A disorder characterised by failure to recover after experiencing or witnessing a terrifying event.
The condition may last months or years, with triggers that can bring back memories of the trauma accompanied by intense emotional and physical reactions.
Symptoms may include nightmares or flashbacks, avoidance of situations that bring back the trauma, heightened reactivity to stimuli, anxiety or depressed mood.
Treatment includes different types of psychotherapy as well as medications to manage symptoms.
Overview of Post Traumatic Stress Disorder including diagnostic criteria from ICD-10 and DSM-5, prevalence, course, differential diagnosis, co-morbidity, assessment, risk, prognostic and protective factors, etiology and management.
Overview of Post Traumatic Stress Disorder including diagnostic criteria from ICD-10 and DSM-5, prevalence, course, differential diagnosis, co-morbidity, assessment, risk, prognostic and protective factors, etiology and management.
Post traumatic stress disorder (PTSD) mamtabisht10
Post traumatic stress disorder (PTSD) is a stress related disorder (DSM5) is characterized by inability to adjust or recover after witnessing or experiencing a traumatic or life threatening event.
Post traumatic stress disorder (PTSD) is a severe anxiety disorder that can develop after exposure to any event which results in psychological trauma.”
Adjustment disorders are commonly seen in primary care settings in which the 1-year prevalence varies from 11% to 18% of those with any clinical psychiatric disorder. [Casey PR et al., 1984]
A recent study [Maercker A et al., 2012] in the general population found the prevalence of adjustment disorder to be 0.9%,
Psychosocial rehabilitation is the process that facilitates opportunities for persons with chronic mental illness to reach their optimal level of independent functioning in society and for improving their quality of life.
This slides explains the Management of aggression in patients with psychiatric illness. Aggression management is one of the important job responsibility of mental health nurse
TREATMENT RESISTANT DEPRESSION IS A AREA THAT IS NOT EXPLORED MUCH, BUT IT REALLY NEEDS LOT OF ATTENTION AS IT IS ONE OF THE MOST COMMON OBSTACLE IN ACHIEVING COMPLETE REMISSION IN DEPRESSION
Psychoeducation is an important element of psychiatric treatment. It has a significant role in
promoting mental health, preventing mental illness, increasing mental health awareness, creating opportunities
and improving the quality of life of the patient, caregivers and the community. To achieve these goals,
psychoeducation programmes seek to provide families with the information they need about mental illness
and the coping skills that will help them to deal with their loved one's psychiatric disorder. In a nutshell
Psychoeducation’s goal is to offer education and therapeutic strategies to improve the quality of life for the
family while decreasing the possibility of relapse for the patient (Solomon, 1996).
Post traumatic stress disorder (PTSD) mamtabisht10
Post traumatic stress disorder (PTSD) is a stress related disorder (DSM5) is characterized by inability to adjust or recover after witnessing or experiencing a traumatic or life threatening event.
Post traumatic stress disorder (PTSD) is a severe anxiety disorder that can develop after exposure to any event which results in psychological trauma.”
Adjustment disorders are commonly seen in primary care settings in which the 1-year prevalence varies from 11% to 18% of those with any clinical psychiatric disorder. [Casey PR et al., 1984]
A recent study [Maercker A et al., 2012] in the general population found the prevalence of adjustment disorder to be 0.9%,
Psychosocial rehabilitation is the process that facilitates opportunities for persons with chronic mental illness to reach their optimal level of independent functioning in society and for improving their quality of life.
This slides explains the Management of aggression in patients with psychiatric illness. Aggression management is one of the important job responsibility of mental health nurse
TREATMENT RESISTANT DEPRESSION IS A AREA THAT IS NOT EXPLORED MUCH, BUT IT REALLY NEEDS LOT OF ATTENTION AS IT IS ONE OF THE MOST COMMON OBSTACLE IN ACHIEVING COMPLETE REMISSION IN DEPRESSION
Psychoeducation is an important element of psychiatric treatment. It has a significant role in
promoting mental health, preventing mental illness, increasing mental health awareness, creating opportunities
and improving the quality of life of the patient, caregivers and the community. To achieve these goals,
psychoeducation programmes seek to provide families with the information they need about mental illness
and the coping skills that will help them to deal with their loved one's psychiatric disorder. In a nutshell
Psychoeducation’s goal is to offer education and therapeutic strategies to improve the quality of life for the
family while decreasing the possibility of relapse for the patient (Solomon, 1996).
Chapter Seven:
Posttraumatic Stress Disorder
Background of PTSD
Psychic trauma is the result of experiencing an acute overwhelming threat in which disequilibrium occurs.
Most people are extremely resilient and will quickly return to a state of mental and physical homeostasis.
Acute stress disorder is when symptoms continue for a period of 2 days to 1 month and have an onset within 1 month of the traumatic event.
Background Cont.
If acute stress disorder symptoms develop, they will typically diminish in 1 to 3 months.
Delayed PTSD is when symptoms disappear for a period of time and then reemerge in a variety of symptomatic forms months or years after the event.
Benchmarks
Railway train accidents
“Railway spine”
Freud’s research on trauma cases of young Victorian women
“Hysterical neurosis”
Traumatized combat veterans (especially veterans of the Vietnam Conflict)
“Shell shock”
“Combat fatigue”
Benchmarks Cont.
Recognition of domestic violence and rape via the women’s movement
“Battered women’s syndrome”
All came together to be defined as posttraumatic stress disorder in the third edition of the American Psychiatric Association’s Diagnostic and Statistical Manual (1980).
Diagnostic Criteria
Exposure to a trauma that involves:
Actual or perceived threat of serious injury or death to self or others
Response to the trauma was intense fear, helplessness, or horror
Symptoms arise that were not evident before the event
Persistent re-experiencing of the trauma in at least ONE of the following ways:
Recurrent and distressing recollections
Recurrent nightmares
Flashback episodes
Distress related to internal or external cues that symbolize the event
Physiological reactions to events that symbolize the trauma
Diagnostic Criteria Cont.
Behaviors consistent with at least THREE of the following:
Persistently avoiding related thoughts, dialogues, or feelings
Persistently avoiding related activities, people, or situations
Inability to recall important details of the trauma
Markedly diminished interest in significant activities
Emotionally detached from others
Restricted range of affect
Sense of foreshortened future
Diagnostic Criteria Cont.
Persistent symptoms of increased nervous system arousal that were not present prior to the trauma, as indicated by at least TWO of the following:
Difficulty falling or staying asleep
Irritability or outbursts of anger
Difficulty concentrating
Hyper-vigilance
Exaggerated startle reactions to minimal stimuli
The disturbance causes clinically significant impairment in social, occupational, or other critical areas of living.
PTSD in Children
Bus kidnapping in Chowchilla, CA
30-50% of children will experience at least one traumatic event by the age of 18.
3-16% of boys and 1-6% of girls will develop PTSD.
The type of trauma will impact the likelihood of developing PTSD.
Nearly 100% if they see a parent killed or sexually assaulted.
Approximately 90% if the child ...
Number of people exposed to traumatic events is on rise
day by day. Despite of this increased rate of exposure, little
is known about the disease, treatments available for
preventing/relieving PTSD symptoms. As research is a
continuous process and huge body of evidence is being
added to the existing literature, it is very important to
update ourselves. All the conclusions made by various
researchers are the result of experiments performed in
their set up which is different from ours. The applicability
of those conclusions in our kind of population has to be
evaluated and build our own body of evidence.
Crime victim are at risk for developing PTSD. Rape trauma syndrome is also known as PTSD. PTSD is not only a veterans condition. PTSD develop after experiencing a traumatic event. Traumatic events may include child abuse, child sex abuse, sexual assault, natural disasters, accidents, or combat trauma. PTSD awareness, education, and early intervention can help survivors of crime from developing PTSD, or chronic long term effects of crime victimization.
Persistent PTSD among Patients with Fragile X Syndrome: Case Seriessemualkaira
Posttraumatic stress disorder (PTSD) affects
about 3.6% of the US population and has clear diagnostic criteria
and treatment modalities. Individuals with autism spectrum disorder (ASD) and intellectual disabilities (ID) are at an elevated
risk for exposure to trauma and development of PTSD. Fragile X
syndrome (FXS) is the most common inherited cause of ID, and
there is currently need for further research regarding presentation
of PTSD among these individuals.
Persistent PTSD among Patients with Fragile X Syndrome: Case Seriessemualkaira
Posttraumatic stress disorder (PTSD) affects
about 3.6% of the US population and has clear diagnostic criteria
and treatment modalities. Individuals with autism spectrum disorder (ASD) and intellectual disabilities (ID) are at an elevated
risk for exposure to trauma and development of PTSD. Fragile X
syndrome (FXS) is the most common inherited cause of ID, and
there is currently need for further research regarding presentation
of PTSD among these individuals.
Persistent PTSD among Patients with Fragile X Syndrome: Case Seriessemualkaira
Posttraumatic stress disorder (PTSD) affects
about 3.6% of the US population and has clear diagnostic criteria
and treatment modalities. Individuals with autism spectrum disorder (ASD) and intellectual disabilities (ID) are at an elevated
risk for exposure to trauma and development of PTSD. Fragile X
syndrome (FXS) is the most common inherited cause of ID, and
there is currently need for further research regarding presentation
of PTSD among these individuals.
Persistent PTSD among Patients with Fragile X Syndrome: Case Seriessemualkaira
Posttraumatic stress disorder (PTSD) affects
about 3.6% of the US population and has clear diagnostic criteria
and treatment modalities. Individuals with autism spectrum disorder (ASD) and intellectual disabilities (ID) are at an elevated
risk for exposure to trauma and development of PTSD. Fragile X
syndrome (FXS) is the most common inherited cause of ID, and
there is currently need for further research regarding presentation
of PTSD among these individuals.
Basic Life Support, or BLS, generally refers to the type of care that first-responders, healthcare providers and public safety professionals provide to anyone who is experiencing cardiac arrest, respiratory distress or an obstructed airway.
The Advanced Cardiovascular Life Support (ACLS) algorithm is a systematic, evidence-based approach designed to guide healthcare providers in the urgent treatment of: Cardiac arrest. Arrhythmias. Stroke. Other life-threatening cardiovascular emergencies.
Diabetes is a chronic, metabolic disease characterized by elevated levels of blood glucose (or blood sugar), which leads over time to serious damage to the heart, blood vessels, eyes, kidneys and nerves. The most common is type 2 diabetes, usually in adults, which occurs when the body becomes resistant to insulin or doesn't make enough insulin. In the past 3 decades the prevalence of type 2 diabetes has risen dramatically in countries of all income levels. Type 1 diabetes, once known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition in which the pancreas produces little or no insulin by itself. For people living with diabetes, access to affordable treatment, including insulin, is critical to their survival. There is a globally agreed target to halt the rise in diabetes and obesity by 2025.
Levels of Organization
1
An Introduction to the Human Body
2
The Chemical Level of Organization
3
The Cellular Level of Organization
4
The Tissue Level of Organization
Support and Movement
Regulation, Integration, and Control
Fluids and Transport
Energy, Maintenance, and Environmental Exchange
Human Development and the Continuity of Life
Anatomy refers to the internal and external structures of the body and their physical relationships, whereas physiology refers to the study of the functions of those structures.
Communicable diseases, including HIV/AIDS, tuberculosis (TB), malaria, viral hepatitis, sexually transmitted infections and neglected tropical diseases (NTDs), are among the leading causes of death and disability in low-income countries and marginalized populations.
Nursing Mangement on occupational and industrial disorders [Autosaved].pptxDR .PALLAVI PATHANIA
What are the 5 types of occupational disease?
Occupational diseases in this registry system including Occupational lung diseases, occupational skin diseases, noise-induced hearing loss, diseases caused by chemical agents (poisoning), diseases caused by biological agents, occupational cancers and other occupational diseases
Acyanotic heart disease is where the blood contains enough oxygen but it's pumped abnormally around the body. Babies born with acyanotic heart disease may not have any apparent symptoms but, over time, the condition can cause health problems.
Congenital heart disease, also called a defect, refers to one or more problems with the heart structure that are present at birth. These abnormalities occur when the heart or blood vessels don't form correctly in utero. At least eight out of every 1000 infants born in the US each year have a heart defect.
Dialysis is a treatment for people whose kidneys are failing. When you have kidney failure, your kidneys don't filter blood the way they should. As a result, wastes and toxins build up in your bloodstream. Dialysis does the work of your kidneys, removing waste products and excess fluid from the blood
Urinary disorders with congenital anomalies of Kidney, ureter. UTIs are common infections that happen when bacteria, often from the skin or rectum, enter the urethra, and infect the urinary tract. The infections can affect several parts of the urinary tract, but the most common type is a bladder infection (cystitis).
Genitourinary disorders are conditions that affect the genitourinary system, which includes the urinary and reproductive systems. Some are congenital, and others are acquired later in life.
Large numbers of patients suffer from a variety of diseases in the genitourinary system, which is composed of kidneys, ureters, bladder, urethra, and genital organs. Genitourinary diseases include congenital abnormalities, iatrogenic injuries, and disorders such as cancer, trauma, infection, and inflammation.
The genitourinary system, or urogenital system, are the organs of the reproductive system and the urinary system. These are grouped together because of their proximity to each other, their common embryological origin and the use of common pathways, like the male urethra.
lymphatic system, a subsystem of the circulatory system in the vertebrate body that consists of a complex network of vessels, tissues, and organs. The lymphatic system helps maintain fluid balance in the body by collecting excess fluid and particulate matter from tissues and depositing them in the bloodstream
The musculoskeletal system is made up of bones, cartilage, ligaments, tendons and muscles, which form a framework for the body. Tendons, ligaments and fibrous tissue bind the structures together to create stability, with ligaments connecting bone to bone, and tendons connecting muscle to bone.
The skin is the largest organ of the body, with a total area of about 20 square feet. ... Skin has three layers: The epidermis, the outermost layer of skin, provides a waterproof barrier and creates our skin tone. The dermis, beneath the epidermis, contains tough connective tissue, hair follicles, and sweat glands.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
2. Posttraumatic stress disorder (PTSD) is a condition
marked by the development of symptoms after
exposure to traumatic life events.
The person reacts to this experience with fear and
helplessness and tries to avoid being reminded of the
events.
Children who are behaviorally inhibited may be
especially susceptible to anxiety or PTSD after
threatening events.
3. To make the diagnosis
the symptoms must last for more than a month after the
event and
must significantly affect important areas of life, such as
family and work.
DSM-IV-TR defines a disorder that is similar to PTSD
called acute stress disorder, which occurs earlier than
PTSD (within 4 weeks of the event) and remits within 2
days to 4 weeks.
If symptoms persist then PTSD is warranted.
4. They can arise from experiences in war, torture,
natural catastrophes, assault, rape, and serious
accidents, for example, in cars and in burning
buildings.
Persons re-experience the traumatic event in their
dreams and their daily thoughts.
to evade anything that would bring the event to mind,
they undergo a numbing of responsiveness along
with a state of hyperarousal.
Other symptoms: depression, anxiety, and cognitive
difficulties, such as poor concentration.
5.
6. History
Soldier’s heart•was the name given during the US Civil
War to a syndrome similar to PTSD.
Jacob DaCosta's 1871 paper, Irritable Heart, described
soldiers with the syndrome. In the 1900s, the influence
of psychoanalysis was strong, particularly in the
United States, and clinicians applied the diagnosis of
traumatic neurosis to the condition.
7. In World War I, the syndrome was called shell shock
and was hypothesized to result from brain trauma
caused by exploding shells.
Psychiatric morbidity associated with Vietnam War
finally brought the concept of PTSD.
8.
9. Epidemiology
The lifetime incidence about 9 to 15 percent,
the lifetime prevalence about 8 percent ,
subclinical forms of the disorder 5 to 15 percent.
it is most prevalent in young adults, because they tend
be more exposed to precipitating situations.
Men and women differ in the types of traumas to which
they are exposed and their liability to develop PTSD.
10. Men's trauma was usually combat experience, and
women's trauma was most commonly assault or rape.
The disorder is most likely to occur in those who are
single, divorced, widowed, socially withdrawn, or
of low socioeconomic level.
The most important risk factors, however, for this
disorder are the severity, duration, and proximity of
a person's exposure to the actual trauma.
11. Comorbidity
Comorbidity rates are high among patients with PTSD
with about two thirds having at least two other
disorders.
Common comorbid conditions include depressive
disorders, substance-related disorders, other
anxiety disorders, and bipolar disorders.
Comorbid disorders make persons more vulnerable to
developing PTSD.
13. Stressor
prime causative factor in the development of PTSD.
The response to the traumatic event must involve
intense fear or horror.
Clinicians must also consider individual preexisting
biological and psychosocial factors and events that
happened before and after the trauma.
For example, a member of a group who lived through a
disaster can sometimes deal with trauma because
others shared the experience.
15. Psychodynamic Factors
Trauma has reactivated a previously quiescent, yet
unresolved psychological conflict.
According to Freud, a splitting of consciousness occurs
in patients who reported a history of childhood sexual
trauma.
A preexisting conflict might be symbolically
reawakened by the new traumatic event.
16. Cognitive-Behavioral Factors
The cognitive model of PTSD posits that affected persons cannot
process or rationalize the trauma that precipitated the disorder.
They attempt to avoid experiencing it by avoidance techniques.
Persons experience alternating periods of acknowledging and blocking
the event.
The behavioral model of PTSD emphasizes two phases in its
development.
1) The trauma (the unconditioned stimulus)
produces a fear response is paired, through classic conditioning, with a
conditioned stimulus.
2) through instrumental learning, the conditioned stimuli elicit the
fear response independent of the original unconditioned stimulus,
and persons develop a pattern of avoiding both the conditioned
stimulus and the unconditioned stimulus.
Some persons also receive secondary gains from the external world,
commonly monetary compensation, increased attention or sympathy,
and the satisfaction of dependency needs. These gains reinforce the
disorder and its persistence.
17. Biological Factors
Preclinical models in animals have led to theories
about norepinephrine, dopamine, endogenous
opioids, and benzodiazepine receptors and the
hypothalamic-pituitary-adrenal (HPA) axis.
In clinical populations, data have supported
hypotheses that the noradrenergic and endogenous
opiate systems, as well as the HPA axis, are hyperactive
in at least some patients with PTSD.
Other major biological findings are increased activity
and responsiveness of the autonomic nervous system.
18. Noradrenergic System
Soldiers with PTSD-like symptoms exhibit
nervousness, increased blood pressure and heart
rate, palpitations, sweating, flushing, and tremor-
-symptoms associated with adrenergic drugs.
Studies found increased 24-hour urine epinephrine
concentrations in veterans with PTSD and increased
urine catecholamine concentrations in sexually abused
girls.
19. Opioid System
Abnormality in the opioid system is suggested by low
plasma B-endorphin concentrations in PTSD.
Combat veterans with PTSD demonstrate a naloxone
(Narcan)-reversible analgesic response to combat-
related stimuli, raising the possibility of opioid system
hyperregulation similar to that in the HPA axis.
20. Corticotropin-Releasing Factor and
the HPA Axis
Studies have demonstrated low plasma and urinary
free cortisol concentrations in PTSD.
More glucocorticoid receptors are found on
lymphocytes, and challenge with exogenous
corticotropin-releasing factor (CRF) yields a blunted
ACTH response.
Some studies have revealed cortisol hypersuppression
in trauma-exposed patients who develop PTSD,
compared with patients exposed to trauma who do not
develop PTSD, indicating that it might be specifically
associated with PTSD and not just trauma.
21. Diagnosis
The DSM-IV-TR diagnostic criteria for PTSD specify
that the symptoms of experiencing, avoidance, and
hyperarousal must have lasted more than 1 month.
symptoms present for less than 1 month - acute
stress disorder.
Acute - If symptoms of PTSD have lasted less than 3
months
Chronic - if the symptoms have lasted 3 months or
more..
26. Clinical Features
The principal clinical features of PTSD are painful
reexperiencing of the event, a pattern of avoidance and
emotional numbing, and fairly constant hyperarousal.
Mental status examination reveals feelings of guilt, rejection,
and humiliation.
Patients may describe dissociative states and panic attacks,
and illusions and hallucinations may be present.
Associated symptoms : aggression, violence, poor impulse
control, depression, and substance-related disorders.
Cognitive testing may reveal that patients have impaired
memory and attention.
28. PTSDs in Children and Adolescents
Symptoms such as repetitive dreams of the event, nightmares
of monsters, and the development of physical symptoms
such as stomachaches and headaches.
High rates of PTSD have been documented in children
exposed to such life-threatening events as combat and other
war-related trauma, kidnapping, severe illness or burns, bone
marrow transplantation, and a number of natural and man-
made disasters.
29.
30. Stressor
Stressors in children
may be sudden, single-
incident trauma or
ongoing or chronic
trauma, such as physical
or sexual abuse.
Children also suffer as
the result of indirect
exposure that is, the
unwitnessed death or
injury of a loved one, as
in situations of disaster,
war, or community
violence.
31. Reenactment and Reexperiencing
“Traumatic play”•- a specific form of reexperiencing seen in
young children, consists of repetitive acting out of the
trauma or trauma-related themes in play.
Older children may incorporate aspects of the trauma into
their lives in a process termed reenactment.
Related behaviors in child and adolescent victims of trauma
include sexual acting out, substance use, and delinquency.
32. Gulf War Syndrome
On the return of American soldiers from the Persian
Gulf War, more than 100,000 US veterans reported a
vast array of health problems, including irritability,
chronic fatigue, shortness of breath, muscle and
joint pain, migraine headaches, digestive
disturbances, rash, hair loss, forgetfulness, and
difficulty concentrating. Collectively, these
symptoms were called the Gulf War syndrome.
the soldiers may have been exposed to chemical
weapons and disorder may have been precipitated by
exposure to an unidentified toxin.
33.
34. Physicians need to acknowledge that many Gulf War
veterans are experiencing stress-related disorders and
the physical consequences of stress.
Thousands of Gulf War veterans developed PTSD .
PTSD is caused by psychological stress and the Gulf
War syndrome is presumed to be caused by
environmental biological stressors. Signs and
symptoms often overlap and both conditions may exist
at the same time.
35. 9/11/01
On September 11, 2001, terrorist activity destroyed the
World Trade Center (Fig. 16.5-1) in New York City and
damaged the Pentagon in Washington.
More than 25,000 people continue to suffer symptoms
of PTSD related to the 9/11 attacks beyond the 1 year
mark.
36.
37. Iraq and Afghanistan
In October 2001, the United States, along with
Australia, Canada, and the United Kingdom, began
the invasion of Afghanistan in the wake of the
September 11, 2001 attacks.
Both wars are ongoing and PTSD is a rising problem
with an estimated 17 percent of returning soldiers
having PTSD.
38. Natural Disasters
Tsunami
On December 26,
2004, a massive
tsunami struck the
shores of Indonesia,
Sri Lanka, South
India, and Thailand
and caused serious
damage.
Those survivors
continue to live in
fear and show signs
of PTSD.
41. Torture
The intentional physical and psychological torture of
one human by another can have emotionally damaging
effects.
Torture is any deliberate infliction of severe mental
pain or suffering, usually through cruel, inhuman, or
degrading treatment or punishment.
This broad definition includes various forms of
interpersonal violence, from chronic domestic abuse
to broad-scale genocide.
42. Torture is distinct from most other types of trauma
because it is human inflicted and intentional.
Methods can be physical (e.g., beatings, burning of
the skin, electric shock, or asphyxiation) or
psychological, through threats, humiliation, or
being forced to watch others, often loved ones,
being tortured.
One distinct method of torture that may combine
physical and psychological aspects is brainwashing.
Treatment methods for survivors of torture are the
same as those for other posttraumatic symptoms and
disorders.
43. Differential Diagnosis
head injury during the trauma
Epilepsy
alcohol-use disorders
substance-related disorders
Acute intoxication or withdrawal from some
substances
Symptoms of PTSD can be difficult to distinguish from
both panic disorder and generalized anxiety
disorder, because all three syndromes are associated
with prominent anxiety and autonomic arousal.
44. Keys to correctly diagnosing PTSD involve a careful
review of the time course relating the symptoms to a
traumatic event.
Major depression is also a frequent concomitant of
PTSD.
Borderline personality disorder can be difficult to
distinguish from PTSD.
The two disorders can coexist or even be causally
related.
45. Course and Prognosis
PTSD usually develops some time after the trauma.
The delay can be as short as 1 week or as long as 30
years.
If untreated :
30 % recover completely
40% with mild symptoms
20% with moderate symptoms
10% remained unchanged or become worst
46. In general, the very young and the very old have more
difficulty with traumatic events than do those in
midlife.
PTSD that is comorbid with other disorders is often
more severe and perhaps more chronic and may be
difficult to treat.
47. Treatment
The major approaches are support, encouragement to
discuss the event, and education about a variety of
coping mechanisms (e.g., relaxation).
The use of sedatives and hypnotics can also be
helpful.
When a patient experienced a traumatic event in the
past and now has PTSD, the emphasis should be on
education about the disorder and its treatment,
both pharmacological and psychotherapeutic.
Additional support for the patient and the family can
be obtained through local and national support
groups for patients with PTSD.
48. Pharmacotherapy
first-line treatments for PTSD
Selective serotonin reuptake inhibitors (SSRIs), such as
sertraline (Zoloft) and paroxetine (Paxil).
Buspirone (BuSpar) is serotonergic and may also be of use.
Other drugs :
Monoamine oxidase inhibitors (MAOIs)
phenelzine [Nardil]),
trazodone (Desyrel),
The anticonvulsants
carbamazepine [Tegretol],
valproate [Depakene].
49. Psychotherapy
Reconstruction of the traumatic events with associated
abreaction and catharsis may be therapeutic, but
psychotherapy must be individualized because
reexperiencing the trauma overwhelms some patients.
Psychotherapeutic interventions for PTSD include
behavior therapy, cognitive therapy, and hypnosis.
The short-term nature of the psychotherapy
minimizes the risk of dependence and chronicity, but
issues of suspicion, paranoia, and trust often adversely
affect compliance.
50. Patients should be encouraged to review and abreact
emotional feelings associated with the traumatic event and
to plan for future recovery.
“Abreaction” -- experiencing the emotions associated with
the event-- may be helpful for some patients. The
amobarbital (Amytal) interview has been used to facilitate
this process.
When PTSD has developed, two major psychotherapeutic
approaches can be taken.
1) Exposure therapy
2) Stress management
51. 1) Exposure therapy : in which the patient reexperiences the
traumatic event through imaging techniques or in vivo
exposure. The result of this therapy lasts longer.
2) Stress management : including relaxation techniques
and cognitive approaches to coping with stress. This shows
result more rapidly.
eye movement desensitization and reprocessing
(EMDR) : the patient focuses on the lateral movement of the
clinician's finger while maintaining a mental image of the
trauma experience.
It is possibly more effective than other treatments for PTSD.
52. Group therapy include sharing of traumatic experiences
and support from other group members. Group therapy has
been particularly successful with Vietnam veterans and
survivors of catastrophic disasters such as earthquakes.
Family therapy often helps sustain a marriage through
periods of exacerbated symptoms.
Hospitalization may be necessary when symptoms are
particularly severe or when a risk of suicide or other
violence exists.