Sunday, December 29, 2019

Anxiety

Although it is normal to experience some anxiety in situations such as public speaking or test taking, when dealing with anxiety disorders, it can alter how an individual lives their life.  Anxiety stems from the fight or flight response and was useful in determining when someone was in danger.  Because individuals in 2020 are not typically running from large animals and the like, the full fight or flight response is not typically necessary.

 Anxiety disorders develop when the length or severity of the anxiety is disproportionate with the stimulus (Felman, 2018).  Anxiety involves excessive nervousness, fear, apprehension and worry (Felman, 2018).  Common types of anxiety disorders include:

  • Generalized Anxiety Disorder
  • Panic Disorder
  • Phobia Related Disorder
  • Agoraphobia (NIMH, n.d.)
There are approximately 40 million people in the United States  who are affected by an anxiety disorder, but only about 36.9% of the receive treatment (Felman, 2018).  Anxiety disorder can occur any age and affects more women than men (Healthline, 2018).  Some possible causes of anxiety disorders include:
  • Environmental stressors
  • Genetics
  • Medical factors
  • Brain chemistry
  • Withdrawal from an illicit drug (Felman, 2018).

Generalized Anxiety Disorder (GAD) lasts most days for at least six months along with three or more symptoms.  During this time, an individual has excessive anxiety which will negatively impact their life.  When struggling with GAD, it is difficult to interrupt the worry cycle, even when there is the realization that there is an imbalance with the severity of the situation and the level of worry.  With mild or moderate disorders, it is possible to function socially, however, as the severity of the disorder increases, the ability to function socially typically decreases (ADAA, 2018).  Symptoms of GAD include:
  • Restlessness
  • Difficulty concentrating
  • Muscle tension
  • Difficulty controlling feelings of worry
  • Sleep issues
  • Sense of impending danger
  • increased heart rate 
  • Feeling weak or tired
  • GI issues (AADA, 2018)(n.d.)
Panic Disorder is characterized by an intense fear coming on rapidly and peaking in several minutes.  These episodes are referred to as panic attacks.  Because they can occur unexpectedly or triggered by something, an individual can often worry about when the next panic attack will occur.  They may also try to avoid places or situations (n.d.).  Some symptoms of Panic disorder include:
  • Heart palpitations
  • Sweating
  • Trembling
  • Shortness of breath
  • Feelings of impending doom
  • Feelings of being out of control
  • Confusion (Felman, 2018)(n.d.)
Phobia Related Disorder is the irrational fear of a situation, animal, or thing.  There are individuals who have phobias of heights, needles, flying, bridges, dogs, etc.  Although it is natural to have some fear regarding these things, having a disproportionate amount of fear can cause distress.  Most phobias develop before 30 years old and may develop after a traumatic experience, or learned from a family member (Brazier, 2017).  With a phobia, people may experience:
  • Irrational worry about situation or thing
  • Actively trying to avoid situation or thing
  • Immediate irrational fear when encountering situation or thing
  • Abnormal breathing
  • Increased heart rate
  • Chest pains
  • Trembling
  • Butterflies in stomach (Brazier, 2017)(n.d.).
Agoraphobia is comprised of both a fear and avoidance of places and situations where flight or escape may be difficult.  It may also be believed that help would not be available in the event that they became trapped.  There may also be the fear of crowds, bridges, or being outside alone (McIntosh, 2017).  Several things to remember about Agoraphobia are:
  • Can develop after one or more panic attacks
  • Can lead to various fears
  • Can make it difficult to leave home
  • Can improve with treatments such as antidepressants or anti-anxiety medications (2017).
Other types of Anxiety disorders include:
  • Selective mutism:  An anxiety that occurs in childhood causing them to not speak in certain situations (2019).  Is often diagnosed with other anxiety disorders (n.d.).
  • Social Anxiety Disorder:  Anxiety stems from an intense fear of social situations and public humiliation.  This causes an avoidance of social situations (2019).
  • Separation Anxiety:  Although commonly thought of with children, can also occur in adults.  Anxiety occurs when separated from someone who is important to the individual.  There can be a feat that harm will occur to the person they are attached to and nightmares as a result (n.d.).
There are several treatments available for anxiety:
  • Psychotherapy:  Geared towards specific Anxiety.
  • Cognitive Behavioral Therapy:  A type of psychotherapy that focuses on teaching new thinking, behaviors and reactions towards anxiety.
  • Anti-Anxiety Medications:  Typically Benzodiazepines are used to relieve anxiety.
  • Antidepressants:  Improves the way the brain use chemicals to change mood (n.d.).

REFERENCES
AADA. (2019) Generalized Anxiety Disorder (GAD).  Anxiety and Depression Association of America.  Retrieved from https://adaa.org/understanding-anxiety/generalized-anxiety-disorder-gad

Brazier, Y. (2017)  Everything You Need to Know About Phobias.  Medical News Times.  Retrieved from https://www.medicalnewstoday.com/articles/249347.php

Felman, A. (2018)  What to Know About Anxiety.  Medical News Times.  Retrieved from https://www.medicalnewstoday.com/articles/323454.php

Holland, K. (2018)  Everything You Need to Know About Anxiety.  Healthline.  Retrieved from https://www.healthline.com/health/anxiety 

McIntosh, J. (2017)  What you Need to Know About Agoraphobia.  Medical News Timed.  Retrieved from https://www.medicalnewstoday.com/articles/162169.php

National Institutes of Mental Health. (n.d.)  Anxiety Disorders.  National Institutes of Health.  Retrieved from https://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml#part_145336




Friday, December 13, 2019

Lupus

Lupus is an autoimmune disease that affects the entire body.  The immune system attacks both tissues and organs within the body, causing inflammation.  Parts of the body that are affected include joints, skin, kidneys, blood cells, brain, heart and lungs, among others (Mayo Clinic, 2023).

There are four forms of lupus:
  • Systemic
  • Cutaneous
  • Drug-induced
  • Neonatal (Lupus Foundation, 2023).
Systemic Lupus makes up 70% of cases and involves a major organ in about half of the cases.  Cutaneous Lupus involves the skin and makes up 10% of cases.  Drug Induced Lupus is caused with high doses of some medications and makes up 10% of cases and can diminish after the medication has been stopped.  Neonatal Lupus occurs when the antibodies of the mother impacts the fetus causing symptoms at birth that subside within six months (Lupus Foundation, 2023).  

Risk factors of developing Lupus include:
  • Gender
  • Age
  • Race
  • Family history (Lupus Foundation, 2023) (Mayo Clinic, 2023).
There are approximately 1.5 million people in the United States diagnosed with Lupus and is more common in women of childbearing age.  In fact, 90% of those diagnosed with Lupus are women.  The most common age range for diagnosis is between 15 and 44 years old (Lupus Foundation, 2023).  Of individuals who have Lupus, 1 in 3 have also been diagnosed with another autoimmune disorder (Lupus Foundation, 2023).  Lupus is more common in women of color.  African American women have a 2 to 3 times higher prevalence rate than White women and Latina, Asians, and Native Americans also have a higher prevalence rate (Medline, 2019).  Genetics plays a role  in developing Lupus.  Genetic variants can impact  both who develops Lupus and how severe it is (Medline, 2016).  
There are several symptoms that someone with Lupus can experience.  The symptoms include:
  • Fatigue
  • Fever
  • Joint pain
  • Joint stiffness
  • Joint swelling
  • Butterfly shaped facial rash
  • Photosensitive skin lesions
  • Raynaud's Phenomenon
  • Shortness of breath
  • Chest pain
  • Dry eyes
  • Headaches
  • Confusion
  • Memory loss
  • Hair loss
  • Swollen glands (Mayo Clinic, 2023)(Medline, 2019).

There are several tools clinicians use to diagnose Lupus.  Lupus can be mistaken for other diseases so it is important that certain tests are done.  When considering Lupus, it is important to complete:
  • Medical history
  • Complete exam
  • Blood tests
    • Complete Blood Count
    • Erythrocyte Sedimentation Rate
    • Liver and Kidney tests
    • Urinalysis
    • Antinuclear Antibody test
  • Skin biopsy
  • Kidney biopsy (Mayo, Clinic 2023) (Medline, 2016)
An individual may experience complications due to Lupus.  These may include:
  • skin scarring
  • heart attack
  • joint deformities
  • bone fractures
  • kidney failure
  • cataracts
  • avascular necrosis
  • pregnancy complications
  • cardiovascular disease
  • headaches
  • dizziness
  • behavior changes
  • vision problems
  • seizures (Mayo Clinic, 2023) (Johns Hopkins, 2023)
Once diagnosed, there are treatments that can be used to control symptoms, as there is no cure.  Because Lupus affects many systems in the body, it is often required to see a team of doctors including a Primary Care Physician, Rhuematologist and others as needed.  

Medications used include:
  •  Non-steroidal anti-inflammatory drugs (NSAIDS)
  • Antimalarial drugs
  • Corticosteriods
  • Biologic Immunosuppressants
  • Rituximab (Mayo Clinic, 2023)
These drugs are used to:
  • decrease swelling
  • decrease pain
  • prevent flares
  • decrease damage to joints (Medline, 2016)
There are lifestyle changes individuals can make to help cope with their Lupus symptoms in addition to their treatment.  Having regular checkups is important to prevent flare ups.  Wearing sun protective items (hat, long sleeves, etc) amd using sunscreen is important.  Regular exercise and a healthy diet are also important.  Smoking can increase the impact of Lupus on the cardiovascular system, so not smoking will help decrease the affects of Lupus on the heart and blood vessels (Mayo Clinic, 2023).

To learn more about Lupus, watch our youtube video.






If you have been diagnosed with Lupus and have questions, either contact your Primary Physician or contact a health educator through the Lupus Foundation at https://www.lupus.org/resources/health-educator .

Updated 3/11/2023

References

Johns Hopkins Medicine. (2023) Lupus Complications and Prognosis.  Johns Hopkins Medicine.  Retrieved from  https://www.hopkinsmedicine.org/health/conditions-and-diseases/lupus/lupus-complications-and-prognosis

Lupus Foundation. (2023)  What is Lupus?  Lupus Foundation.  Retrieved from https://www.lupus.org/resources/what-is-lupus

Mayo Clinic.  (2023) Lupus.  Mayo Clinic.  Retrieved from https://www.mayoclinic.org/diseases-conditions/lupus/symptoms-causes/syc-20365789

Medline. (2016) Lupus.  US National Library of Medicine.  Retrieved from https://medlineplus.gov/lupus.html

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