What about medications?
The use of medications to treat Trichotillomania is empirical. Because so little is known about the disorder, no one really knows what the best medications are, when to start the pill and for how long the treatment should be continued. The most common class of medications used to treat Trichotillomania are the anti depressants. There are no clinical trials on effectiveness of these drugs, but anecdotal reports do indicate that some patients do improve over time. Some patients need to take the anti depressants for 3-9 months to see an improvement. Because of side effects, compliance with these drugs is poor. Many patients stop taking the drug after 2-4 months. The most common complications of these drugs include weight gain, loss of libido, fatigue, and dry mouth. The side effects do stop when the drug is discontinued. Most experts recommend drug therapy with CBT for the best results.
The unfortunate thing is that not all individuals respond to drugs or CBT therapy. Many individuals do relapse even when the treatment is initially successful. Because the disorder can create havoc in one’s life it is recommended that one see a health care worker for help. Even though present day treatments are not ideal, in some individuals, drugs or CBT can help one make a dramatic recovery.
Alternative medicine
Because conventional medicine has not been successful in treatment of many mental disorders, including trichotillomania, many patients have been turning to alternative health care. There are reports that some individuals do benefit from hypnotherapy. When this treatment is combined with drugs or CBT, the frequency of relapse is much less. Alone, hypnotherapy works in less than 5% of individuals. The treatment is prolonged and requires patience and commitment.
Another technique that has been reported to help individuals with Trichotillomania is biofeedback. In this therapy, one is taught how to control or change certain physical responses. For example, when one encounters a certain stress, headache or a frustrating situation, biofeedback can help reduce tension and erases the urge to pull hair. The technique can also help decrease anxiety and helps control negative behaviors like pulling hair. However, on its own biofeedback often fails to work. For the best results, it must be combined with drug therapy or CBT.
Sunday, April 26, 2009
Treatment for hair pulling (trichotillomania)
Trichotillomania is a dreadful disorder and very little is known about it. For one thing, the disorder is associated with a lot of torment and internal turmoil. The most important aspect of this disorder is that the individual is not to be blamed for it. why Trichotillomania happens is not well understood and like most medical disorders bad luck or bad genes seem to part of the problem.
One reason why there is little known about Trichotillomania is because many individuals who have this disorder do not go and see their health care worker. Over the years, fear, embarrassment and lack of family support has driven these individuals into the closet. Medical professionals rarely come across individuals with Trichotillomania and most health care professionals have no idea how to treat it. Nevertheless, if one does seek help, there are some treatments that can improve the disorder. Two basic treatments are currently available for hair pulling.
Psychotherapy or cognitive behavior therapy (CBT) is an effective treatment for Trichotillomania. It is a slow process but helps one understand the disorder and brings awareness to the problem. Over time, some individuals learn not to pull their hair. The therapy centers around control of emotions, stress and trigger factors. The triggers and negative behaviors are then substituted for positive things. For example, if one used to pull hair, then now one will go for a swim, read a book or cook a meal. CBT requires commitment and patience. It is not a one shot deal because recovery can take 3-8 months. Frequently CBT also entails family involvement to help members understand the disorder and what they can do to help the affected individual. Over time, CBT can help diminish urges to pull hair and relieves strong impulses causing disruptive behavior.
Does CBT always work? No. CBT does work when treatment is sought out early. In normal people who have capacity to understand and comprehend, the results are good. Individuals who have other problems like drug abuse, alcoholism or personality disorders, CBT does not work well. From anecdotal reports, about 30-50 percent of individuals do benefit from this therapy.
One reason why there is little known about Trichotillomania is because many individuals who have this disorder do not go and see their health care worker. Over the years, fear, embarrassment and lack of family support has driven these individuals into the closet. Medical professionals rarely come across individuals with Trichotillomania and most health care professionals have no idea how to treat it. Nevertheless, if one does seek help, there are some treatments that can improve the disorder. Two basic treatments are currently available for hair pulling.
Psychotherapy or cognitive behavior therapy (CBT) is an effective treatment for Trichotillomania. It is a slow process but helps one understand the disorder and brings awareness to the problem. Over time, some individuals learn not to pull their hair. The therapy centers around control of emotions, stress and trigger factors. The triggers and negative behaviors are then substituted for positive things. For example, if one used to pull hair, then now one will go for a swim, read a book or cook a meal. CBT requires commitment and patience. It is not a one shot deal because recovery can take 3-8 months. Frequently CBT also entails family involvement to help members understand the disorder and what they can do to help the affected individual. Over time, CBT can help diminish urges to pull hair and relieves strong impulses causing disruptive behavior.
Does CBT always work? No. CBT does work when treatment is sought out early. In normal people who have capacity to understand and comprehend, the results are good. Individuals who have other problems like drug abuse, alcoholism or personality disorders, CBT does not work well. From anecdotal reports, about 30-50 percent of individuals do benefit from this therapy.
Can thiamine help reverse or delay Alzheimer’s dementia? part 2
It has been observed that individuals who develop Wernicke’s Korsakoff syndrome have a deficiency of thiamine. The most common cause of this disorder is alcoholism. These individuals develop dementia, have memory loss, unsteady gait, and muscle weakness. When individuals with this disorder are treated with thiamine, the symptoms do dramatically reverse. Thus, there has been a recent trend to recommend thiamine to patients with Alzheimer’s dementia.
Thiamine is one of the Group B vitamins and known as B1. It is found in both plants and animals. Thiamine is vital for many metabolic functions in the body that use energy. Thiamine deficiency is quite rare but individuals who drink excess alcohol can develop deficiency of this amino acid.
Because lack of thiamine can cause dementia in Wernicke’s Korsakoff syndrome, it has been proposed that perhaps thiamine can also be used to reduce severity of Alzheimer’s disease. Almost every health food stores sells thiamine and this amino acid is widely hyped up as a cure for many dementias. Thiamine has been marketed heavily for treatment of many medical disorders including Alzheimer’s, but does it work?
Several years ago several controlled studies looked at the effects of thiamine on dementia. Thiamine was administered daily and compared with a sugar pill. The three studies from the 90s did not reveal any benefit of thiamine in patients with Alzheimer’s disease. The only positive observation was that thiamine had no side effects. Since then many anecdotal reports have been published and countless patient testimonials indicate that thiamine does not reverse or slow down dementia in patients with Alzheimer’s disease.
For the moment, thiamine cannot be recommended as a treatment for Alzheimer’s. For individuals who still believe in thiamine and would like to treat their family members with dementia, foods containing thiamine are much better than pills.
Capsules or pills containing thiamine have often been found to contain fake and counterfeit products Foods which are rich in thiamine include whole grains, rice, bran, brewer’s years and wheat germ. These foods are cheaper and also more nutritious than any pill.
Thiamine is one of the Group B vitamins and known as B1. It is found in both plants and animals. Thiamine is vital for many metabolic functions in the body that use energy. Thiamine deficiency is quite rare but individuals who drink excess alcohol can develop deficiency of this amino acid.
Because lack of thiamine can cause dementia in Wernicke’s Korsakoff syndrome, it has been proposed that perhaps thiamine can also be used to reduce severity of Alzheimer’s disease. Almost every health food stores sells thiamine and this amino acid is widely hyped up as a cure for many dementias. Thiamine has been marketed heavily for treatment of many medical disorders including Alzheimer’s, but does it work?
Several years ago several controlled studies looked at the effects of thiamine on dementia. Thiamine was administered daily and compared with a sugar pill. The three studies from the 90s did not reveal any benefit of thiamine in patients with Alzheimer’s disease. The only positive observation was that thiamine had no side effects. Since then many anecdotal reports have been published and countless patient testimonials indicate that thiamine does not reverse or slow down dementia in patients with Alzheimer’s disease.
For the moment, thiamine cannot be recommended as a treatment for Alzheimer’s. For individuals who still believe in thiamine and would like to treat their family members with dementia, foods containing thiamine are much better than pills.
Capsules or pills containing thiamine have often been found to contain fake and counterfeit products Foods which are rich in thiamine include whole grains, rice, bran, brewer’s years and wheat germ. These foods are cheaper and also more nutritious than any pill.
Can thiamine help reverse or delay Alzheimer’s dementia?
Alzheimer’s is a devastating disorder that gradually results in memory impairment, disorganized thoughts, and poor reasoning. Over time, these cognitive impairments become so severe that there is a gradual decline in the individual’s usual level of functioning. Although all individuals have some degree of memory loss as part of aging, these cognitive changes generally do not interfere with level of function. In Alzheimer’s, the memory loss is much faster and associated with severe impairment in cognition. The disease progresses relentlessly and most individuals become incapable of independently looking after themselves. During the later stages of the disorder, depression, paranoia and delusions often accompany the illness and usually persists for long periods.
Today we have no cure for Alzheimer’s disease, but there are a few treatments available to alleviate some symptoms that are causing suffering.
The management of alzheimer's consists of use of medications and non-medications based treatments. The two different class of medications that have been approved by the FDA for treating Alzheimer’s include choline esterase inhibitors like Tacrine (Aricept) and partial glutamate antagonists. However, both class of drugs only work during early dementia and do not slow rate of progression of Alzheimer’s disease. Recently, there has been a surge in alternative care for patients with Alzheimer’s dementia.
Today we have no cure for Alzheimer’s disease, but there are a few treatments available to alleviate some symptoms that are causing suffering.
The management of alzheimer's consists of use of medications and non-medications based treatments. The two different class of medications that have been approved by the FDA for treating Alzheimer’s include choline esterase inhibitors like Tacrine (Aricept) and partial glutamate antagonists. However, both class of drugs only work during early dementia and do not slow rate of progression of Alzheimer’s disease. Recently, there has been a surge in alternative care for patients with Alzheimer’s dementia.
Thursday, April 16, 2009
What are options for treating PICA (eating crap)? Part 2
The role of Social worker
In toddlers and young children, pica behavior training must also bring about a positive appreciation of the environment and/or sensory stimulation. In young children with PICA, other issues that may need to be addressed are improvement of financial problems, schooling, social welfare, and prevention of isolation. One may also need to assess cultural beliefs and practices, educate both child and family, and teach about the harm of PICA. In children, it is vital that the surrounding environment be free of lead based paints, toys and furniture.
Medications
The majority of health care workers believe that PICA resolves spontaneously or can be improved with behavior treatment. Moreover, this is true in a number of individuals. However, there are many reports of adults with PICA who realize that their eating habits are troublesome. Many of these individuals have tried behavior therapy and have not improved. There are no approved drug regimens for PICA. In the literature, all drug therapy treatment for PICA is anecdotal and only isolated case reports exist. No one really knows what the ideal drugs are and how long to treat PICA.
However, based on case reports and effectiveness, the drugs with the best benefit for PICA are the atypical anti psychotics. Drugs like olanzapine, risperidone, or clozapine have shown to be more easily tolerated and produce relief in many cases.
Isolated reports do indicate that with time PICA does diminish and the drugs can be stopped. Some individuals required drug therapy for 3-9 months. The principal brain target of all antipsychotic drugs is the dopamine D2 receptor. One should be aware that a few mentally handicapped individuals who have been treated with anti psychotics have gone on to develop worsening of PICA. This may be due to ineffective dose, improper diagnosis or a combination of other emotional problems.
It is highly recommended that one follow up with a psychiatrist when using these drugs. The lowest dose of drug should be used. The effects of anti psychotics are not immediate and can take anywhere from 2-4 weeks to manifest. Other drugs which have been tried for treatment of PICA with some benefit include bromocriptine and methylphenidate.
At low dose, these drugs are fairly well tolerated and to avoid side effects one should not practice polypharmacy. Careful titration of dose with gradual increases can have a major impact on PICA
(http://www.psychiatrictimes.com/display/article/10168/1159376?pageNumber=4)
In toddlers and young children, pica behavior training must also bring about a positive appreciation of the environment and/or sensory stimulation. In young children with PICA, other issues that may need to be addressed are improvement of financial problems, schooling, social welfare, and prevention of isolation. One may also need to assess cultural beliefs and practices, educate both child and family, and teach about the harm of PICA. In children, it is vital that the surrounding environment be free of lead based paints, toys and furniture.
Medications
The majority of health care workers believe that PICA resolves spontaneously or can be improved with behavior treatment. Moreover, this is true in a number of individuals. However, there are many reports of adults with PICA who realize that their eating habits are troublesome. Many of these individuals have tried behavior therapy and have not improved. There are no approved drug regimens for PICA. In the literature, all drug therapy treatment for PICA is anecdotal and only isolated case reports exist. No one really knows what the ideal drugs are and how long to treat PICA.
However, based on case reports and effectiveness, the drugs with the best benefit for PICA are the atypical anti psychotics. Drugs like olanzapine, risperidone, or clozapine have shown to be more easily tolerated and produce relief in many cases.
Isolated reports do indicate that with time PICA does diminish and the drugs can be stopped. Some individuals required drug therapy for 3-9 months. The principal brain target of all antipsychotic drugs is the dopamine D2 receptor. One should be aware that a few mentally handicapped individuals who have been treated with anti psychotics have gone on to develop worsening of PICA. This may be due to ineffective dose, improper diagnosis or a combination of other emotional problems.
It is highly recommended that one follow up with a psychiatrist when using these drugs. The lowest dose of drug should be used. The effects of anti psychotics are not immediate and can take anywhere from 2-4 weeks to manifest. Other drugs which have been tried for treatment of PICA with some benefit include bromocriptine and methylphenidate.
At low dose, these drugs are fairly well tolerated and to avoid side effects one should not practice polypharmacy. Careful titration of dose with gradual increases can have a major impact on PICA
(http://www.psychiatrictimes.com/display/article/10168/1159376?pageNumber=4)
What are options for treating PICA (eating crap)?
Pica is an eating disorder typically characterized by the continual eating of nonnutritive substances for a period of at least 4 weeks at an age in which this behavior is developmentally inappropriate (e.g., >18-24 mo). Today, the definition of PICA has been expanded to include eating of nonnutritive substances.
Individuals who are diagnosed with pica have been reported to mouth and/or gulp down a wide variety of nonfood materials, including, but not limited to, clay, dirt, sand, stones, pebbles, hair, feces, lead, laundry starch, vinyl gloves, plastic, pencil erasers, ice, fingernails, paper, paint chips, coal, chalk, wood, plaster, light bulbs, needles, string, cigarette butts, wire, and burnt matches.
In the majority of cases of children who have been diagnosed with PICA, natural recovery occurs with time. Most children who have no mental problems simply grow out of the disorder. However, some children may need a multidisciplinary approach involving psychologists or social workers. The role of physician in early treatment stage is that of reassurance.
When spontaneous recovery does not take place, some type of treatment must be offered. Expansion of management plan must take into relation symptoms of pica and causative factors, as well as treatment of potential complications of the disorder.
The variety of behavioral strategies that have been proven to be effective in treating PICA include
- Antecedent treatment
- Distinction guidance between edible and
non-edible items
- Self-protection equipment that prevent
insertion of objects in the mouth
(mouth guards)
- Sensory strengthening of proper foods
- Differential strengthening of other or
unrelated behaviors, such as screening
(covering eyes briefly), or performing
exercise (or watching TV) is encouraged
- Conditional aversive oral taste (silver
acetate, lemon)
- Conditional aversive smell consciousness
(sulfur or ammonia),
- Conditional aversive physical awareness
(water spray, mild static shock therapy),
- Brief time out with physical restraint of
arms
- Correction of the environment
- Administer appropriate responses to
reinforce positive behavior
Individuals who are diagnosed with pica have been reported to mouth and/or gulp down a wide variety of nonfood materials, including, but not limited to, clay, dirt, sand, stones, pebbles, hair, feces, lead, laundry starch, vinyl gloves, plastic, pencil erasers, ice, fingernails, paper, paint chips, coal, chalk, wood, plaster, light bulbs, needles, string, cigarette butts, wire, and burnt matches.
In the majority of cases of children who have been diagnosed with PICA, natural recovery occurs with time. Most children who have no mental problems simply grow out of the disorder. However, some children may need a multidisciplinary approach involving psychologists or social workers. The role of physician in early treatment stage is that of reassurance.
When spontaneous recovery does not take place, some type of treatment must be offered. Expansion of management plan must take into relation symptoms of pica and causative factors, as well as treatment of potential complications of the disorder.
The variety of behavioral strategies that have been proven to be effective in treating PICA include
- Antecedent treatment
- Distinction guidance between edible and
non-edible items
- Self-protection equipment that prevent
insertion of objects in the mouth
(mouth guards)
- Sensory strengthening of proper foods
- Differential strengthening of other or
unrelated behaviors, such as screening
(covering eyes briefly), or performing
exercise (or watching TV) is encouraged
- Conditional aversive oral taste (silver
acetate, lemon)
- Conditional aversive smell consciousness
(sulfur or ammonia),
- Conditional aversive physical awareness
(water spray, mild static shock therapy),
- Brief time out with physical restraint of
arms
- Correction of the environment
- Administer appropriate responses to
reinforce positive behavior
Tuesday, April 14, 2009
How can I improve my libido while taking an antidepressant? part 3
Some individuals prefer to use only an SSRI. However, almost all SSRI have the ability to induce sexual dysfunction. Recently Fluvoxamine (luvox) has been speculated to help individuals with sexual dysfunction. At present Luxol is used to treat OCD and does work well. The drug does maintain sexual function but it has two side effects of concern. When the drug is abruptly discontinued, it can cause withdrawal symptoms of dizziness, fatigue, nausea, vivid dreams, irritability, and headaches. The other problem is that luvox may increase the risk of suicide in young adults and children. Individuals who are depressed have been found to have worsening of depression and suicidal thoughts when taking Luvox. Therefore, at the moment, the drug is rarely prescribed without close supervision.
Some physicians do try an add a psychostimulant to the patient’s regimen to counter the sexual dysfunction. Addition of drugs like Ritalin or methyl phenidate have been shown to work, but often the side effects of anxiety and insomnia also dominate. Further, these drugs have ability to cause physical dependence and cause withdrawal reactions when the drugs are abruptly stopped.
The latest and perhaps the one with the least controversy are Viagra and Tadalafil. Since the availability of Viagra and related drugs, there have been a few studies to see if the sexual dysfunction can be reversed. There have been a few studies which showed that both tadalafil and sildenfail both slightly improved sexual function in individuals who took anti depressants. However, most of the studies included small numbers and long-term data are not available. Anecdotal reports indicate that while Viagra does work, the effects are not sustained in the long run. In any case, Viagra is perhaps the best option for individuals with sexual dysfunction which occurs with anti depressants. The few negatives about viagra are that it is expensive and fake/counterfeit products are common.
Some physicians do try an add a psychostimulant to the patient’s regimen to counter the sexual dysfunction. Addition of drugs like Ritalin or methyl phenidate have been shown to work, but often the side effects of anxiety and insomnia also dominate. Further, these drugs have ability to cause physical dependence and cause withdrawal reactions when the drugs are abruptly stopped.
The latest and perhaps the one with the least controversy are Viagra and Tadalafil. Since the availability of Viagra and related drugs, there have been a few studies to see if the sexual dysfunction can be reversed. There have been a few studies which showed that both tadalafil and sildenfail both slightly improved sexual function in individuals who took anti depressants. However, most of the studies included small numbers and long-term data are not available. Anecdotal reports indicate that while Viagra does work, the effects are not sustained in the long run. In any case, Viagra is perhaps the best option for individuals with sexual dysfunction which occurs with anti depressants. The few negatives about viagra are that it is expensive and fake/counterfeit products are common.
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