 30 times during an hour;  at this point the brain and the body may not be getting enough oxygen.  

2 Types of Sleep Apnea

• Obstructive Sleep Apnea

This is the most common of the two; it is estimated that over 12 million people suffer from obstructive sleep apnea, it is caused by blockage of the airway usually when the soft tissue in the back of the throat  collapse during sleep.  The majority of people who suffer this form of sleep apnea are overweight and snore. 

Sleep apnea is seen more in men; one out of 25 middle aged men and one out of fifty middle aged women.  Sleep apnea is commonly seen in African Americans, Hispanics, and may occur in children that snore.  

• Central Sleep Apnea

Unlike obstructive sleep apnea, there is no throat blockage the brain just fails to signal the muscles to breathe due to instability in the respiratory control  

Who is at risk?

Sleep apnea does not discriminate it can affect anyone and at any age.

• Males
• Overweight
• Over the age of forty
• Large neck size (Men 17in or more Women 16in or more)
•  Large tonsils, tongue, or a small jaw bone
• Family history of sleep apnea
• Gastroesophageal reflux
• Nasal obstruction due to deviated septum, allergies, or sinus problems

Signs & Symptoms

• Loud snoring
• Sudden choking or gasping for air
• Sleepiness during the day

Diagnosis

Your physician may order a sleep study to monitor your breathing and how often the interruptions are happing during sleep.

Treatment

Most common treatment for sleep apnea is Continuous positive airway pressure; it consist of the patient wearing a mask over the nose during sleep.  The mask provides air into the throat at a pressure level keeping the throat open while the patient sleeps.  The air pressure is adjusted enough to stop the airways from getting too small during sleep.  The patient must use the mask nightly and must use it correctly to get the maximum benefits.

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A child called IT……..

Intersex???? A condition in which a person is born with a reproductive or sexual anatomy that does not seem to fit the typical definition of female or male.  The person has the appearance a normal female but has male typical anatomy in the inside.  Or the person may be born with genitals that seem to be in between male and female.

The original term for this condition, hermaphroditism that came from joining the names of a Greek god and goddess, Hermes and Aphrodite.  As you may have already made the connection, Hermes was the god of male sexuality and Aphrodite the goddess of female sexuality, love, and beauty.

Causes

Intersex can be divided into 4 categories

• 46 - XX Intersex
• 46 - XY Intersex
• True Gonadal Intersex
• Complex or Undetermined Intersex

46 - XX intersex
The person has the chromosomes of a woman along with the ovaries, but external genital that appear male.  This the result of the fetus having been exposed to excess male hormones before birth.  These women have an enlarge clitoris that appears like a penis but usually they have normal uterus and fallopian tubes


46 - XY Intersex
This person has the chromosomes of a man but with external genitals are incompletely formed.  Internally testes may be normal, malformed or absent; this condition is also known as 46 - XY with undervirilization.  It was known as male pseudohermaphroditism; forming male external genitals depends on the right balance between male and female hormones.

True Gonadal Intersex
This person has both ovarian and testicular tissue, the person might have one ovary and one testis.  This person may have XX chromosomes, XY chromosomes, or both; but the external genitals may be unclear or may appear to female or male.  This condition was known as true hermaphroditism; in most people with true gonadal intersex the cause is unknown, yet in some animal studies it has been linked to exposure to common agricultural pesticides.

Symptoms 

• Unclear genitalia at birth
• Micropenis
• Clitoromegaly
• Partial labial fusion
• Undescended testes in boys (may be ovaries)
• Labial or inguinal masses (may be testes) in girls
• Hypospadias 
• Electrolyte abnormalities
• Delayed or absent puberty
• Unexpected changes at puberty

Exams

• Chromosome Analysis
• Hormone leves
• Hormone Stimulation tests
• Electrolyte test
• Specific Molecular testing
• Endoscopic examination - to verify the absence or presence of a vaginal or cervix
• Ultrasound or MRI to evaluate internal sex organs

Conclusion

It use to be that surgery was highly recommended because having to reconstruct the female genitalia was easier than male genitalia, yet surgery or no surgery the child was assigned to be a female.  

Now many experts disagree and encourage the delay of surgery for as long as possible without harming the child while involving the child in the gender decision.

Be aware that intersex is complex and its treatment has a short and long term consequences parents are encourage to have a good understanding of the condition before making  rushing into a decision. 

Smell……Men vs. Women

What is smell; is it that nasty smell coming from someone in the elevator or is that awesome smell you can not seem to get enough of.  

It is olfaction, a sense of smell, the ability of humans and other animals to perceive odors; odor the resultant from the sense of smell.  Smell is the response to chemicals that contact the membranes inside the nose.  Smell is usually our first response to stimuli, just like the smell of fire alerts us before the flames and the smell of rotten food before we even taste it.

Just like taste, smell is a chemical sense detected by sensory cells call chemoreceptors.  When smell stimulates the chemoreceptors in the nose that are alerted by smell, they pass on electrical impulses to the brain.  The brain then communicates these patterns in electrical activity as specific odors and olfactory sensation becomes perception; which we recognize as smell.  

Men vs. Women

On average women detect odors more easily than men, brain responses to odors are stronger in women than men.  According to research the women's greater ability to detect odors and aromas may be linked to the estrogen hormone.  

Another study showed that females are far better at singling out odors than men after repeated exposure to the origin of the smell by one ten-thousand; whereas men never improve their ability to recognize odors with experience. 

It has been suggested by researchers that female sex hormones have a role in enabling exposure induce increases in odor sensitivity.

At the end of the day the structure of nose in women and men are the same; women do not have more receptors in the nose than men, only a better sense of smell.

Alzheimer's Disease

Alzheimer's Disease 

It is a developing brain disease that slowly does away with memory and thinking skills results in confusion, disorientation, reason, understanding, and eventually leading up to the inability to perform the most basic tasks of daily living.  Alzheimer's disease is the most common cause of dementia among older people.

The disease is named after Dr. Alois Alzheimer a german psychiatrist and neuropathologist who was the first to publish a case of  "presenile dementia" which would later be known as Alzheimer's Disease.

What is Dementia??

The loss of cognitive functioning; thinking, remembering, reasoning, and behavior abilities.  

Dementia is cause by many conditions and diseases but the two most common cause for dementia in older people are Alzheimer's disease and vascular dementia.

Continue

Memory loss or dementia may also be caused by:

• medication side effects
• chronic alcoholism 
• tumors or infections in the brain
• blood clots in the brain
• vitamin B12 deficiency
• thyroid, kidney, or liver disorders

Note that most of these conditions are temporary and reversible.

What happens to the Brain??

Alzheimer's disease comes into the brain like a thief, there is no specific knowledge of how the disease begins until there is  significant evidence that could have started a decade or more before.  Even though the person is asymptomatic at the early stage of Alzheimer's there is toxic changes taking place in the brain.  Alzheimer's disease causes abnormal deposits of proteins from amyloid plaques and tau tangles on both the inside and outside neurons while damage dendritic spines, decrease synaptic input, and decrease plasticity.  As the plaques accumulates the damages spreads to the cerebral cortex and  hippocampus, which is responsible for forming memories.  As the neurons die in large numbers the affected regions of the brain begin to shrink.

Early signs and symptoms

Memory problems, such as trouble finding the correct words or poor judgment.

Mild Alzheimer's disease 

Memory loss worsens and cognitive abilities are significant:

• getting lost
• trouble handling money and paying bills
• repeating questions
• taking longer to complete normal daily tasks
• poor judgement 
• losing things - misplacing things in odd places
• mood and personality changes

Moderate Alzheimer's disease

At this point the damage done to the brain affects language, reasoning, sensory processing, and conscious thoughts.

• increase memory loss and confusion
• problem recognizing familiar faces
• inability to learn new things
• unable to multitask 
• problems coping with new situations 
•  hallucinations, delusions, and paranoia 
• impulsive behavior

Severe Alzheimer's disease 

Once Alzheimer's is full blown the person is no longer able to communicate and is completely dependent on others and may be bedridden. 

• unable to communicate
• weight loss
• seizures
• skin infections
• difficulty 
• groaning, moaning, or grunting
•  sleeps most of the time
• uncontrolled bladder and bowel

Unfortunately there is no cure for Alzheimer's disease but there are medications that can help with the managing of symptoms allowing the patient to function at a higher level and for longer periods of time.