Chest pain


 chest pain
Overview
Chest pain is any pain that is experienced in the chest (area above abdomen and Below the neck). Chest pain varies depending on location in the chest. Chest pain can be caused by trauma( injury), infection e.g TB wounds in the oesophagus etc. 
Chest pain  may feel like a sharp, stabbing pain or a dull ache. It may be a sign of a serious heart-related problem. Many common causes that aren’t life-threatening may also have caused it.
When you have chest pain, your first thought may be that you’re having a heart attack. While chest pain is a well-established sign of a heart attack, it can also be caused by many other less serious conditions.
About 13 percentTrusted Source of all emergency room (ER) visits for chest pain result in a diagnosis of a serious heart-related problem, according to the National Center for Health Studies (NCHS).
Heart-related causes of chest pain
The following are heart-related causes of chest pain:
  • heart attack, which is a blockage of blood flow to the heart
  • angina, which is chest pain caused by blockages in the blood vessels leading to your heart
  • pericarditis, which is an inflammation of the sac around the heart
  • myocarditis, which is an inflammation of the heart muscle
  • cardiomyopathy, which is a disease of the heart muscle
  • aortic dissection, which is a rare condition involving a tear of the aorta, the large vessel that comes off of the heart
Gastrointestinal causes of chest pain
The following are gastrointestinal causes of chest pain:
  • acid reflux, or heartburn
  • swallowing problems related to disorders of the esophagus
  • gallstones
  • inflammation of the gallbladder or pancreas
Lung-related causes of chest pain
The following are lung-related causes of chest pain:
  • pneumonia
  • viral bronchitis
  • pneumothorax
  • a blood clot, or pulmonary embolus
  • bronchospasm
Bronchospasms commonly occur in people who have asthma and related disorders such as chronic obstructive pulmonary disease (COPD).
Muscle- or bone-related causes of chest pain
The following are causes of chest pain related to the muscles or bones:
  • bruised or broken ribs
  • sore muscles from exertion or chronic pain syndromes
  • compression fractures causing pressure on a nerve
Other causes
Shingles can cause chest pain. You may develop pain along your back or chest before the shingles rash becomes apparent. Panic attacks can also cause chest pain.
You may have other symptoms that occur with chest pain. Identifying symptoms you may be having can help your doctor make a diagnosis. These include:
Heart-related symptoms
While pain is the most common symptom of a heart problem, some people experience other symptoms, with or without chest pain. Women, in particular, have reported unusual symptoms that later have been identified as being the result of a heart condition:
  • chest pressure or tightness
  • backjaw, or arm pain
  • fatigue
  • lightheadedness
  • dizziness
  • shortness of breath
  • abdominal pain
  • nausea
  • pain during exertion
Other symptoms
Symptoms that may indicate your chest pain isn’t heart-related include:
  • a sour or acidic taste in your mouth
  • pain that only occurs after you swallow or eat
  • difficulty swallowing
  • pain that’s better or worse depending on your body position
  • pain that’s worse when you breathe deeply or cough
  • pain accompanied by a rash
  • fever
  • aches
  • chills
  • runny nose
  • cough
  • feelings of panic or anxiety
  • hyperventilating
  • back pain that radiates to the front of your chest
Seek emergency treatment immediately if you think you may be having a heart attack and especially if your chest pain is new, unexplained, or lasts more than a few moments.
Your doctor will ask you some questions, and your answers can help them diagnose the cause of your chest pain. Be prepared to discuss any related symptoms and to share information about any medications, treatments, or other medical conditions you may have.
Diagnostic tests
Your doctor may order tests to help diagnose or eliminate heart-related problems as a cause of your chest pain. These may include:
  • an electrocardiogram (ECG or EKG), which records your heart’s electrical activity
  • blood tests, which measure enzyme levels
  • a chest X-ray, which is used to examine your heart, lungs, and blood vessels
  • an echocardiogram, which uses sound waves to record moving images of the heart
  • an MRI, which is used to look for damage to the heart or aorta
  • stress tests, which are used to measure your heart function after exertion
  • an angiogram, which is used to look for blockages in specific arteries

Bipolar disorder Treatment

bipolar disorder treatment
Overview
Bipolar disorder, formerly called manic depression, is a mental health condition that causes extreme mood swings that include emotional highs (mania or hypomania) and lows (depression).
Periods of high or irritable mood are called manic episodes. The person becomes very active, but in a scattered and unproductive way, sometimes with painful or embarrassing consequences. Examples are spending more money than is wise or getting involved in sexual adventures that are regretted later. A person in a manic state is full of energy or very irritable, may sleep far less than normal, and may dream up grand plans that could never be carried out. The person may develop thinking that is out of step with reality -- psychotic symptoms -- such as false beliefs (delusions) or false perceptions (hallucinations). During manic periods, a person may run into trouble with the law. If a person has milder symptoms of mania and does not have psychotic symptoms, it is called "hypomania" or a hypomanic episode.
The expert view of bipolar disorder will continue to evolve, but it is now commonly divided into two subtypes (bipolar I and bipolar II) based on the dividing line between mania and hypomania described above.
  • Bipolar I disorder is the classic form where a person has had at least one manic episode.
  • In bipolar II disorder, the person has never had a manic episode, but has had at least one hypomanic episode and at least one period of significant depression.
Most people who have manic episodes also experience periods of depression. In fact, there is some evidence that the depression phase is much more common than periods of mania in this illness. Bipolar depression can be much more distressing than mania and, because of the risk of suicide, is potentially more dangerous.
A disorder that is classified separately, but is closely related to bipolar disorder, is cyclothymia. People with this disorder fluctuate between hypomania and mild or moderate depression without ever developing a full manic or depressive episode.
Some people with bipolar disorder switch frequently or rapidly between manic and depressive symptoms, a pattern that is often called "rapid cycling." If manic and depressive symptoms overlap for a period, it is called a "mixed" episode. During such periods, it may be difficult to tell which mood -- depression or mania -- is more prominent.
People who have had one manic episode most likely will have others if they do not seek treatment. The illness tends to run in families. Unlike depression, in which women are more frequently diagnosed, bipolar disorder happens nearly equally in men and women.
Since bipolar disorder can come in so many forms, it is difficult to determine its prevalence. Depending on how they define the disorder, researchers estimate that bipolar disorder occurs in up to 4% of the population. When a particularly broad definition is used, the estimate can be even higher.
The most important risk of this illness is the risk of suicide. People who have bipolar disorder are also more likely to abuse alcohol or other substances.

Symptoms

During the manic phase, symptoms can include:
  • High level of energy and activity
  • Irritable mood
  • Decreased need for sleep
  • Exaggerated, puffed-up self-esteem ("grandiosity")
  • Rapid or "pressured" speech
  • Rapid thoughts
  • Tendency to be easily distracted
  • Increased recklessness
  • False beliefs (delusions) or false perceptions (hallucinations)
During elated moods, a person may have delusions of grandeur, while irritable moods are often accompanied by paranoid or suspicious feelings.
During a depressive period, symptoms may include:
  • Distinctly low or irritable mood
  • Loss of interest or pleasure
  • Eating more or less than normal
  • Gaining or losing weight
  • Sleeping more or less than normal
  • Appearing slowed or agitated
  • Fatigue and loss of energy
  • Feeling worthless or guilty
  • Poor concentration
  • Indecisiveness
  • Thoughts of death, suicide attempts or plans

Diagnosis

Since there are no medical tests to establish this diagnosis, a mental health professional diagnoses bipolar disorder based on a person's history and symptoms. The diagnosis is based not just on the current symptoms, but also take into account the problems and symptoms that have occurred through a person's life.
People with bipolar disorder are more likely to seek help when they are depressed than when manic or hypomanic. It is important to tell your doctor about any history of manic symptoms (like those described above). If a doctor prescribes an antidepressant for a person with such a history, the antidepressant could trigger a manic episode.
Because medications and other illnesses can cause symptoms of mania and depression, a psychiatrist and primary care physician must sometimes work together with other mental health professionals to evaluate the problem. For example, the course of the illness can be affected by steroid treatment or a thyroid problem.

Expected Duration

If left untreated, a first episode of mania lasts an average of two to four months and a depressive episode up to eight months or longer, but there can be many variations. If the person does not get treatment, episodes tend to become more frequent and last longer as time passes.

Prevention

There is no way to prevent bipolar disorder, but treatment can prevent manic and depressive episodes or at least reduce their intensity or frequency. Also, if you are able to talk to your health care provider as early as you can about milder forms of the disorder, you may be able to ward off more severe forms. Unfortunately, worries about stigma often stop people from mentioning their concerns to their primary care doctor or other caregiver.

Treatment

A combination of medication and talk therapy is most helpful. Often more than one medication is needed to keep the symptoms in check.

Mood Stabilizers

The best-known and oldest mood stabilizer is lithium carbonate, which can reduce the symptoms of mania and prevent them from returning. Although it is one of the oldest medicines used in psychiatry, and although many other drugs have been introduced in the meantime, much evidence shows that it is still the most effective of the available treatments.
Lithium also may reduce the risk of suicide.
If you take lithium, you have to have periodic blood tests to make sure the dose is high enough, but not too high. Side effects include nausea, diarrhea, frequent urination, tremor (shaking) and diminished mental sharpness. Lithium can cause some minor changes in tests that show how well your thyroid, kidney and heart are functioning. These changes are usually not serious, but your doctor will want to know what your blood tests show before you start taking lithium. You will have to get an electrocardiogram (EKG), thyroid and kidney function tests, and a blood test to count your white blood cells.
For many years, antiseizure medications (also called "anticonvulsants") have also been used to treat bipolar disorder. The most common in use are valproic acid (Depakote) and lamotrigine (Lamictal). A doctor may also recommend treatment with other antiseizure medications — gabapentin (Neurontin), topiramate (Topamax), or oxcarbazepine (Trileptal).
Some people tolerate valproic acid better than lithium. Nausea, loss of appetite, diarrhea, sedation and tremor (shaking) are common when starting valproic acid, but, if these side effects occur, they tend to fade over time. The medication also can cause weight gain. Uncommon but serious side effects are damage to the liver and problems with blood platelets (platelets are necessary for the blood to clot).
Lamotrigine (Lamictal) may or may not be effective for treating a depression that is active, but some studies show that it is more effective than lithium for preventing the depression of bipolar disorder. (Lithium, however, is more effective than lamotrigine in preventing mania.) The most troubling side effect of lamotrigine is a severe rash -- in rare cases, the rash can become dangerous. To minimize the risk, usually the doctor will recommend a low dose to start and increase dosages very slowly. Other common side effects include nausea and headache.
Lithium and valproic acid should be avoided during the first three months of pregnancy, because they are known to cause birth defects. In some cases, however, the return of manic or depressive symptoms could present a more significant risk to the fetus than medicines would. Therefore, it is important to discuss the various treatment options and risks with your doctor.
For valproic acid, lamotrigine, and other antiseizure medications, there is a small risk that suicidal thoughts or behaviors will increase. The risk is quite low. However, anyone being treated with psychotropic medications should report to their doctor immediately if new or more intense symptoms occur — symptoms of depression, changes in mood, thoughts of suicide or any self-destructive behavior.
Antipsychotic Medications
In recent years, studies have shown that some of the newer antipsychotic medications can be effective for controlling bipolar disorder symptoms. Side effects often have to be balanced against the helpful effects of these drugs:
  • Olanzapine: sleepiness, dry mouth, dizziness and weight gain.
  • Risperidone: sleepiness, restlessness and nausea.
  • Quetiapine: dry mouth, sleepiness, weight gain and dizziness.
  • Ziprasidone: sleepiness, dizziness, restlessness, nausea and tremor.
  • Aripiprazole: nausea, stomach upset, sleepiness (or sleeplessness) or restlessness.
  • Asenapine: sleepiness, restlessness, tremor, stiffness, dizziness, mouth or tongue numbness.
Some of these new antipsychotic drugs can increase the risk of diabetes and cause problems with blood lipids. Olanzapine is associated with the greatest risk. With risperidone, quetiapine and asenapine, the risk is moderate. Ziprasidone and aripiprazole cause minimal weight change and not as much risk of diabetes.
Antianxiety Medications
Antianxiety medications such as lorazepam (Ativan) and clonazepam (Klonopin) sometimes are used to calm the anxiety and agitation associated with a manic episode.

Antidepressants

The use of antidepressants in bipolar disorder is controversial. Many psychiatrists avoid prescribing antidepressants because of evidence that they may trigger a manic episode or induce a pattern of rapid cycling. Once a diagnosis of bipolar disorder is made, therefore, many psychiatrists try to treat the illness using mood stabilizers.
Some studies, however, continue to show the value of antidepressant treatment to treat low mood, usually when a mood stabilizer or antipsychotic medication is also being prescribed.
There are so many different forms of bipolar disorder that it is impossible to establish one general rule. Using an antidepressant alone may be justified in some cases, especially if other treatments have not given relief. This is another area where the pros and cons of treatment should be reviewed carefully with your doctor.
Psychotherapy
Talk therapy (psychotherapy) is important in bipolar disorder as it provides education and support and helps a person come to terms with the illness. Research has shown that for mania, psychotherapy helps people recognize mood symptoms early and helps them follow a course of treatment more closely. For depression, psychotherapy can help people develop coping strategies. Family education helps family members communicate and solve problems. When families are kept involved, patients adjust more easily, are more likely to make good decisions about their treatment and have a better quality of life. They have fewer episodes of illness, fewer days with symptoms and fewer admissions to the hospital.

Psychotherapy helps a person deal with painful consequences, practical difficulties, losses or embarrassment stemming from manic behavior. A number of psychotherapy techniques may be helpful depending on the nature of the person's problems. Cognitive behavioral therapy helps a person recognize patterns of thinking that may keep him or her from managing the illness well. Psychodynamic, insight-oriented or interpersonal psychotherapy can help to sort out conflicts in important relationships or explore the history that has contributed to current problems.

Schizophrenia Causes and treatment

schizophrenia

Overview

Schizophrenia is a chronic and severe mental disorder that affects how a person thinks, feels, and behaves. People with schizophrenia may seem like they have lost touch with reality. Although schizophrenia is not as common as other mental disorders, the symptoms can be very disabling. Most definitive clinical features are hallucinations and delusions. 

Symptoms

Schizophrenia involves a range of problems with thinking (cognition), behavior or emotions. Signs and symptoms may vary, but usually involve delusions, hallucinations or disorganized speech, and reflect an impaired ability to function. Symptoms may include:
  • Delusions. These are false beliefs that are not based in reality. For example, you think that you're being harmed or harassed; certain gestures or comments are directed at you; you have exceptional ability or fame; another person is in love with you; or a major catastrophe is about to occur. Delusions occur in most people with schizophrenia.
  • Hallucinations. These usually involve seeing or hearing things that don't exist. Yet for the person with schizophrenia, they have the full force and impact of a normal experience. Hallucinations can be in any of the senses, but hearing voices is the most common hallucination.
  • Disorganized thinking (speech). Disorganized thinking is inferred from disorganized speech. Effective communication can be impaired, and answers to questions may be partially or completely unrelated. Rarely, speech may include putting together meaningless words that can't be understood, sometimes known as word salad.
  • Extremely disorganized or abnormal motor behavior. This may show in a number of ways, from childlike silliness to unpredictable agitation. Behavior isn't focused on a goal, so it's hard to do tasks. Behavior can include resistance to instructions, inappropriate or bizarre posture, a complete lack of response, or useless and excessive movement.
  • Negative symptoms. This refers to reduced or lack of ability to function normally. For example, the person may neglect personal hygiene or appear to lack emotion (doesn't make eye contact, doesn't change facial expressions or speaks in a monotone). Also, the person may have lose interest in everyday activities, socially withdraw or lack the ability to experience pleasure.
Symptoms can vary in type and severity over time, with periods of worsening and remission of symptoms. Some symptoms may always be present.
In men, schizophrenia symptoms typically start in the early to mid-20s. In women, symptoms typically begin in the late 20s. It's uncommon for children to be diagnosed with schizophrenia and rare for those older than age 45.


Symptoms in teenagers

Schizophrenia symptoms in teenagers are similar to those in adults, but the condition may be more difficult to recognize. This may be in part because some of the early symptoms of schizophrenia in teenagers are common for typical development during teen years, such as:
  • Withdrawal from friends and family
  • A drop in performance at school
  • Trouble sleeping
  • Irritability or depressed mood
  • Lack of motivation
Compared with schizophrenia symptoms in adults, teens may be:
  • Less likely to have delusions
  • More likely to have visual hallucinations
Helping someone who may have schizophrenia
If you think someone you know may have symptoms of schizophrenia, talk to him or her about your concerns. Although you can't force someone to seek professional help, you can offer encouragement and support and help your loved one find a qualified doctor or mental health professional.
If your loved one poses a danger to self or others or can't provide his or her own food, clothing or shelter, you may need to call 911 or other emergency responders for help so that your loved one can be evaluated by a mental health professional.
In some cases, emergency hospitalization may be needed. Laws on involuntary commitment for mental health treatment vary by state. You can contact community mental health agencies or police departments in your area for details.

Suicidal thoughts and behavior

Suicidal thoughts and behavior are common among people with schizophrenia. If you have a loved one who is in danger of attempting suicide or has made a suicide attempt, make sure someone stays with that person. Call 911 or your local emergency number immediately. Or, if you think you can do so safely, take the person to the nearest hospital emergency room.
Causes
It's not known what causes schizophrenia, but researchers believe that a combination of genetics, brain chemistry and environment contributes to development of the disorder.
Problems with certain naturally occurring brain chemicals, including neurotransmitters called dopamine and glutamate, may contribute to schizophrenia. Neuroimaging studies show differences in the brain structure and central nervous system of people with schizophrenia. While researchers aren't certain about the significance of these changes, they indicate that schizophrenia is a brain disease.

Diagnosis

Diagnosis of schizophrenia involves ruling out other mental health disorders and determining that symptoms are not due to substance abuse, medication or a medical condition. Determining a diagnosis of schizophrenia may include:
  • Physical exam. This may be done to help rule out other problems that could be causing symptoms and to check for any related complications.
  • Tests and screenings. These may include tests that help rule out conditions with similar symptoms, and screening for alcohol and drugs. The doctor may also request imaging studies, such as an MRI or CT scan.
  • Psychiatric evaluation. A doctor or mental health professional checks mental status by observing appearance and demeanor and asking about thoughts, moods, delusions, hallucinations, substance use, and potential for violence or suicide. This also includes a discussion of family and personal history.
  • Diagnostic criteria for schizophrenia. A doctor or mental health professional may use the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.

Treatment

Schizophrenia requires lifelong treatment, even when symptoms have subsided. Treatment with medications and psychosocial therapy can help manage the condition. In some cases, hospitalization may be needed.
A psychiatrist experienced in treating schizophrenia usually guides treatment. The treatment team also may include a psychologist, social worker, psychiatric nurse and possibly a case manager to coordinate care. The full-team approach may be available in clinics with expertise in schizophrenia treatment.

Drugs used to treat schizophrenia

Medications are the cornerstone of schizophrenia treatment, and antipsychotic medications are the most commonly prescribed drugs. They're thought to control symptoms by affecting the brain neurotransmitter dopamine.
The goal of treatment with antipsychotic medications is to effectively manage signs and symptoms at the lowest possible dose. The psychiatrist may try different drugs, different doses or combinations over time to achieve the desired result. Other medications also may help, such as antidepressants or anti-anxiety drugs. It can take several weeks to notice an improvement in symptoms.
Because medications for schizophrenia can cause serious side effects, people with schizophrenia may be reluctant to take them. Willingness to cooperate with treatment may affect drug choice. For example, someone who is resistant to taking medication consistently may need to be given injections instead of taking a pill.
Ask your doctor about the benefits and side effects of any medication that's prescribed.

Second-generation antipsychotics

These newer, second-generation medications are generally preferred because they pose a lower risk of serious side effects than do first-generation antipsychotics. Second-generation antipsychotics include:
  • Aripiprazole (Abilify)
  • Asenapine (Saphris)
  • Brexpiprazole (Rexulti)
  • Cariprazine (Vraylar)
  • Clozapine (Clozaril)
  • Iloperidone (Fanapt)
  • Lurasidone (Latuda)
  • Olanzapine (Zyprexa)
  • Paliperidone (Invega)
  • Quetiapine (Seroquel)
  • Risperidone (Risperdal)
  • Ziprasidone (Geodon)

First-generation antipsychotics

These first-generation antipsychotics have frequent and potentially significant neurological side effects, including the possibility of developing a movement disorder (tardive dyskinesia) that may or may not be reversible. First-generation antipsychotics include:
  • Chlorpromazine
  • Fluphenazine
  • Haloperidol
  • Perphenazine
These antipsychotics are often cheaper than second-generation antipsychotics, especially the generic versions, which can be an important consideration when long-term treatment is necessary.

Psychosocial interventions
Once psychosis recedes, in addition to continuing on medication, psychological and social (psychosocial) interventions are important. These may include:
  • Individual therapy. Psychotherapy may help to normalize thought patterns. Also, learning to cope with stress and identify early warning signs of relapse can help people with schizophrenia manage their illness.
  • Social skills training. This focuses on improving communication and social interactions and improving the ability to participate in daily activities.
  • Family therapy. This provides support and education to families dealing with schizophrenia.
  • Vocational rehabilitation and supported employment. This focuses on helping people with schizophrenia prepare for, find and keep jobs.
Most individuals with schizophrenia require some form of daily living support. Many communities have programs to help people with schizophrenia with jobs, housing, self-help groups and crisis situations. A case manager or someone on the treatment team can help find resources. With appropriate treatment, most people with schizophrenia can manage their illness.
Hospitalization
During crisis periods or times of severe symptoms, hospitalization may be necessary to ensure safety, proper nutrition, adequate sleep and basic hygiene.

Electroconvulsive therapy in Schizophrenia

For adults with schizophrenia who do not respond to drug therapy, electroconvulsive therapy (ECT) may be considered. ECT may be helpful for someone who also has depression.
Coping and support
Coping with a mental disorder as serious as schizophrenia can be challenging, both for the person with the condition and for friends and family. Here are some ways to cope:
  • earn about schizophrenia. Education about the disorder can help motivate the person with the disease to stick to the treatment plan. Education can help friends and family understand the disorder and be more compassionate with the person who has it.
  • Join a support group. Support groups for people with schizophrenia can help them reach out to others facing similar challenges. Support groups may also help family and friends cope.
  • Stay focused on goals. Managing schizophrenia is an ongoing process. Keeping treatment goals in mind can help the person with schizophrenia stay motivated. Help your loved one remember to take responsibility for managing the illness and working toward goals.
  • Ask about social services assistance. These services may be able to assist with affordable housing, transportation and other daily activities.
  • Learn relaxation and stress management. The person with schizophrenia and loved ones may benefit from stress-reduction techniques such as meditation, yoga or tai chi.

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