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Archive for July 2011

THE BIG NO-NO’S – INTRODUCTION

Are you aware that you might be putting you and your children’s mental, emotional and physical health at risk each me you bathe, shave, and apply sunscreens, body lotion or nail polish?Or, did you know that when you clean your house, you may be creating greater toxic air pollution indoors that exists outdoors?Everyday we use products that we think are perfectly safe but the truth is that all too often they are far from it — and manufacturers don’t have to tell us so. Ever since 1938 — when the FDA granted self-regulation to the cosmetics industry — such products can be marketed, regardless of what tests show. Most of the 25,000 chemicals used have not been tested for long-term toxic effects. In a typical day, you might be exposed to over 200 different chemicals, many of which are suspected of causing cancer or disrupting hormones. The Environment Protection Agency tests conclude that ingredients in shampoos, dyes and other personal care products “May be laying havoc with hormones that control reduction and development.”*44/165/1*

DELIRIUM: DIFFERENTIAL DIAGNOSIS-SCHIZOPHRENIA

Psychiatrists are sometimes asked whether patients with hypoactive-hypoalert delirium might not have catatonic schizophrenia. It is important to remember here that catatonic phenomena occur not only in psychiatric conditions (especially affective disorders) but also in a large number of medical and neurological illnesses capable of producing delirium, such as hepatic failure, viral encephalitis, and neuroleptic malignant syndrome. Catatonia, then, does not equal schizophrenia.     In the unlikely event that the differential diagnosis cannot be resolved from the patient’s history, examination, and laboratory tests, a trial of benzodiazepines may settle the matter. When such medications are given to catatonic patients with affective disorders or schizophrenia, their motor signs and mutism almost always abate. A mental status examination will then reveal that the patients have been alert and aware of their surroundings despite their withdrawn and uncommunicative behavior. In contrast, if benzodiazepines are given to patients with hypoactive-hypoalert delirium, they may become even more obtunded and inaccessible.     Delirium tremens can initially be mistaken for paranoid schizophrenia because agitation, delusions, and hallucinations occur in both. Although it may be difficult to assess an agitated patient, it should not be hard to recognize certain features of delirium tremens that are useful in differential diagnosis. The most important of these characteristics are autonomic overactivity, tremulousness, severe insomnia, and prominent visual hallucinations.     If a patient’s agitation is due to paranoid schizophrenia, it will eventually be clear that he has no fundamental disturbance of consciousness. Even when schizophrenic patients are frightened or distracted, it is possible to “make contact” with them and to prove that they are aware of their surroundings. When I asked one such patient where he was, he replied: “You say this is Johns    Hopkins Hospital in Baltimore, but I know it’s really a police station in Washington, D.C.” The first part of his answer demonstrated that he was well oriented; the second, that he was delusional. Observations of this sort help to distinguish paranoid schizophrenia from hyperactive-hyperalert delirious states, whether or not they take the form of delirium tremens.*27\172\2*

WHY YOU CAN’T STAY AWAKE: OTHER TYPES OF DOES – KLEINE-LEVIN SYNDROME

This rare cause of hypersomnia usually affects males, most often between the ages of ten and twenty-one. Victims experience bouts of extreme daytime sleepiness coupled with unusual eating patterns. The fact that victims alternate between periods of enormous appetite and near starvation leads some authorities to suspect that the cause of the syndrome lies in a malfunctioning appetite control center in the brain. Other behavior helps differentiate this syndrome: irritability, confusion, incoherent speech, delusions, social isolation, shyness, and apathy. Victims may demonstrate exceptionally aggressive or inappropriate sexual activity, such as exhibitionism. Metabolic disturbances can be detected through urinalysis. Victims experience earlier and shorter REM periods and less deep NREM sleep. After a period of time the condition enters a stage of remission that can last months or even years. Sleep during this time is normal. Diagnosis of this unusual condition is tricky, since some of these symptoms may appear to be just part of the transition from prepubes-cence to young adulthood. Indeed, there may be some connection to the rampaging hormonal activity of this stage of life. Treatment with lithium carbonate may prevent (but not eliminate) attacks; the condition usually resolves itself spontaneously before the age of forty.*161\226\8*