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In my private psychotherapy practice, as well as the TMS treatment component, many of my patients struggle to achieve or maintain a healthy body weight. Studies on weight loss and obesity reveal a disturbing trend toward a ‘thinness bias’ – in the media and our public health system. A woman whose waist measures more than 35 inches and a man whose waist measures more than 40 inches may be at particular risk for developing health problems. It is discouraging for my patients to realize that many drugs prescribed for high blood pressure, diabetes and depression – conditions common to individuals with overweight issues – may increase the likelihood of more weight gain, and set in motion a very frustrating circle. A 2010 study found that people with depression were at a 58% greater risk of becoming obese (30-39.9 BMI). Major depressive disorder (MDD) can be a chronic condition involving recurrent episodes throughout a patient’s life. Other Studies have found that antidepressants lead to increased body weight, in anywhere between 24-100% of patients.
Many patients choose to discontinue antidepressant medication due to the long term side effects resulting from these drugs – one of which is consistent weight gain over time. Among the antidepressants most strongly linked to clinically significant weight gain (defined as at least a 7 percent increase in body weight), include older tricyclic antidepressants, such as amitriptyline (Elavil) and nortriptyline (Pamelor), as well as newer medications, such as paroxetine (Paxil) and phenelzine (Nardil). The antidepressant mirtazapine (Remeron) is so potent at promoting weight gain that it is sometimes prescribed to underweight senior adults and AIDS patients. Second-generation antipsychotic drugs, such as olanzapine (Zyprexa) and Clozapine (clozaril), can induce a triad of symptoms – dramatic weight gain, diabetes and elevated blood cholesterol levels – that are associated with metabolic syndrome.
In every age group, women with depression were more likely to be obese than women without depression. The proportion of adults with obesity rose as the severity of depressive symptoms increased. Fifty-five percent of adults who were taking antidepressant medication, but still reported moderate to severe depressive symptoms, were obese. Understanding the relationship between depression (defined by moderate to severe symptoms) and antidepressant usage and obesity may indicate treatment and prevention strategies for both conditions.
More than one-half of adults with moderate to severe depressive symptoms, who were also taking antidepressant medication, were obese. Among adults who took antidepressant medication, of those with moderate or severe depressive symptoms, 55% were obese while 38% with mild or no depressive symptoms were obese (Figure 5). Among adults not taking antidepressant medication, 39% of adults with moderate or severe depressive symptoms were obese compared with 33% of adults with mild or no depressive symptoms. Adults who took antidepressant medication were more likely to be obese than those not taking antidepressants. While the physical health costs of obesity have become increasingly clear, the existence and nature of a relationship between obesity and mental health in the general population has been less clear.
The unfavorable effect of depression on development of obesity, and the effect of obesity on development of depression, may be reinforced by time. Obesity can be seen as an inflammatory state, as weight gain has been shown to activate inflammatory pathways and inflammation in turn has been associated with depression.
Also, the hypothalamic-pituitary-adrenal axis (HPA axis) might play a role, because obesity might involve HPA-axis dysregulation and HPA-axis dysregulation is well known to be involved in depression. Through HPA-axis dysregulation, obesity might cause development of depression. Finally, obesity involves increased risks of diabetes mellitus and increased insulin resistance, which could induce alterations in the brain and increase the risk of depression. Being overweight and the perception of overweight increases psychological distress. In both the United States and Europe, thinness is considered a beauty ideal, and partly because of social acceptance and sociocultural factors, obesity may increase body dissatisfaction and decrease self-esteem, which are risk factors for depression.
Disturbed eating patterns and eating disorders, as well as experiencing physical pain as a direct consequence of obesity, are also known to increase the risk of depression. In Part 2 we will consider these findings, and discuss ‘Implications for Patient Treatment’.
Hear what Nashville TMS patients have to say about their depression treatment experiences and outcomes! For more information on this and other topics related to the treatment of depression and mental health issues, contact us at (615) 327-4877. Last updated: 23 Dec 2015Views expressed are those solely of the writer and have not been reviewed. Schizophrenia is a chronic and disabling neuropsychiatric illness possibly best characterized as a syndrome rather than as a single disease entity. The point prevalence of schizophrenia is 1% to 1.5%, a finding that has been fairly constant across time, cultures, races, and continents.
Accumulating evidence shows that genetic and neurodevelopmental factors are associated with greater susceptibility to schizophrenia. The birthrate of patients with schizophrenia is 5% to 8% higher worldwide than the birthrate of the general population in the winter and spring months. Population density, industrialization, emigration, and low socioeconomic status at birth have been proposed as possible influences on the development of schizophrenia.
Although not described as a separate entity in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5),2 acute psychosis refers to a symptom complex that includes disturbance of thought processes and behavior. The median age at onset for the first psychotic episode of schizophrenia is the early to mid-20s for men and the late 20s for women.
The prodromal phase of schizophrenia is characterized by social avoidance, emotional flattening, eccentricity or magical thinking, idiosyncratic speech, and peculiarities of attitude and behavior that fail to meet criteria for a specific psychiatric illness. Factor analysis has identified three main psychotic symptom dimensions in schizophrenia: positive, negative, and cognitive. Accurate diagnosis of schizophrenia is often challenging because symptoms are nonspecific and progression to full illness is gradual.
If symptoms are not specific and signs and symptoms do not last for 6 months as required for diagnosing schizophrenia, the clinician is obliged to eliminate other important diagnostic considerations. Acute psychosis, although not recognized as a diagnostic term in DSM-5 is commonly used to describe a rapid deterioration of behavior associated with hallucinations and delusions. Schizoaffective disorder is a chronic mental illness that includes prominent features of both schizophrenia and a mood disorder. A diagnosis of mood disorder with psychotic features is made if psychotic symptoms occur solely during episodes of mood disturbance. Acute psychosis caused by substance use or medication toxicity is distinguished from schizophrenia by clear-cut evidence of substance use leading to symptoms. The successful treatment of schizophrenia requires simultaneous attention to medical variables and psychosocial factors relevant to the patient.
The primary care physician’s principal role is to recognize the illness, initiate treatment, and refer to a psychiatrist.
Proper medical care is another important consideration in the comprehensive management of the schizophrenic patient. Antipsychotics are considered to be the first line of therapy in the pharmacologic treatment of schizophrenia. Note: First-generation antipsychotics are no longer considered first-line treatment for schizophrenia unless an atypical antipsychotic is not available, and then either haloperidol or chlorpromazine should be considered.
The SGAs affect several receptor typesa€”serotonin, histamine, noradrenergic, and muscarinic-in addition to the D2 receptors.4 The multiplicity of receptors targeted by SGAs contributes to their efficacy and side-effect profiles. The use of antipsychotics in elderly patients with dementia-related psychosis has been associated with a 1.7-fold increase in risk of death. The dosage of medication used to achieve remission or optimal control in the acute phase should be continued for at least 6 months to prevent relapse. Have the patient sit on a firm, armless chair with hands on knees, legs slightly apart, and feet flat on the floor. Developed in the late 1960s, assertive community treatment provides the patient with around-the-clock support in the community, thereby significantly reducing the time spent in hospitals. The quality of the therapeutic alliance may be the best predictor of compliance and outcome. The schizophrenic patient’s behavior can trigger a vicious cycle of conflict between the patient and family. The principles of learning theory are used to improve social skills such as interpersonal relationships, employment, and leisure. Workshops and part-time employment programs help the patient acquire greater functionality. Most prevention efforts are in the realm of secondary and tertiary prevention, or reducing the number and severity of episodes.
Populations with special needs include patients with pervasive developmental disorders and mental retardation, women with childbearing potential, children, the elderly, and the homeless.
Schizophrenia is a treatable neuropsychiatric disorder present in approximately 1% of the general population. The etiology is multifactorial and includes genetic, developmental, and possibly environmental causes. The signs and symptoms of schizophrenia are nonspecific, warranting a thorough evaluation for other medical and psychiatric disorders that can manifest with psychosis. The primary care physician should be familiar with the use, benefits, and potential adverse effects of antipsychotic medications used to treat schizophrenia. Metabolic syndrome is a common comorbidity, especially since the introduction of atypical (second-generation) antipsychotics.
Lieberman JA, Stroup TS, McEvoy JP, et al; Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Investigators. American Diabetes Association, American Psychiatric Association, American Association of Clinical Endocrinologists, North American Association for the Study of Obesity. As you know, Cushinga€™s is a rarely diagnosed endocrine disorder characterized by hypercortisolism. The adrenal glands release cortisol in response to stress, so atheletes, women experiencing pregnancy, and those suffering from alcoholism, panic disorders and malnutrition naturally have higher-than-normal levels of cortisol. People with Cushinga€™s Syndrome live life with too much cortisol for their bodies as a result of a hormone-secreting tumor. Worse, the psychological and emotional effects of having a chronic, debilitating and disfiguring disease range from distressing to demoralizing. Imagine that, in the space of a year, you became unrecognizable to those around you and to yourself.
You feel increasingly sick, but when you explain your array of symptoms to your doctor, you are dismissed as a depressed hypochondriac who needs to diet and exercise more. Most people with Cushinga€™s long for the ability to do simple things, like walk a flight of stairs without having to sit for half an hour afterwards, or vacuum the house or even unload a dishwasher. Sometimes, as with any serious illness, performing even basic tasks of daily care such as showering and dressing can exhaust the limited reserves of energy available to a Cushinga€™s patient. Though we wouldna€™t want it, we wish our disease were as well-understood as cancer so that those who love uswould have a frame of reference for what we go through. The most frustrating misconception about this disease is that we somehow are a€?doing this to ourselves,a€? or delaying recovery because we need to continue steroid replacement or lack the energy to excercise often, which is sadly false.
Fortunately, there is a good likelihood of remission from Cushinga€™s in the hands of a skilled pituitary surgeon.
Until this happens, we must take synthetic steroids or else risk adrenal insufficiency or adrenal crisis, which can be quickly life-threatening.
The physical recovery from surgery can be quick, but the withdrawal from hydrocortisone can be a lengthy and extremely painful process. The physical pain experienced while weaning from cortisol has been described as worse than weaning from heroin. People who have struggled with Cushinga€™s Syndrome all hope to return to a€?normala€? at some point. The best support you can give someone who is suffering from Cushinga€™s or its aftermath is to BELIEVE them and to understand that they are not manufacturing their illness or prolonging recovery. Because ita€™s these little everyday tasks, which can fall by the wayside when someone has (or has had) Cushinga€™s, and these are the things we miss the most: doing for ourselves. In the meantime, I am attaching a brief article written by a woman who recently was diagnosed with Cushinga€™s. Endocrinologists (doctors who specialize in Cushing's Syndrome and its related issues) realize the medical aspect and know the damaging effects that Cushing's has on the body. Cushings Help Organization, Inc., a non-profit family of websites maintained by MaryO, a pituitary Cushing's survivor, provides this letter for patients to provide to their family and friends in hopes of providing a better understanding Cushing's and it's many aspects. We're sorry to hear that your family member or friend has Cushing's Syndrome or suspected Cushing's. Cushing's can cause the physical appearance change due to weight gain, hair loss, rosacea, acne, etc.


Cushing's patients need to be able to take one day at time and learn to listen to their bodies.
It can be very depressing and frustrating having so many limitations and experience things in life being taken from you. Testing procedures can be lengthy and this can become frustrating for the patient and family. Once the diagnosis has been made and treatment has finished then it's time for the recovery process. The recovery from the surgery itself is similar to any other surgery and will take a while to recover. Thank you for reading this and we hope it will help you to understand a little more about Cushing's and the dibilating affect it can have on a person. When Fedela Vincent, 68, of Rye, was diagnosed with Cushinga€™s disease, she was relieved, almost happy. Vincent had spent years trying to figure out what was wrong with her, what was happening to her and her body.
Cushinga€™s disease victims dona€™t share the same symptoms, but many of the symptoms are physically noticeable: the extreme weight gain in the upper body, the moon face, a buffalo hump on the back, hair loss and blotchy, red skin with breakouts. Her doctors at this time urged her to lose weight, giving medications that often made her sick in an effort to solve the problem.
Non-diagnosed, Cushinga€™s disease can lead to uncontrollable diabetes, and eventually, death. But Fedela was carefully watching what she ate, often eating less than her doctors prescribed. Then, on Mothera€™s Day of this year, during the New Hampshire floods, she was operated on. When she came out of the surgery, Bob was there beside her, along with a very special teddy bear. This support group is still there for Vincent as she continues to recover and regain her health. Fedela also hopes that by sharing her story, others may learn that diet alone is not always the cause of weight gain. Lastly, Fedela wants to publicly thank her husband, family, friends and physicians who have stood by her during this difficult struggle. Tritos, a leading endocrinologist at the Lahey Clinic, says it is common for Cushinga€™s disease to not be immediately diagnosed.
Weight Gain and ObesityIf you eat a lot of food in a short amount of time on a regular basis, you might have binge eating disorder (BED). They tell me about their frustrating efforts with the latest weight loss plan or supplement, even though they report that they’ve “tried just about everything”. The struggle to be thin is fast becoming the cause of drastic eating disorders and other serious psychological problems among both overweight and non-overweight individuals. Studies indicate that increased abdominal or upper body fat is related to the risk of developing heart disease, diabetes, high blood pressure, gallbladder disease, stroke, and certain cancers; and is associated with overall increases in mortality (likelihood of death). In order to reduce the chance of relapse, long term treatment with antidepressants is often deemed necessary. Because inflammation plays a role in both obesity and depression, inflammation could be the mediator of the association. Our goal is to offer patients alternative  treatment options that break this Vicious Cycle. West brought the technology of NeuroStar TMS to Nashville, becoming the first physician in Tennessee to offer the option of Transcranial Magnetic Stimulation for patients whose severe depression has not responded to a course of antidepressant medication or treatment for depression. The abnormal, often bizarre behavior that typifies schizophrenia is a product of disturbances in cognition, perception, and volition.
Mounting evidence supports a strong genetic contribution, but genetic factors alone do not fully account for the variance in cause. According to twin and adoption studies, up to 50% of identical (monozygotic) twins share a diagnosis of schizophrenia, compared with about 12% of nonidentical (dizygotic) twins. Modern neuroimaging techniques, however, including computed tomography (CT), magnetic resonance imaging (MRI), functional MRI, and positron emission tomography, demonstrate evidence of nonspecific structural and metabolic abnormalities in the frontotemporal cortices, especially in the prefrontal areas and periventricular limbic structures of the schizophrenic brain. The first agents to demonstrate promise in the pharmacologic control of schizophrenia were recognized to have dopamine-blocking properties. The presence of psychotic symptoms usually indicates an underlying organic or psychiatric condition.
Prodromal symptoms that suggest social anxiety, panic, obsessive-compulsive or major depressive disorder, and antisocial behavior or substance misuse often lead to early misdiagnosis and unsuccessful treatment efforts. The acute phase of the illness features a predominance of positive psychotic symptoms, whereas the chronic phase is typified by negative and cognitive symptoms.
Relevant signs and symptoms must be present for at least 6 months before a diagnosis of schizophrenia can be made.
These include psychiatric disorders, substance use, and general medical disorders (Boxes 2 and 3). Schizophreniform disorder, brief psychotic disorder, and organic psychoses fall under this rubric. The diagnostic criteria for schizoaffective disorder are characteristic symptoms of schizophrenia concurrent with a major mood disturbance (major depressive or manic episode). A multimodal approach encompassing biologic and psychosocial therapies as well as programs that offer rehabilitation and social reintegration has been found to be most effective.
Acute psychosis, like schizophrenia, has a differential diagnosis that includes general medical, psychiatric, and substance-use disorders, (see Boxes 2 and 3). The patient’s idiosyncratic behavior, poor hygiene, or nonadherence to medical recommendations often interferes with attention to and successful management of medical problems. This includes simultaneous attention to potentially life-endangering causes of acute psychosis or delirium (Box 4) and other psychiatric, substance-use (see Box 2), and general medical (see Box 3) causes. Typically, much of this information is either unavailable or difficult to obtain, and the clinician is forced to rely on rapid observation, clinical intuition, and laboratory measures (Table 1). They are generally categorized as first-generation (typical) antipsychotics (FGAs) or second-generation (atypical) antipsychotics (SGAs). Food and Drug Administration for IV use, but off-label use is common when IV access is available.
The choice of antipsychotic drug, dosage, and desired route of administration is based on phase of treatment, intensity of agitation, adherence to treatment recommendations, history of response to antipsychotic medications, and antipsychotic side-effect profile. The phenothiazines are more anticholinergic, cause more weight gain, and are more likely than butyrophenones to cause postural hypotension. The results of the oft-cited Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) demonstrated that FGAs and SGAs have similar efficacy, but both groups have potentially troublesome side effects that warrant careful monitoring and can disrupt otherwise effective treatment.4-7 Although SGAs are less likely to cause EPS, they are not risk free. Movements that occur only on activation merit 1 point less than those that occur spontaneously.
There are no strict guidelines for the minimum antipsychotic dose required to prevent relapse. Optimal outcome requires additional use of psychosocial therapies and programs that foster recovery through vocational rehabilitation and social reintegration. A team composed of a social worker, nurse, and case manager provides treatment in community settings. The emphasis is on education, support, and problem-solving, rather than on developing insight. Anger, criticism, and devaluing comments directed by family members at the patienta€”referred to in the literature as high expressed emotiona€”are associated with a greater increase of relapse even when pharmacologic management is optimal. Behaviors such as odd facial expressions, lack of spontaneity, and inappropriate perception of others’ emotional states are targeted and modified.
Public health education on schizophrenia helps to reduce stigma and resistance to seeking treatment. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the National Comorbidity Survey. Second-generation (atypical) antipsychotics and metabolic effects: a comprehensive literature review.
Cortisol is a hormone produced by the adrenal glands and is vital to regulate the bodya€™s cardivoascular functions and metabolism, to boost the immune system and to fight inflammation. Worse, your family members think the same thing a€” and are often quick to tell you how you need to a€?change your lifestylea€? to overcome the effects of what you eventually will discover, once properly diagnosed, is a serious and rare disease. Not only do we become socially isolated because of the virilzing effects of an endocrine tumor, which drastically alters our appearance, but we no longer feel like ourselves with regard to energy.
What response is sufficient to express the grief and frustration over losing so much of ourselves? With Cushinga€™s, there is such limited public awareness that we are left to describe the effects of the disease from a void, often with limited understanding from those who love us most, which is disheartening.
Unfortunately, the long-term remission rate is only 56%, meaning that 44% of people with Cushinga€™s will require a second (sometimes third) pituitary surgery, radiation or bilateraly adrenalectomy to resolve the hypercortisolism.
Because the tumor takes over control of the bodya€™s production of cortisol, the adrenal glands, which had lain dormant prior to surgery, require time to start functioning properly again.
Though none of us want to have Cushinga€™s, it is often a relief finally to have a correct diagnosis and treatment plan.
Depending on the severity of the disease and the length of time before diagnosis and treatment, the prognosis can be poor and lead to shortened life expectancy and diminished quality of life.
Ask them what they are able (and not able) to do, and then be prepared to help them in ways that matter a€” whether that be to bring them a meal or help them to run errands, pick up prescriptions from the pharmacy or clean their house.
We know you dona€™t know much about Cushinga€™s a€” even our doctors sometimes lack information about this rare disease.
I hope hearing another persona€™s experiences will help you to understand what Ia€™m going through so that when we talk, we will be coming from a similar starting place.
There will most likely be times when naps are needed during the day and often times may not be able to sleep at night due to surges of cortisol. Fedela says the worst for her was the insomnia, the anxiety, the fear of abandonment and pain. Cushinga€™s disease is such a traumatic disease that it is estimated more than half of husbands leave their wives.
It is the body reacting to a constant overdose of steroids being released by the adrenal glands. The fact that it is relatively rare in numbers is one cause of the lack of public knowledge and awareness of this disease. The symptoms can be so varied and mimic so many other conditions, that Cushinga€™s disease is often not diagnosed or misdiagnosed. Even when her energy level was almost non-existent, she and her husband would go to the gym. Fifty percent of one side of the pituitary was removed and 25 percent of the other side to remove the offending tumorous tissues.
Americaa€™s obsession with skinny bodies and the resulting negative judgmental views on those who do not fit this picture is something she hopes people may think twice about before making judgments.
She still has a long way to go, but she is on the mend now and knows what was wrong with her. It can affect your health in a lot of ways, but two of the main risks are weight gain and obesity. It is intended for general informational purposes only and does not address individual circumstances.
This weight gain is especially troublesome as it also heightens a person’s risk of physical problems, such as diabetes and cardiovascular disease.
So we clearly see how that could easily translate into a weight gain of 72 pounds or more over two years. However, a longitudinal meta-analysis confirms a reciprocal association between obesity and depression in both men and women. With TMS, we can start them on the path to improved health, both physically and psychologically. The Nashville TMS Team has treated patients from Tennessee, Kentucky, Colorado, California, Missouri, New York, Florida, and Alabama.
Clinical manifestations are believed to result from incompletely understood dysregulation of frontotemporal and limbic neurocircuitry. In the United States, about 2.5% of total annual health care expenditures are for schizophrenia. As with other common illnesses such as hypertension, the risk of developing schizophrenia is a product of multiple genes interacting not only with one another but also with environmental factors.


The strength of genetic factors varies across families, but approximately 10% of a patient’s first-degree relatives (parents, siblings, and children) are also schizophrenic, as are 50% of the children of two schizophrenic parents.
There have been some correlates of gray matter changes in the left dorsolateral prefrontal cortex in patients with predominantly negative symptoms.
Several neurotransmitter systems have been implicated, but the primary focus has been on dopamine and the brain structures that are high in its content (substantia nigra, ventral tegmentum, mesolimbic structures, and the tuberoinfundibular system). Disruption of thought processes, hallucinations, delusions, agitation, and rapid deterioration in behavior are some of the common manifestations of acute psychosis. Acute psychosis, the hallmark of the acute phase, follows the prodrome insidiously or occurs abruptly and sometimes explosively. The DSM-5 diagnosis of schizophreniform disorder depends on the persistence of schizophrenia-like symptoms for at least 1 month and exclusion of other causes of acute psychosis. Although mood symptoms and episodes must be present for a substantial portion of the total course of the illness, a diagnosis of schizoaffective disorder also requires that psychotic symptoms, such as delusions or hallucinations, have been present for a minimum of 2 weeks in the absence of an active mood disturbance. Schizophrenia generally does not occur in isolation but rather with other comorbid conditions, commonly alcohol or drug abuse, or both. At this point the primary care physician’s role may be to ensure safe transfer of the acutely psychotic patient to an emergency facility where appropriate evaluation and stabilization can be conducted.
Schizophrenic patients have a high incidence of cardiovascular problems such as hypertension and coronary artery disease, diabetes, and tobacco-related disorders. An electroencephalogram should be obtained if one suspects organic psychosis such as delirium (encephalopathy).
This was initially thought to be an atypical antipsychotic–specific phenomenon, but studies have shown that FGAs may pose a similar risk. Patients should be helped with the transition to life in the community and helped to adjust to their lives outside the hospital through realistic goal setting. For FGAs, the optimal dose is regarded as the minimum dose at which mild EPS are detectable on physical examination. Services delivered include case management, initial and ongoing assessments, access to psychiatric services, employment and housing assistance, family support and education, substance-abuse services, and any other services and support critical to successful adaptation in the community.
A therapist works with the family to reduce expressed emotion by educating them about schizophrenia and helping to modify the behaviors and attitudes that undermine the patient. Family history of schizophrenia is an important indicator of risk that should increase vigilance for early detection and treatment of prodromal symptoms. Endogenous hypercortisolism leaves the body in a constant state of a€?fight or flight,a€? which ravages the body and tears down the bodya€™s major systems including cardivascular, musculo-skeletal, endocrine, etc.
You endure the stares and looks of pity from those who knew you before Cushinga€™s, fully aware that they believe you have a€?let yourself goa€? or otherwise allowed this to happen to your body. We would love to take a long bike ride, run three miles or go shopping like we used to a€” activities, which we took for granted before the disease struck. It is often difficult to find the strength to explain how your well-meaning words of prompting and encouragement (to diet or exercise) only serve to leave us more isolated and feeling alone. It is a rare but sad fact that some peoplea€™s adrenal glands never return to normal, and those people must continue to take hydrocortisone or prednisone a€” sometimes for life a€” simply in order for the body to perform correctly its basic systemic functions.
While there is an over-abundance of cortisol in our bodies (as a result of the tumor), we often cana€™t feel the effects of the muscle-wasting and bone deterioration because of the anti-inflammatory action of cortisol. It is imperative for people who are on replacement steroids after Cushinga€™s surgery to carry extra Cortef (or injectable Solu-Cortef) with them at all times in addition to wearing a medic alert bracelet so that medical professionals will be alerted to the possiblity of adrenal insufficiency in the event of an adrenal crisis.
For many, there is a gradual resolution of many Cushinga€™s symptoms within a few years of surgery or other successful treatment, and a good quality of life can be achieved.
This is not a choice or something we can control, but it is the reality for some people who have suffered the consequences of long-term hypercortisolism.
But know we appreciate the interest and will tell you everything you want to know, because those of us who have it necessarily become experts in it just in order to survive. It's common for a Cushing's patient to have burst of energy and then all of a sudden they become lethargic and don't feel like moving a muscle.
Don't look to far ahead just take one day at a time and deal with the situation that is at hand at the present time. The pituitary gland over-stimulates the adrenal glands, which in turn send crisis-level chemical messages to all the other endocrine glands.
South Church, in Portsmouth, put together a Fedela Vincent Support Group, with people from Portsmouth, Rye, Salem, Mass., and Greenland, to provide moral support, company and meals. It is not a substitute for professional medical advice, diagnosis or treatment and should not be relied on to make decisions about your health. Additionally, overweight and obese individuals are at risk for numerous psychological and physiological health problems, such as depression and disordered eating. The National Alliance on Mental Illness (NAMI), a patient- and family-oriented self-help group, has designated schizophrenia a brain disorder, emphasizing that schizophrenia is not simply a product of dysfunctional parenting or other psychosocial stressors. It is also possible that specific risk factors predict occurrence of specific schizophrenia subtypes. Reports indicate suggestive linkage on chromosomes 1,2, 3, 5, and 11 and on the X chromosome. Acute psychosis can be a feature of schizophrenia, but the diagnosis of schizophrenia requires the fulfillment of a variety of other diagnostic criteria.
The natural history without treatment (and sometimes with) is for symptoms to wax and wane, punctuated by recurrent episodes of acute psychosis. Negative symptoms are believed to reflect neuroimaging evidence of reduced metabolic activity in the dorsolateral prefrontal cortex. The diagnostic criteria for schizophrenia are symptomatic, functional, and time based, and they require exclusion of both medical and other psychiatric disorders that can mimic schizophrenia.
Brief psychotic disorder (often referred to as brief reactive psychosis) lasts less than 1 month, but more than 1 day. Failure to recognize and treat comorbid substance abuse is a common cause of treatment resistance in schizophrenia. Once the proper treatment regimen for a schizophrenic patient has been identified, the primary care physician may be called on to prescribe maintenance medication, with specialist referral for assistance in managing recurrent illness episodes. Given that many schizophrenic patients are homeless, higher rates of tuberculosis, HIV infection, and problems associated with poor foot care are also common in this population. Simultaneous administration of IM olanzapine and lorazepam is not recommended because the combination has been associated with respiratory failure.
Haloperidol, the most widely prescribed butyrophenone, is associated with a high risk of all types of extrapyramidal symptoms (EPS).
Once the diagnosis is made, the team should develop a comprehensive treatment plan that includes family involvement with goals of adhering to treatment and reducing symptoms. Nothing you can say or do will persuade them otherwise, so at some point, you stop trying and resolve to live your life in a strangera€™s body.
Those activities are sadly impossible at times for those with advanced stages of the disease. Even with successfultreatment, I will have to be monitored for possible recurrencefor the rest of my life. Never ignore professional medical advice in seeking treatment because of something you have read on the WebMD Site. Almost 11% of adults take antidepressant medications, including persons who are responding well and persons who still have moderate to severe symptoms of depression.
Studies have consistently shown, however, that both genetic and nongenetic factors play a role in the origin of schizophrenia. Blockade of the D2 receptor appears to have the greatest relevance to the antipsychotic efficacy as well as adverse effects of neuroleptic drugs. The pattern of symptoms can change over time, with progressive deterioration of function and cognition in some instances and progressive improvement of psychotic symptoms and function in others. It is typically regarded as a reaction to marked stress in persons with borderline or antisocial personality disorders. Comprehensive management of schizophrenia, therefore, typically requires the involvement of a multidisciplinary team including a psychiatrist, social worker, case manager, individual or family therapist, and one or more family members. Although effective, the FGAs have fallen out of favor because of their side-effect profiles, especially their propensity to cause EPS (Box 5). Clozapine (Clozaril), the first SGA to be developed and marketed, has retained its reputation for being the most effective of all antipsychotics at treating negative symptoms. Assertive community treatment has been very effective at maintaining community and keeping patients out of the hospital. Warren was the first doctor to suggest Cushinga€™s disease might be the cause of Fedelaa€™s weight gain. Characteristic features of positive, negative, and cognitive symptoms are outlined in Box 1.
Episodes of illness can require treatment in multiple settings, including outpatient, intensive outpatient, hospital, and residential. Voluntary or involuntary hospitalization is often necessary for the first episode of psychosis in schizophrenia.
Unfortunately, its tendency to cause bone marrow suppression, weight gain, and metabolic syndrome also distinguishes it from the other SGAs. Assiduous attention to substance abuse and abstinence is a key to a good outcome in schizophrenia. Extrapyramidal symptoms can be attributed to D2-receptor blockade in the substantia nigra and ventral tegmentum, positive symptom suppression to D2 blockade in mesolimbic structures, and hyperprolactinemia to D2 blockade in the tuberoinfundibular structures (dopamine is a prolactin-inhibiting factor).
Comorbid substance abuse is common, prolongs the illness, and contributes to treatment resistance. The primary symptoms are rated based on their current severity (defined as most severe in the past 7 days) on a 5 point scale ranging from 0 (not present) to 4 (present and severe).
The relationship to schizophrenia of serotonin, glutamate, gamma-aminobutyrate, neurotensin, and their relevant receptors is also under investigation.
That means your body can’t use the hormone insulin correctly, which makes your blood sugar levels harder to control. How to Handle Your DiabetesThe more you know about diabetes, the better you can take control of your condition.
You’ll need to keep track of your blood sugar levels, eat a healthy diet, and get plenty of exercise. Doctors think many things can lead to BED, so it’s hard to say for sure that depression or anxiety cause it.
How to Manage Mood DisordersEat nutritious food, exercise, and get your ZZZs, because healthy habits like those can help you fight your anxiety or depression. But treatment for BED also might include sessions with a mental health professional, who could recommend talk therapy, antidepressant medications, or other medicines that can help treat binge-eating behavior.
Troubles With DigestionLong-lasting heartburn and irritable bowel syndrome (IBS) can also happen to people who binge eat.
Those issues are often linked with weight gain and obesity, so doctors aren’t sure if the disorder itself or the excess pounds are to blame. Treatment for Heartburn and IBSHeartburn that doesn’t get better can cause serious issues, including damage to your esophagus, the tube that connects your mouth to your stomach. She might give you prescription meds or tell you to see another doctor who specializes in digestion. Gallbladder DiseaseMany health problems linked to BED -- obesity, high cholesterol, high triglycerides (fat in your blood), and yo-yo weight gain and loss -- also raise the risk of trouble with your gallbladder. Treatment for GallstonesYour doctor might be able to remove them with surgery, or she may have to take out your gallbladder. Sometimes doctors prescribe a drug to dissolve gallstones, but that’s not a long-term solution. Stroke and Heart DiseaseHigh blood pressure and high cholesterol are common with BED, and they can raise your chances of a stroke and heart disease. Make Heart-Smart ChangesStop smoking, lose extra weight, and exercise regularly to lower your blood pressure.
Those same steps can lower your cholesterol, as will a diet rich in vegetables, whole grains, and lean proteins.




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