Borderline Personality Disorder

 Raising questions, finding answers

Borderline personality disorder (BPD) is a serious mental illness characterized by pervasive instability in moods, interpersonal relationships, self-image, and behavior. This instability often disrupts family and work life, long-term planning, and the individual's sense of self-identity. Originally thought to be at the "borderline" of psychosis, people with BPD suffer from a disorder of emotion regulation. While less well known than schizophrenia or bipolar disorder (manic-depressive illness), BPD is more common, affecting 2 percent of adults, mostly young women. There is a high rate of self-injury without suicide intent, as well as a significant rate of suicide attempts and completed suicide in severe cases. Patients often need extensive mental health services, and account for 20 percent of psychiatric hospitalizations. Yet, with help, many improve over time and are eventually able to lead productive lives.

Symptoms

While a person with depression or bipolar disorder typically endures the same mood for weeks, a person with BPD may experience intense bouts of anger, depression, and anxiety that may last only hours, or at most a day. These may be associated with episodes of impulsive aggression, self-injury, and drug or alcohol abuse. Distortions in cognition and sense of self can lead to frequent changes in long-term goals, career plans, jobs, friendships, gender identity, and values. Sometimes people with BPD view themselves as fundamentally bad, or unworthy. They may feel unfairly misunderstood or mistreated, bored, empty, and have little idea who they are. Such symptoms are most acute when people with BPD feel isolated and lacking in social support, and may result in frantic efforts to avoid being alone.
People with BPD often have highly unstable patterns of social relationships. While they can develop intense but stormy attachments, their attitudes towards family, friends, and loved ones may suddenly shift from idealization (great admiration and love) to devaluation (intense anger and dislike). Thus, they may form an immediate attachment and idealize the other person, but when a slight separation or conflict occurs, they switch unexpectedly to the other extreme and angrily accuse the other person of not caring for them at all. Even with family members, individuals with BPD are highly sensitive to rejection, reacting with anger and distress to such mild separations as a vacation, a business trip, or a sudden change in plans. These fears of abandonment seem to be related to difficulties feeling emotionally connected to important persons when they are physically absent, leaving the individual with BPD feeling lost and perhaps worthless. Suicide threats and attempts may occur along with anger at perceived abandonment and disappointments.
People with BPD exhibit other impulsive behaviors, such as excessive spending, binge eating and risky sex. BPD often occurs together with other psychiatric problems, particularly bipolar disorder, depression, anxiety disorders, substance abuse, and other personality disorders.

Treatment

Treatments for BPD have improved in recent years. Group and individual psychotherapy are at least partially effective for many patients. Within the past 15 years, a new psychosocial treatment termed dialectical behavior therapy (DBT) was developed specifically to treat BPD, and this technique has looked promising in treatment studies. Pharmacological treatments are often prescribed based on specific target symptoms shown by the individual patient. Antidepressant drugs and mood stabilizers may be helpful for depressed and/or labile mood. Antipsychotic drugs may also be used when there are distortions in thinking.

Recent Research Findings

Although the cause of BPD is unknown, both environmental and genetic factors are thought to play a role in predisposing patients to BPD symptoms and traits. Studies show that many, but not all individuals with BPD report a history of abuse, neglect, or separation as young children. Forty to 71 percent of BPD patients report having been sexually abused, usually by a non-caregiver. Researchers believe that BPD results from a combination of individual vulnerability to environmental stress, neglect or abuse as young children, and a series of events that trigger the onset of the disorder as young adults. Adults with BPD are also considerably more likely to be the victim of violence, including rape and other crimes. This may result from both harmful environments as well as impulsivity and poor judgement in choosing partners and lifestyles.
NIMH-funded neuroscience research is revealing brain mechanisms underlying the impulsivity, mood instability, aggression, anger, and negative emotion seen in BPD. Studies suggest that people predisposed to impulsive aggression have impaired regulation of the neural circuits that modulate emotion. The amygdala, a small almond-shaped structure deep inside the brain, is an important component of the circuit that regulates negative emotion. In response to signals from other brain centers indicating a perceived threat, it marshals fear and arousal. This might be more pronounced under the influence of drugs like alcohol, or stress. Areas in the front of the brain (pre-frontal area) act to dampen the activity of this circuit. Recent brain imaging studies show that individual differences in the ability to activate regions of the prefrontal cerebral cortex thought to be involved in inhibitory activity predict the ability to suppress negative emotion.
Serotonin, norepinephrine and acetylcholine are among the chemical messengers in these circuits that play a role in the regulation of emotions, including sadness, anger, anxiety, and irritability. Drugs that enhance brain serotonin function may improve emotional symptoms in BPD. Likewise, mood-stabilizing drugs that are known to enhance the activity of GABA, the brain's major inhibitory neurotransmitter, may help people who experience BPD-like mood swings. Such brain-based vulnerabilities can be managed with help from behavioral interventions and medications, much like people manage susceptibility to diabetes or high blood pressure.

Future Progress

Studies that translate basic findings about the neural basis of temperament, mood regulation, and cognition into clinically relevant insights which bear directly on BPD represent a growing area of NIMH-supported research. Research is also underway to test the efficacy of combining medications with behavioral treatments like DBT, and gauging the effect of childhood abuse and other stress in BPD on brain hormones. Data from the first prospective, longitudinal study of BPD, which began in the early 1990s, is expected to reveal how treatment affects the course of the illness. It will also pinpoint specific environmental factors and personality traits that predict a more favorable outcome. The Institute is also collaborating with a private foundation to help attract new researchers to develop a better understanding and better treatment for BPD.

Intermittent Explosive Disorder:

Overview

Intermittent explosive disorder is marked by sudden, unpredictable acts of violent, aggressive behavior in otherwise normal persons. The reaction is out of proportion to the event that triggers or provokes the outburst.

What is going on in the body?

The exact cause of intermittent explosive disorder is not known. Some evidence suggests there may be a link between this disorder and mild neurological problems similar to those associated with some learning disabilities.

What are the signs and symptoms of the condition?

A person who has intermittent explosive disorder:

• destroys property

• has repeated acts of sudden verbal or physical aggression

• is unable to stop or control the impulsive, aggressive actions

A person who has this disorder is not violent or aggressive most of the time. The outbreaks of severe rage and anger are usually isolated. The amount of aggression is out of proportion with the incident that triggered the outburst.

What are the causes and risks of the condition?

The cause of intermittent explosive disorder is not known. It may be caused by an abnormality in the nervous system. Things that increase a person's risk for the disorder include: a caregiver who is antisocialchild abuse and neglectconflict with a spouse or significant otherparents who abuse drugs or alcohollower socioeconomic statusparents who are not consistent in their availability or disciplinepsychiatric illness

How is the condition diagnosed?

To be diagnosed with this disorder, an individual must have had at least three episodes in his or her life where he or she lost control and committed an act of destruction, completely out of proportion to any provocation that may have occurred. Evaluation of intermittent explosive disorder begins with a medical history and physical exam. A complete psychological evaluation should be done to rule out another medical or mental disorder.

What are the long-term effects of the condition?

Someone who has intermittent explosive disorder may have social or legal problems as a result of the aggressive behavior. The behavior may also cause problems at home or school.

What are the risks to others?

Intermittent explosive disorder is not contagious.

What are the treatments for the condition?

A combination of medication and psychological treatment is generally used to treat this disorder. A wide variety of medications have been used, including antidepressants such as fluoxetine (i.e., Prozac, Sarafem), antipsychotics, anti-anxiety agents, and anticonvulsants such as phenytoin (i.e., Dilantin). Psychotherapy with a focus on awareness of appropriate limits in social settings is often helpful.

What are the side effects of the treatments?

Side effects of medicines vary. They may include allergic reactions and drowsiness.

What happens after treatment for the condition?

With effective treatment, the person can live a normal life.

How is the condition monitored?

Any new or worsening symptoms should be reported to the healthcare professional. 

 

If you or anyone you know have these issues, seek help immediately. 

http://www.minddisorders.com/Flu-Inv/Intermittent-explosive-disorder.html

 

 

 

 

 

Stay safe in the sun:

Prevention

Protection from sun exposure is important all year round, not just during the summer or at the beach. Ultraviolet (UV) rays can reach you on cloudy and hazy days, as well as bright and sunny days. UV rays also reflect off of surfaces like water, cement, sand, and snow.
The hours between 10 a.m. and 4 p.m. daylight savings time (9 a.m. to 3 p.m. standard time) are the most hazardous for UV exposure in the continental United States. UV rays are the greatest during the late spring and early summer in North America.
CDC recommends easy options for sun protection

• Use sunscreen with sun protective factor (SPF) 15 or higher, and both UVA and UVB protection.
• Wear clothing to protect exposed skin.
• Wear a hat with a wide brim to shade the face, head, ears, and neck.
• Wear sunglasses that wrap around and block as close to 100% of both UVA and UVB rays as possible.
• Seek shade, especially during midday hours.

Sunscreen

The sun's UV rays can damage your skin in as little as 15 minutes. Put on sunscreen before you go outside, even on slightly cloudy or cool days. Don't forget to put a thick layer on all parts of exposed skin. Get help for hard-to-reach places like your back.
How sunscreen works. Most sun protection products work by absorbing, reflecting, or scattering sunlight. They contain chemicals that interact with the skin to protect it from UV rays. All products do not have the same ingredients; if your skin reacts badly to one product, try another one or call a doctor.
SPF. Sunscreens are assigned a sun protection factor (SPF) number that rates their effectiveness in blocking UV rays. Higher numbers indicate more protection. You should use a sunscreen with at least SPF 15.
Reapplication. Sunscreen wears off. Put it on again if you stay out in the sun for more than two hours, and after you swim or do things that make you sweat.
Expiration date. Check the sunscreen's expiration date. Sunscreen without an expiration date has a shelf life of no more than three years, but its shelf life is shorter if it has been exposed to high temperatures.
Cosmetics. Some make-up and lip balms contain some of the same chemicals used in sunscreens. If they do not have at least SPF 15, don't use them by themselves.

Clothing

Loose-fitting long-sleeved shirts and long pants made from tightly woven fabric offer the best protection from the sun's UV rays. A wet T-shirt offers much less UV protection than a dry one. Darker colors may offer more protection than lighter colors.
If wearing this type of clothing isn't practical, at least try to wear a T-shirt or a beach cover-up. Keep in mind that a typical T-shirt has an SPF rating lower than 15, so use other types of protection as well.

Hats

For the most protection, wear a hat with a brim all the way around that shades your face, ears, and the back of your neck. A tightly woven fabric, such as canvas, works best to protect your skin from UV rays. Avoid straw hats with holes that let sunlight through. A darker hat may offer more UV protection.
If you wear a baseball cap, you should also protect your ears and the back of your neck by wearing clothing that covers those areas, using sunscreen with at least SPF 15, or by staying in the shade.

Sunglasses

Sunglasses protect your eyes from UV rays and reduce the risk of cataracts. They also protect the tender skin around your eyes from sun exposure.
Sunglasses that block both UVA and UVB rays offer the best protection. Most sunglasses sold in the United States, regardless of cost, meet this standard. Wrap-around sunglasses work best because they block UV rays from sneaking in from the side.

Shade

You can reduce your risk of skin damage and skin cancer by seeking shade under an umbrella, tree, or other shelter before you need relief from the sun. Your best bet to protect your skin is to use sunscreen or wear protective clothing when you're outside—even when you're in the shade.

For more information: http://www.medicinenet.com/sun_protection_and_sunscreens/article.htm 

Crohns: What is it and how do you treat it?

Recently, while working in a nursing home, was I presented with a patient with a diagnosis of Crohns.

While there is no cure for Crohn's Disease, treatment options available vary due to the complex nature and life-altering symptoms of the disorder.
This disease covers inflammation of the gastrointestinal tract from the mouth on down, several combinations might be needed to control the varying side effects, which include diarrhea, abdominal pain, vomiting, weight loss, and possibly arthritis, skin rashes, inflammation of the eye and fatigue.
Depending on the severity and combination of the symptoms, where the disease is located in the tract, or whether Crohn's is in remission, treatment options can range from simple diet changes to surgery.
With the direction of your physician or a specialist, several treatment options might be needed to keep Crohn's under control.

 

Medication

Physicians often prescribe anti-inflammatory drugs as the first course of treatment for Crohn's, but many have a number of side effects ranging from nausea to insomnia. Included in the list of drugs are Sulfasalazine, Mesalamine and Corticosteroids, depending on the severity of the symptoms. Other medications include immune system suppressors, antibiotics, over-the-counter pain relievers, anti-diarrheal medicine. and laxatives, and vitamin and mineral supplements. Antibiotics are used to heal fistulas and abscesses to hopefully avoid surgery. As with any medication, report any and all side-effects to your doctor.

Diet

Nutrition is important with Crohn's because the disease generally decreases appetite but the body needs more caloric intake, as is normal with any chronic illness. Proper hydration and diet also play a large factor in controlling symptoms as the disease affects the digestive tract. Physicians might suggest eating smaller meals in lieu of larger ones to help with diminished appetite or prevent unnecessary inflammation. Especially during inflammations, blander foods are recommended instead of spicy foods because they are gentler on the digestive tract. Some patients might be directed to follow a low dietary fiber diet or keep a "food diary" to identify triggering foods, while others will be instructed to avoid lactose-based foods like milk or cheese. In some cases, a doctor might recommend a feeding tube or nutrition to be administered via an IV. This allows the bowel to rest, but when normal eating resumes symptoms could immediately return.

Lifestyle

Diet, proper exercise and regular sleep patterns can also help control the fatigue regularly associated with Crohn's. Cigarette smoking has been linked to Crohn's, so if you are a smoker, quitting greatly reduces the symptoms of the disease, as well as other health risks.

Surgery

As with any other disease, surgery is generally a last-choice option should other forms of therapy inadequately treat Crohn's. Again, since there is no cure for Crohn's, the ultimate goal of surgery is to provide, hopefully, a few years of remission. However, the Mayo Clinic estimates that about 75 percent of all Crohn's patients will need some type of surgery in their lives. A common procedure is bowel resection. That is when a surgeon removes damaged sections of the intestine and reconnects the ends of healthy tissue. Surgery can also be used to remove scar tissue, close fistulas or drain abscesses. Another surgery is strictureplasty where a surgeon widens a narrowed section of the bowel to allow regular flow without further shortening the intestines. Unfortunately, Crohn's generally returns to other areas of the intestine so surgery is only a temporary fix. About half of patients will need a second surgery or more, according to the Mayo Clinic.

Some helpful web resources:

Living with Crohn's disease: Practical strategies

Water Safety:

When the weather turns warm, everyone wants to be in or around the water. Hanging out at the pool or the beach on a hot day is a great way to beat the heat.

Between having fun and checking out the lifeguards, most people don't think much about water safety — but they should. For people between the ages of 5 and 24, drowning is the second leading cause of accidental death.

It doesn't have to be that way, though. Most water-related accidents can be avoided by knowing how to stay safe and following a few simple guidelines.
Swimming Smarts

"Buddy up!"
That's what swimming instructors say. Always swim with a partner, every time — whether you're swimming in a backyard pool or in a lake. Even experienced swimmers can become tired or get muscle cramps, which might make it difficult to get out of the water. When people swim together, they can help each other or go for help in case of an emergency.

Get skilled. Speaking of emergencies, it's good to be prepared. Learning some life-saving skills, such as CPR and rescue techniques, can help you save a life. If you live in DFW area we can help. Go to www.MalecHealthEducation.com for more information. A number of other organizations offer free and low fee classes for both beginning and experienced swimmers and boaters. Check with your YMCA or YWCA, local hospital, or chapter of the Red Cross.


Know your limits
  Swimming can be a lot of fun — and you might want to stay in the water as long as possible. If you're not a good swimmer or you're just learning to swim, don't go in water that's so deep you can't touch the bottom and don't try to keep up with skilled swimmers. That can be hard, especially when your friends are challenging you — but it's a pretty sure bet they'd rather have you safe and alive.

If you are a good swimmer and have had lessons, keep an eye on friends who aren't as comfortable or as skilled as you are. If it seems like they (or you) are getting tired or a little uneasy, suggest that you take a break from swimming for a while.

Swim in safe areas only. It's a good idea to swim only in places that are supervised by a lifeguard. No one can anticipate changing ocean currents, riptides, sudden storms, or other hidden dangers. In the event that something does go wrong, lifeguards are trained in rescue techniques.

Swimming in an open body of water (like a river, lake, or ocean) is different from swimming in a pool. You need more energy to handle the currents and other conditions in the open water.

If you do find yourself caught in a current, don't panic and don't fight the current. Swim with the current, gradually trying to make your way back to shore as you do so. Even a very good swimmer who tries to swim against a strong current will get worn out. If you're going to be swimming in an open body of water, it's a great idea to take swimming lessons that provide you with tips on handling unexpected hazards.

Some areas with extremely strong currents are off limits when it comes to swimming. Do your research so you know where not to swim.Be careful about diving. Diving injuries can cause permanent spinal cord damage, paralysis, and sometimes even death. Protect yourself by only diving in areas that are known to be safe, such as the deep end of a supervised pool. If an area is posted with "No Diving" or "No Swimming" signs, pay attention to them. A "No Diving" sign means the water isn't safe for a head-first entry. Even if you plan to jump in feet first, check the water's depth before you leap to make sure there are no hidden rocks or other hazards. Lakes or rivers can be cloudy and hazards may be hard to see.

Watch the sun
Sun reflecting off the water or off sand can intensify the burning rays. You might not feel sunburned when the water feels cool and refreshing, but the pain will catch up with you later — so remember to reapply sunscreen frequently and cover up much of the time.

Drink plenty of fluids
It's easy to get dehydrated in the sun, particularly if you're active and sweating. Keep up with fluids — particularly water — to prevent dehydration. Dizziness, feeling lightheaded, or nausea can be signs of dehydration and overheating.

Getting too cool
Speaking of temperature, it's possible to get too cool. How? Staying in very cool water for long periods can lower your body temperature. A temperature of 70° Fahrenheit (20° Celsius) is positively balmy on land, but did you know that water below 70° Fahrenheit will feel cold to most swimmers? Your body temperature drops far more quickly in water than it does on land. And if you're swimming, you're using energy and losing body heat even faster than if you were keeping still. Monitor yourself when swimming in cold water and stay close to shore. If feel your body start to shiver or your muscles cramp up, get out of the water quickly; it doesn't take long for hypothermia to set in.

Alcohol and water never mix
Alcohol is involved in numerous water-related injuries and up to half of all water-related deaths. The statistics for teenage guys are particularly scary: One half of all adolescent male drownings are tied to alcohol use.At the Water Park

OK, so you do more splashing than swimming, but it's just as important to know your skill level at the water park as it is at the pool. Take a moment to read warnings and other signs. And make sure you do slide runs feet first or you'll put yourself at risk for a ride that's a lot less fun — one to your doctor or dentist.
Boating Safety

More people die in boating accidents every year than in airplane crashes or train wrecks, but a little common sense can make boating both enjoyable and safe. If you are going to go boating, make sure the captain or person handling the boat is experienced and competent.

Alcohol and water still don't mix
One third of boating deaths are alcohol related. Alcohol distorts a person's judgment no matter where they are — but that distortion is even greater on the water. The U.S. Coast Guard warns people about a condition called boater's fatigue, which means that the wind, noise, heat, and vibration of the boat all combine to wear you down when you're on the water.

Because there are no road signs or lane markers on the water and the weather can be unpredictable, it's important to be able to think quickly and react well under pressure. If you're drinking, this can be almost impossible.

Personal flotation devices
It's always a good idea for everyone on the boat to wear a Coast Guard-approved life jacket, whether the boat is a large speedboat or a canoe — and whether you're a good swimmer or not. Wearing a life jacket (also known as a personal flotation device, or PFD) is the law in some states for certain age groups, and you could face a stiff penalty for breaking it. Your state may also require that you wear an approved life jacket for water skiing and other on-water activities. Wearing a PFD is like wearing a helmet while biking. It may take a few minutes to get used to it, but it definitely can be a lifesaver. Don't leave land without it.

Stay in touch
Before going out on a boat, let somebody on land know where you are going and about how long you'll be out. That way, if you do get into trouble, someone will have an idea of where to look for you. If you're going to be on the water for a long time, it's a good idea to have a radio with you so you can check the weather reports. Water conducts electricity, so if you hear a storm warning, get off the water as quickly as you can.

Jet skis
If you're using jet skis or personal watercraft, follow the same rules as you do for boating. You should also check out the laws in your area governing the use of personal watercraft. Some states won't allow people under a certain age to operate these devices; others require you to take a course or pass a test before you can ride one.

Now Have Fun! Be Safe!!

The pool and the beach are great places to learn new skills, socialize, and check out everyone's new bathing suit. So don't let paying attention to safety turn you off. Being prepared will make you feel more comfortable and in charge.

For more information go to National Drowning Prevention Alliance.