Antidepressants Blog

At times it is impossible to walk away from the child in the midst of a tantrum: for example, at other people’s houses or when shopping. It is still important that the behaviour not be reinforced. Suggested strategies for dealing with tantrums are outlined in a separate section on management of behaviour problems.

Sometimes the child can become quite frightened during a tantrum, probably because he feels out of control, and appears genuinely distressed. On these occasions you should simply hold the child for a few minutes, until he is back in control. Even during this period it is important not to reinforce the behaviour by being too warm and affectionate to the child. Furthermore, there should never be a reward for the child at the end of the temper tantrum. For example, a child may have a tantrum after his parents have insisted that he tidy up the toys, or perform another task. Once the tantrum is over and the child has regained composure, you should gently guide him back to the original task. If this is not done, then the child will very quickly learn that the way to avoid doing things is to have a temper tantrum.

If parents can manage a child’s temper tantrums correctly, then they will be able to manage successfully most of the other difficult behaviours that are an integral part of childhood. If they unwittingly allow the child to use repeated temper tantrums to get his own way, there is a good chance that the child will continue to use temper tantrums, or variations of them, as a way of relating to parents, other adults and peers. It will be likely to interfere with social learning, relationships and learning to deal with frustration.

When to see your doctor

You may want to speak to your doctor or another health professional to ‘coach’ you about behaviour management techniques. It is very often helpful to have somebody to support and encourage you during what is often a taxing time. Occasionally the family doctor will refer you and the child to a paediatrician or psychologist for more specialised advice.

Prevention

It is unlikely that temper tantrums can be totally prevented — they are a normal part of growing up. However, parents can certainly do much to make sure that they are not prolonged or made worse and that there are no associated behaviour problems, by handling the tantrums appropriately in the way suggested above. A commonsense, low key approach will usually work.

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THREATENING SAME-SEX CHILDHOOD FOE

Do you remember a bully, a “meany,” some child who just seemed to have it in for you? There seemed to be something about you that resulted in a monstrous reaction on the part of this one particular child. You might have sprinted with terror past his house, snuck down the alley on the way home from school, done anything to avoid direct confrontation with this one child.

One husband reported, “His name was Carl. This kid hated my looks, my name, my clothes, my walk, my parents, even my dog. I have never been so afraid in my life, not even in the war, as I was afraid of Carl.”

“She was the meanest girl. She gave the word ‘bitch’ a bad name. She put me down to everybody. I hated her. I wished she would die. I’ll bet she became a gossip columnist.” This wife frowned, reliving her anger as she described this love-map imprint.

The same-gender conflict and fear gets on our love map, a danger zone that is reflected in our choice of a partner and in our day-today working and loving. Think about conflicts with people at work, about conflicts with certain family members, and try to relate these relationships to your love map. You will see that these maps influence all living.

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At this stage of the process some people may go into psychotherapy. As was discussed in chapter four, psychotherapy can be extremely beneficial. Many of us who have an anxiety disorder have suppressed our primary emotions of anger, grief and so on. Psychotherapy helps us contact these feelings. Experiencing them is part of the healing process.

People have asked the question of what to do with their thoughts while working through issues in psychotherapy. There will be issues in therapy which need to be thought through and worked with, and they may cause anxiety and attacks. Again, it means walking a fine line. Be aware of why they have occurred and let them happen.

As our management skills increase we will begin to realise a subtle pattern emerging with our anxiety and attacks. When we are avoiding confronting particular personal issues, or in other words, not being honest with ourselves, we may find ourselves reacting with anxiety or an attack. We can use these subtle guides to get to know and understand ourselves on a deeper level.

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For many types of cancer, complete surgical removal of the primary tumour is the only treatment that is ever capable of producing a complete and permanent cure. Surgery cures more cancers than does any other form of treatment. Surgery is also recommended to cancer patients for other reasons: to make a diagnosis, to relieve or prevent symptoms and to reconstruct parts of the body. We will look at each of these in turn later in this chapter.

There is one basic problem with surgical treatment which does not apply with other types of treatment. Surgery is done while you are unconscious and therefore incapable of making any decisions.

If something unexpected is found during an operation on you, decisions about the best immediate course of action will be taken out of your hands. They will be made on your behalf by the surgeon. Most surgeons take it for granted that they should be making all the decisions, so they have no strong reasons for trying to prevent this situation from arising. There is only one way to make sure that you make the decisions about what operation will be done. You must make sure that you know, as completely and accurately as possible, before your operation what will be found when you are opened up, and what can be done to deal with this situation. The more careful and thorough your pre-operative assessment is, the greater the possibility of the exact opertion lat you agree to being performed.

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If the blockage occurs in a large artery, so much heart muscle may be deprived of blood that the heart cannot cope with its normal function and death may occur. This may be immediate or happen within a few hours, a day, or longer.

Sudden death is always a possibility following a heart attack and the risk is greatest in the first few hours, decreasing over the following 48.

The cause of death is usually due to the development of an abnormal heart rhythm.

Damage to the heart muscle may make electrical conduction through the heart unstable.

There are a number of abnormalities of rhythm but the one causing death is ventricular fibrillation.

The best way to prevent or treat this is for the person to be under the care of trained medical or paramedical personnel.

Coronary care units have been established in all public and most large private hospitals. The person with the suspected heart attack is admitted to this special ward and is monitored by having a continuous electrocardiograph displayed on screens.

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It must be stressed that the evidence is not all bad. Some of the studies involve such small numbers that no valid conclusions can be drawn.

An epileptic woman who stops taking drugs because she becomes pregnant is at risk of having convulsions. The convulsion with the associated lack of oxygen during the fit may, in itself, be dangerous to the foetus.

Besides, most women do not know they are pregnant until four or six weeks after conception.

The developing foetus has already been exposed to the drug and stopping it when pregnancy is confirmed may be too late, if in fact, the drug does have harmful effects.

All life is a risk and, at the moment, it appears there is a greater risk to the baby if the epileptic woman stops her medication during pregnancy than if she continues it.

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Firstly, it performs an essential protective role. Because of its resilience or ability to resume its previous shape after deformation, it can withstand considerable trauma without permanent damage. This mechanical barrier is mainly due to the arrangement and nature of the collagen and elastic fibres in the dermis. It also constitutes an effective barrier to the passage of substances into or out of the skin. This chemical barrier is provided by the layered cells of the epidermis, which impede the loss of water and body salts and prevent the penetration of external substances.

Secondly, the skin is a most effective and essential sensory organ. This is a result of it being richly supplied with nerve endings, which provide an effective sensory defence against potentially harmful stimuli. It also acts as a ‘relay station’ between external influences and internal organs, via a network of nerve fibres. Of equal importance, is its role as an organ of expression: for instance we may express anxiety by sweating, fear by pallor, anger by redness, pain as a grimace, or happiness with a smile.

Thirdly, the skin acts as a remarkable thermostat. This is mainly achieved by its blood vessels and sweat glands. The metabolic processes of the body continually produce heat, which must be dissipated to maintain a constant body temperature. Under normal environmental conditions this may be achieved by varying the diameter of the blood vessels in the skin, resulting in changes in the volume of the blood flow. This blood flow can be varied 100-fold from maximum constriction to maximum dilation of the vessels. Increased blood flow is accompanied by increased heat loss, whereas a reduced blood flow retains heat.

If, however, blood flow alterations are insufficient to regulate the body temperature, then the sweat glands are activated. This will occur with extreme external temperature increases, excessive exertion, or the fever accompanying an illness. The sweat bathes the skin and cooling results from its evaporation.

Fourthly, the skin plays an active part in the body’s defence against such micro-organisms as bacteria, fungi, and viruses. The surface of the skin is never sterile. It is host to a permanent resident colony of various bacteria which are relatively innocuous. Their presence, however, inhibits the growth of more dangerous organisms on the skin. Further protection is provided by the dryness of the skin’s surface. Most organisms are relatively intolerant to dry conditions, much preferring humid or moist environments. The continual shedding of the superficial epidermis also discourages bacterial invaders. Sebum, the oily secretion produced by the active sebaceous glands, contains fatty adds which have a strong anti-bacterial and anti-fungal action. A thin coating of this on the skin provides a further protection.

Finally, the skin is an important barrier against damaging ionizing radiation, such as ultra-violet light. For skin unprotected by hair or clothing, the only significant defence against the destructive effects of U.V.L. is melanin. Without melanin the epidermis would be a thin transparent membrane, allowing

U.V.L to damage the sensitive structure of the dermis. Melanin is a complicated large protein produced by special cells, melanocytes in the basal layer. From there it is distributed throughout the epidermis. The amount of melanin in the epidermis governs the colour of a person’s skin: the more melanin, the darker the skin colour. There is no difference though in the number of melanocytes in white and in black skin. The difference is simply one of activity, reflected in the amount of melanin or pigment these cells produce. Various factors may influence this, including sun exposure, pregnancy, various hormonal disorders, and drugs.

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Hypoglycaemia is a condition in which the sugar level in the blood fails below normal levels. From the Greek words hypo meaning under and glycaemia meaning blood sugar—hence blood sugar level below normal.

These days, hypoglycaemia is a popular diagnosis for all sorts of problems which cannot be attributed to a more specific diagnosis. There has been considerable publicity about hypoglycaemia which is often blamed for many non-specific health problems ranging from tiredness to depression. Unfortunately, it is often wrongly blamed which can delay a proper diagnosis and correct treatment.

Nevertheless, genuine hypoglycaemia does occur in a few people, and the G.I. factor has a role to play in treating some forms of this condition. The most common form of hypoglycaemia occurs after a meal is eaten. This is called reactive hypoglycaemia.

Normally, when a meal containing carbohydrate is eaten, the blood sugar level rises. This causes the pancreas to make insulin which ‘pushes’ the sugar out of the blood and into the muscles where it provides energy for you to carry out your regular tasks and activities. The movement of sugar out of the blood and into the muscles is finely controlled by just the right amount of insulin to drop the sugar back to normal. In some people, the blood sugar level rises too quickly after eating and causes an excessive amount of insulin to be released. This draws too much sugar out of the blood and causes the blood sugar level to fall below normal. The result is hypoglycaemia.

Hypoglycaemia causes a variety of unpleasant symptoms. Many of these are stress-like symptoms such as sweating, tremor, anxiety, palpitations and weakness. Others affect mental function and lead to restlessness, irritability, poor concentration, lethargy and drowsiness.

The diagnosis of true reactive hypoglycaemia cannot be made on the basis of vague symptoms. It depends on detecting a low blood sugar level when the symptoms are actually being experienced. This means a blood test.

Because it may be difficult (or almost impossible) for someone to be in the right place at the right time to have a blood sample taken while experiencing the symptoms, a glucose tolerance test is sometimes used to try to make the diagnosis. This involves drinking pure glucose which causes the blood sugar levels to rise. If too much insulin is produced in response, a person with reactive hypoglycaemia will experience an excessive fall in their blood sugar level. Sounds simple enough, but there are pitfalls.

Testing must be done under strictly controlled conditions and capillary (not venous) blood samples collected correctly. Home blood glucose meters are not sufficient for the diagnosis of hypoglycaemia in people without diabetes.

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Body Mass Index (BMI). BMI (sometimes also called ‘Quetelet’s index’) was developed to account for the influence of height on body mass. The measure is weight (in kg) divided by height (in m) squared, i.e. BMI = wt(kg)/ht(m)2. Recommended ideal range for BMI is 20-25 kg/m2. Overweight is regarded as over these upper levels and the different levels of obesity are defined.

BMI has as its main advantage the ability to be used in large scale population studies. It requires only two measures; height and weight, which can both be measured accurately by a person with minimal training. It suffers similar deficiencies to weight in that it is less valid in those with a mesomorphic build, and particularly athletic men. The validity of BMI, although higher than weight, is lower than is necessary for a good measure of body fatness. Validity has also been found to be higher in women than men and to be significantly influenced by body build.

Comparisons with other anthropometric measures, at least in large populations, show the usefulness of BMI measures. Its reliability is relatively high, but as with weight, this can be influenced by fluid content. Sensitivity could be expected to be similar to that for weight as height is not expected to change significantly, except with age. The BMI therefore is useful for large scale population studies and, in combination with other measures, is useful for individuals. Some researchers have called for the total abandonment of BMI. However, according to Lohman. ‘. . . BMI needs to be included with skinfolds or bioelectric impedence and other laboratory body composition measures of muscle, bone, and fat’.

The limitations of BMI, as with weight, need to be understood in working with individuals, i.e. there is a need to apply other assessments (including a practised ‘calibrated eyeball technique’) to raw BMI data.

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This means the kidney structure is affected by disease. It also goes by the name acute glomerulonephritis. It may be preceded by a seemingly simple infection of the throat, or skin, by a germ called the haemolytic streptococcus. By the time kidney symptoms occur, the original infection has usually cleared up.

Symptoms are often vague to start with. The first may be blood in the urine, and the patient might not seem very ill. Sometimes the amount of urine passed is less than normal, and the patient may seem to gain weight quickly as fluid is retained. There may be slight headaches, feeling off colour, tummy upsets and a mild fever.

Sometimes as the disease progresses, more serious symptoms may occur, as the blood pressure rises and adversely affects the brain. The child may become restless and vomit, and mental vagueness, convulsions, visual disturbances and coma are possible. These complicated forms are uncommon, but if any of these symptoms take place, urgent medical attention is essential. Sometimes as the disease worsens, the heart may be affected and the kidneys become more severely involved.

Treatment

Prompt medical attention is essential with any abnormal urinary symptoms. Blood in the urine needs immediate investigation by the doctor. Although a large number of children appear to recover completely, a certain number develop a longer illness, chronic nephritis. Often hospitalization is necessary.

The important fact is for the parents to be aware of the seriousness of kidney disorders and make certain the child receives prompt attention if showing any of the sinister symptoms that may indicate kidney disease.

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