Echolalia is characterized by a tendency to repeat immediately and spontaneously, like an echo, noises or the words of a speaker.
People with echolalia may be unable to communicate effectively because they have difficulty expressing their own thoughts.
For example, a person may only be able to repeat a question rather than answer it. In many cases, echolalia is an attempt to communicate or learn a language.
It is not the same as Tourette syndrome, where a speaker may suddenly shout or say random things. In this case, the speaker has no control over what he says or when he says it.
Repetitive speech is a common part of language development and is commonly seen in young toddlers learning to communicate. Many children will begin to mix their own utterances with repetitions of what they hear by age 2. The majority of children’s echolalia will be minimal by age 3.
Echolalia is a common symptom for autistic or developmentally delayed children, especially if they are experiencing delayed speech development.
Symptoms of echolalia
The main symptom is the repetition of phrases and noises heard. It can be immediate, with the speaker repeating something immediately after hearing it. The speaker can also be delayed, with the speaker repeating something for hours or days after hearing it.
A person with echolalia may be unusually irritable, especially when asked questions.
Causes and risk factors
All children suffer from echolalia when learning a spoken language. Most develop independent thinking as they age, but some continue to repeat what they hear. Children with communication disabilities retain echoed expressions much longer. Children with autism are particularly susceptible to echolalia.
Some people only experience this problem when they are distressed or anxious. Others experience it all the time, which can eventually make them dumb because they can’t express themselves.
Adults with severe amnesia or head trauma may experience echolalia when trying to regain their speech abilities.
Types of echolalia
There are two broad categories: functional (or interactive) echolalia and non-interactive echolalia, where sounds or words may only be for personal use rather than communication.
Interactive echolalia
It is an attempt at communication intended to be interactional, acting as communication with another person. Examples include:
the person uses sentences to allow an alternating verbal exchange;
speech is used to complete familiar verbal forms spoken by others. For example, if people are asked to complete a task, they might say « good job! » while complementing it, echoing what they are used to hearing.
speech can be used to offer new information, but it can be difficult to make the connections. A mother might ask her child what he wants for lunch, for example, and he’ll sing the song from a lunch meat commercial to say he wants a sandwich.
the person may say, “Do you want lunch? to signify that she wants her own lunch.
Non-interactive echolalia
It is generally not intended for communication and is intended for personal use. For example :
the person with echolalia says something unrelated to the context of the situation, such as reciting excerpts from a television program;
speech is triggered by a situation, visual, person, or activity, and does not appear to be an attempt to communicate;
the speaker may say the same phrase softly to himself several times before responding in a normal voice;
individuals can use guidelines to guide themselves through a process. If they’re making a sandwich, for example, they might say to themselves, “Turn on the water. Use soap. Rinse hands. Turn off the water. Dry hands. Get bread. Put the bread on the plate. Get meat for lunch”, and so on until the process is complete.
Diagnosing echolalia
A professional can diagnose echolalia by having a conversation with the affected person. If she finds it difficult to do anything other than repeat what has been said, it may affect her.
Echolalia ranges from mild to severe. A doctor can identify the stage of echolalia and prescribe the appropriate treatment.
Treatment
Echolalia can be treated by a combination of the following methods:
Speech therapy
Some people with echolalia attend regular speech therapy sessions to learn how to speak their mind.
In this treatment, the speech therapist asks the person with the condition to answer a question correctly.
Medications
A doctor may prescribe antidepressants or anti-anxiety medications to combat the side effects of echolalia. It helps the person to stay calm. Since symptoms can increase when a person is stressed or anxious, the calming effect can help lessen the severity of the condition.
Home Care
People with echolalia can work with others at home to develop their communication skills.
Progressive weakness and loss of muscle mass are caused by Muscular dystrophy.
Mutations in abnormal genes can affect the production of proteins needed to build healthy muscle.
There are many types of muscular dystrophy. Symptoms of the most common variety begin in childhood, usually in boys. Other types only surface in adulthood.
There is no cure for muscular dystrophy. But medications and therapy can help manage symptoms and slow the progression of the disease.
Symptoms
1. Duchenne-type muscular dystrophy
This is the most common form. Although girls can be carriers and mildly affected, it is much more common in boys than girls.
Symptoms, which usually appear in early childhood, may include
Frequent falls
Difficulty getting up from a lying or sitting position
Difficulty running and jumping
Waddling gait
walk on toes
Muscle pain and stiffness
Learning disabilities
stunted growth
2. Becker muscular dystrophy
The signs and symptoms of Becker muscular dystrophy are similar to those of Duchenne muscular dystrophy, but they progress more slowly. Symptoms usually begin in adolescence, but may appear in your twenties or later.
3. Other types of muscular dystrophy
Some types of muscular dystrophy are defined by where symptoms begin.
Myotonic. This is characterized by an inability to relax the muscles after contractions. The face and neck muscles are usually the first to be impacted.
Facio-scapulo-humeral muscle . Muscle weakness usually begins in the face, hip and shoulders. Onset usually occurs in adolescence, but can begin in childhood or up to age 50.
Congenital. This type affects both boys and girls and is apparent at birth or before age 2. Some forms progress slowly and cause mild disability, while others progress rapidly and cause severe impairment.
Girdle myopathies. The hip and shoulder muscles are usually affected first. People with this type of muscular dystrophy may have difficulty lifting the front part of the foot and therefore may stumble frequently. Onset usually begins in childhood or adolescence.
Causes of Muscular Dystrophy
Certain genes are involved in making proteins that protect muscle fibers. Muscular dystrophy occurs when one of these genes is defective.
Each form of muscular dystrophy is caused by a genetic mutation specific to the type of disease. Most of these mutations are inherited.
Risk factors
Muscular dystrophy occurs in both sexes and at all ages and affects all races. However, the most common variety, Duchenne, usually occurs in young boys. People with a family history are at higher risk of developing the disease or passing it on to their children.
Complications
Complications associated with progressive muscle weakness include:
Difficulty walking.
Difficulty using the arms.
Shortening of the muscles or tendons around the joints (contractures).
Breathing problems.
Curved spine (scoliosis).
Heart problems.
Swallowing problems.
Diagnostic
The doctor will likely begin by taking the patient’s medical history and doing a physical exam.
After that, he might recommend:
Enzymatic tests (creatine kinase).
A genetic test.
A muscle biopsy.
echocardiogram
Pulmonary function tests.
Electromyography.
Treatment
Although there is no cure for any form of muscular dystrophy, treating some forms of the disease can help extend the time a person with the disease can stay mobile and strengthen heart and lung muscles.
People with muscular dystrophy should be monitored throughout their lives. The care team should include a neurologist specializing in neuromuscular diseases, a specialist in physical medicine and rehabilitation, physiotherapists and occupational therapists.
Some people may also need a pulmonologist (pulmonologist), cardiologist, endocrinologist, and orthopedic surgeon.
1. Medicines
The doctor may recommend:
Corticosteroids. Prolonged use of these types of medications, however, can cause weight gain and weaken bones, increasing the risk of fracture.
Medicines such as eteplirsen or golodirsen.
Heart medications, such as angiotensin -converting enzyme (ACE) inhibitors or beta-blockers, if muscular dystrophy is damaging the heart.
2. Therapy
Several types of exercises and devices can improve the quality and sometimes the length of life for people with muscular dystrophy:
Range of motion and stretching exercises.
Low-impact aerobic exercise, such as walking and swimming, can help maintain strength, mobility, and overall health.
Braces.
Canes, walkers and wheelchairs.
Device to combat sleep apnea.
3. Surgery
Surgery may be needed to correct any contractures or curvature of the spine that could possibly make it harder to breathe.
4. Prevent respiratory infections
Respiratory infections can lead to complications. It is therefore important to be vaccinated against pneumonia and to keep up to date with flu shots.
Dystonia is a movement disorder in which muscles contract involuntarily, causing repetitive or twisting movements of a limb or body part.
It is distinguished between primary (or primitive) dystonia and secondary dystonia.
Primary dystonia
It is most often sporadic and localized. The different forms of primary dystonia are:
Generalized dystonia. It is a dystonia which is localized at the beginning then which generalizes all the more so as it begins early, with for consequence a severe incapacity. It is an autosomal dominant disease (also called Schwalbe-Ziehen-Oppenheim disease).
focal dystonia. It is more common in women, except for writer’s cramp.
Spasmodic torticollis. It affects the muscles of the neck, causing lateral deviation of the head (torticollis), and sometimes extension (retrocollis) or flexion (antecolis) of the head. About 3 per 10,000 people suffer from it.
Blepharospasm. It is characterized by sustained contraction of the orbicularis of the eyelids, often triggered by bright light or emotional stress.
Oromandibular facial dystonia. It concerns the muscles of the face, lips, tongue and masticatory muscles, innervated by the facial nerve.
Writer’s cramp. It is one of the frequent forms in adults, which is characterized by a contraction of the muscles of the fingers. This condition is especially present in high-risk professions that overuse writing (teachers, doctors, accountants) or in individuals who have poor gestural habits. Spasms begin in the fingers, then spread to the hand and upper limb.
Spasmodic dysphonia. It is caused by a spasmodic contraction of the adductors of the vocal cords.
Secondary dystonia
The main cause of secondary dystonia is the inadequate intake of a drug (iatrogenic dystonia) or the presence of a cerebrovascular accident (CVA) of ischemic or hemorrhagic origin. Appearing from a few weeks to a few years after a stroke, secondary dystonia rather concerns the discal part of the contralateral limbs (hemidystonia). The cause can be detected by magnetic resonance imaging. Wilson’s disease is a hereditary neurological disease caused by an accumulation in the body of copper which cannot be eliminated, and which results, among other things, in dystonia.
Causes
The exact cause of dystonia is not known. It may be due to a problem with nerve transmission in several regions of the brain. Some forms of dystonia are hereditary.
Dystonia can also be a symptom of another disease or condition, including:
Parkinson’s disease
Huntington’s disease
Wilson’s disease
A traumatic brain injury
A birth injury
A cerebral vascular accident
A brain tumor or certain disorders that develop in some people with cancer (paraneoplastic syndromes)
Oxygen deprivation or carbon monoxide poisoning
Infections, such as tuberculosis or encephalitis
Reactions to certain medications or heavy metal poisoning
Complications
Depending on the type of dystonia, complications can include:
Physical disabilities that affect your performance of daily activities or specific tasks
Difficulty seeing that affects your eyelids
Difficulty moving the jaw, swallowing, or speaking
Pain and fatigue, due to constant contraction of your muscles
A mental health disorder (depression, anxiety)
Diagnostic
The doctor will begin by reviewing the medical history, performing a physical examination, and determining the causes through the following tests:
Blood or urine tests. These tests can reveal signs of toxic products.
MRI or CT scan. These imaging tests can identify abnormalities in the brain, such as tumors, lesions, or signs of stroke.
Electromyography (EMG). This test measures the electrical activity in the muscles.
Genetic test. Some forms of dystonia are associated with certain gene mutations.
Treatment
Medications
Injections of botulinum toxin into specific muscles can reduce or eliminate muscle twitching and improve posture. The injections are usually repeated every three to four months.
Side effects are usually mild and temporary. They may include weakness, dry mouth, or voice changes.
Other drugs target neurotransmitters in the brain that affect muscle movement, including:
Carbidopa-levodopa . This medication increases levels of the neurotransmitter dopamine.
Trihexyphenidyl and benztropine. Both of these drugs act on neurotransmitters besides dopamine.
Diazepam, clonazepam, and baclofen.
Therapy
Your doctor might suggest:
Physiotherapy or occupational therapy to help relieve symptoms.
Speech therapy if dystonia affects the voice
Stretching or massage to relieve muscle pain
Surgery
If the symptoms are severe, the doctor might recommend:
Deep brain stimulation.
Selective denervation surgery. This procedure involves cutting the nerves that control muscle spasms.
Usually, swallowing disorders are caused by neurological or esophageal problems or by medications. They can lead to health problems, such as malnutrition and respiratory complications, and social problems.
Their frequency is high in the elderly, especially in institutions, but they are probably underestimated and underdiagnosed. It is useful to screen patients with a swallowing test, especially since the symptoms are not always easy to detect.
It allows us to carry out additional examinations and offer individualized care, in particular on how to eat and stay hydrated.
Swallowing in three stages
Food or liquids are sucked, chewed, and moved down the throat.
Pharyngeal phase: food passes into the throat. The upper esophageal sphincter, which is the tube that goes from the mouth to the stomach, opens, allowing the bolus to pass into the esophagus. The airways are closed to prevent food or any liquid from entering. Food entering the airways can cause coughing or choking.
The esophageal phase begins after the esophagus is closed and ends with the arrival of the bolus in the stomach. Food may get stuck in the esophagus or you may vomit if there is a problem with the esophagus.
Esophageal peristalsis includes a first phase triggered during swallowing by receptors in the posterior pharyngeal wall. The second peristaltic phase is triggered by the arrival of the bolus and the dilation of the esophagus.
Signs of trouble swallowing
The swallowing disorder is called dysphagia.
General signs of a swallowing problem can include:
A cough during or just after eating or drinking
Extra effort or time needed to chew or swallow
Food or liquid leaking from the mouth
Food stuck in mouth
Having trouble breathing after meals
Weight loss
As a result, the person with swallowing difficulties may have:
Dehydration or malnutrition.
Food or liquid entering the airways.
Pneumonia or other lung infection.
Oropharyngeal dysphagia
Oropharyngeal dysphagia is a swallowing disorder that is caused by a structural or functional problem.
Consequences include airway blockage, food transfer into the airways, and aspiration pneumonia.
These eating issues are often accompanied by significant weight loss and have a psychological impact.
Causes of swallowing disorders
Many diseases can cause swallowing problems.
Medications. It is difficult to chew and swallow some medications that cause a dry mouth. Others cause a sedative effect or a decrease in the activity of the central nervous system. Here is a list:
Anxiolytics and some sleeping pills.
Certain antibiotics (aminoglycosides, erythromycin), botulinum toxin or penicillamine can block the neuromuscular junction.
Corticosteroids, colchicine, or statins can decrease muscle tone.
Drugs that lower dopamine levels (antipsychotics, antiemetics or antiparkinsonian drugs that cause undesirable motor effects (e.g. dyskinesias), among others in the mouth and face.
All drugs that lower acetylcholine levels such as tricyclic antidepressants and selective serotonin reuptake inhibitors.
Opiates or inhaled bronchodilators can also cause xerostomia.
NSAIDs can irritate the lining of the esophagus, which is a cause of trouble swallowing.
Other causes are related to brain or nerve damage by:
Cerebrovascular accident (CVA). Strokes are an important cause of dysphagia, particularly when they affect the brain stem or cortical areas involved in swallowing. During the acute phase of stroke, dysphagia is associated with increased mortality and an increased risk of institutionalization.
Parkinson disease. The prevalence of dysphagia in Parkinson’s disease varies between 30% and more than 80% depending on the study. Swallowing disorders can occur very early during the disease, or even precede the appearance of other classic motor signs.
Dementias. All forms of dementia can be accompanied by swallowing disorders, particularly in the severe stage of the disease, while attention disorders and praxis disorders are more significant. Neuroimaging studies indicate a decrease in activity of cortical areas during swallowing in Alzheimer’s patients.
Amyotrophic lateral sclerosis (or Lou Gehrig’s disease). Swallowing disorders are caused by weakness of the various muscles involved in swallowing, resulting in an increased risk of malnutrition.
Other neurological disorders or diseases: multiple sclerosis, muscular dystrophy and cerebral palsy, spinal cord injury.
Disorders or diseases related to the head or neck, such as certain cancers (mouth, throat, or esophagus).
Head or neck injuries.
Mouth or neck surgery.
Poor dentition, missing teeth or ill-fitting dentures.
Evaluation of swallowing disorders
A history and clinical examination are a first step before proceeding to a clinical evaluation or additional examinations.
The anamnesis
The doctor inquires about the patient’s history and current illnesses (e.g. neurological), about his complaints (e.g. pain when swallowing), current drug treatments, the social context (entourage, presence or absence of a caregiver ) and the type of power supply usually used.
Apart from the emergency situation of an obvious aspiration bronchoaspiration, the signs suggestive of dysphagia are often non-specific.
The clinical examination
The examination includes a complete neurological and ENT examination, in particular of the oropharyngeal and cervical region. Cough reflex, voice, speech, saliva production and swallowing, oral status, and breathing at rest are also assessed.
Depending on the cognitive state of the patient, other complementary examinations will be carried out.
Swallowing test
Different evaluation methods are available to detect and quantify swallowing disorders.
Some tests – including the water test – require the patient to swallow a predetermined volume of liquid, usually water.
Videofluoroscopy. This examination allows a real-time dynamic analysis of the different phases of swallowing, the patient swallowing a barium-based contrast product.
Flexible nasal endoscopy. It allows direct visualization of the nasopharynx, pharynx and larynx.
Pharyngoesophageal manometry. It measures pharyngeal pressure during swallowing.
There is also a swallowing screening tool: the Eating Assessment Tool (EAT-10)
Treatments
Management depends on the causes identified during the assessment.
A first step is to train the family and caregivers to detect signs of swallowing disorders and to supervise patients at risk at mealtimes.
It is important to ensure regular oral hygiene.
Management then includes several components: postural adjustment, learning compensatory maneuvers and changes in the volume and consistency of the bolus.
Proper positioning of the patient (ideally vertical and symmetrical) at mealtime reduces the risk of choking. The environment in which the meal is taken should be in a calm atmosphere without distraction.
Rehabilitation based on muscle strengthening of the tongue, respiratory muscles, movements of the lips, cheeks, larynx and vocal cords can improve dysphagia following a stroke.
Are you interested in learning about the benefits of using marijuana to improve your physical and mental health? From reducing pain and inflammation to promoting relaxation and relieving stress, the therapeutic potential of weed is undeniable.
However, how can you ensure you take advantage of weed’s immense healing power? This article will explore three ways weed can help boost your well-being and unlock your inner health.
How Can Cannabis Active and Healthy Lifestyle?
A poll found that four out of every five surveyed consume weed before or after engaging in physical activity. The research was published in the international journal Nature. The fact that people who used cannabis had reduced rates of obesity sparked the inquiry into the topic.
The following are the three ways weed improves your health:
Improve Your Quality of Sleep and Relieve Stress
A healthy lifestyle entails more than just physical activity. Before attempting any type of fitness goal, the body’s basic needs must be met.
This involves getting the rest you need for physical and mental recovery. The majority of the body’s basic healing and growth occurs while sleeping.
Various factors, including stress, anxiety, grief, pain, and disease, can disrupt sleep. Unfortunately, many of these issues are interconnected, all exacerbated by a lack of sleep.
This could be a difficult catch for those not getting enough rest and well-being. Moreover, one of the weeds’ primary benefits is their ability to help with sleep issues. Marijuana is well known for improving sleep quality and relieving stress.
Furthermore, cannabis improves sleep quality by:
Lessening the sensation of pain
Body and mind relaxation
Enhancing convenience
Lowering anxiety
Smoking is not the healthiest activity for someone with an active lifestyle. However, smoking is not the only way to experience cannabis’s soothing qualities.
Weed edibles, such as gummies and chocolate, capsules, and vape pens, are examples of modern marijuana products that offer a smoke-free method to enjoy marijuana’s calming effects. Moreover, edibles come in various shapes, sizes, and flavours that can be used in place of typical snacks and desserts, and you can buy them in any best online weed dispensary.
Strengthen Your Workouts Drive and Concentration
Discipline is required to maintain fitness, activity, and health. It is difficult to exercise when the body is willing, but the mind is resistant. A trace amount of marijuana can help the mind overcome stress, lack of desire, and negative thoughts.
Concentrating and entering the zone is possible by emptying the mind and building a solid mind-body connection. It’s amazing how a minor cannabinoid-induced shift in positive attitude could boost your motivation.
When you start moving, your body releases endorphins, and you feel great and productive. Cannabis can help you focus and experience your fitness on a deeper and more potent level.
Before you know it, you’ve completed your workout, whether a run or a class, and you’re ready to move on to the next set of strength-training activities. Additionally, it has been proved that cannabis provides many health benefits, most notably for patients suffering from chronic pain.
Live resin is an increasingly popular cannabis concentrate known for its strong natural flavour and high cannabinoid content.
THC, the plant’s major psychoactive component, relieves pain and improves the quality of life for patients suffering from chronic diseases. It has also been shown that the chemical enhances the body’s ability to concentrate and focus.
Promotes Rapid Recovery From Exercise
The maintenance of a lifestyle that is both healthy and active calls for self-discipline and may be challenging. It is far too simple to skip days and then overcompensate by exercising more than necessary out of guilt. The next morning, you will likely feel pain and regret.
When day-to-day stress enters your life, in addition to the ups and downs that disrupt your normal sleeping habits, it becomes even more challenging to keep a routine. Indeed, there is a serious conflict. The time needed to recuperate from an intense workout may be reduced because of the therapeutic benefits of cannabis.
Cannabinoids accelerate the rate at which the body recovers from physical exertion by lowering the expression of stress hormones like cortisol and the features associated with inflammatory processes.
Weeds’ Positive Effects on Healthy, Active People
Keeping a Balanced Appetite
If you have an active lifestyle, you know how important it is to eat a diet high in nutrients. Despite this, many individuals are forced to endure hunger daily due to fear, disease, and other factors. Cannabis has been shown to stimulate healthy appetites in anorexic patients, which may benefit patients who have trouble consuming enough food.
Offering Pain Relief
Cannabinoids are responsible for the analgesia and greater physical comfort arising from activating the body’s inherent pain-relieving mechanisms.
The euphoric and intoxicating properties of cannabis contribute to the plant’s soothing effects and enhanced mood; these benefits, along with the plant’s ability to promote sleep, make cannabis an effective medicine.
Conclusion
Cannabis may enhance physical and mental health by lowering pain and inflammation, inducing relaxation, and relieving stress. Moreover, adopting cannabis into a healthy lifestyle can uncover additional benefits, including improved sleep, increased exercise drive, and accelerated physical recovery. It is essential to remember that the effects of cannabis might differ from person to person and to begin with a low dose and progress with caution. Cannabis can be a potent tool for increasing general well-being and leading a healthy lifestyle if utilized correctly.
Dysarthria is a speech disorder that is caused by the degeneration of a muscle or certain brain structures.
These affected structures are the medulla oblongata or the cortex in the latter case.
Multiple sclerosis (a neurological disease) or a stroke can cause dysrathrias.
Parkinson’s disease and Huntington’s disease are some of the neurological diseases that lead to dysarthria. Only the expression is altered.
It is not caused by damage to the organs of phonation (tongue, lips, palate) and must be differentiated from aphasia, which is an oral and/or written language disorder affecting the expression and understanding of speech. language (aphasia is found in particular in Alzheimer’s disease).
Patients have weakness, slowness, or incoordination in breathing, articulation, phonation, rate, and/or prosody (loudness and duration of sound).
The condition is often characterized by slurred or slow speech that can be difficult to understand.
The different forms of dysarthria
Here is the classification of dysarthria with the pathologies in parentheses. 1. Spastic dysarthria (stroke). 2. Flaccid dysarthria (neuropathy innervating the effector muscles of the face, for example). 3. Ataxic dysarthria (involvement of the cerebellum). 4. Hypokinetic (Parkinson’s disease) and hyperkinetic dysarthria (Huntington’s disease). 5. Mixed dysarthria (head trauma, multiple sclerosis, amyotrophic lateral sclerosis).
How are dysarthria assessed?
GBRAS scale
GRBAS stands for Grade, Breathness, Roughness, Asthenicity and Strain.
G (for Grade): what is the general impression of the quality of the voice? R (for Roughness): is the voice hoarse?. B (for Breathness): is a breath audible when the patient speaks? A (asthenicity): is there a feeling of asthenia? S (strain): is there an impression of the patient?
These five parameters are rated from 0 (normal voice) to 3 (maximum alteration of the voice). Scoring is relatively easy for hoarseness and breath, but it is difficult for asthenia and forcing.
Perceptual assessment of dysarthria
It consists of 32 criteria related to the volume and timbre of the voice, breathing, etc. A scale notes the severity of the criterion (0: no anomaly, 4: severe anomaly).
Intelligibility measurement
Several tests translated from English have been developed including the Assessment of Intelligibility in Dysarthric Speakers.
Additional tests
There are instruments that perform acoustic and aerodynamic measurements of speech. For example, the Assisted Voice Assessment device records certain physiological parameters of voice and speech (intensity, pitch, airflow, pressure). .
Chronic pain is one of the costliest health problems. The economic consequences of chronic pain include increased medical expenses, loss of income, loss of productivity, compensation payments, and legal fees.
Low back pain is one of the most important health problems. It is a common cause of activity limitation in adults, especially back pain.
Cancer pain affects most people with advanced cancer.
Approximately 15-20% of the population is affected by arthritis.
Headaches affect millions of adults. Migraines and tension headaches are some of the most common types of chronic headache.
Neuropathy and other pain disorders affect nerves throughout the body.
Pain caused by damage to the central nervous system (the brain and spinal cord) as well as pain without a physical cause.
What is the source of the pain?
The pain begins in the receptor nerve cells located under the skin and in the organs of the body. The message is sent along nerve pathways to the spinal cord, which then transmits the message to the brain when you are sick, injured or have a problem. These messages are reduced or blocked by painkillers before they reach the brain.
The pain can be something bothersome, like a mild headache, or very intense, like chest pain that accompanies a heart attack, or pain due to kidney stones. The pain can be acute, that is to say new, subacute, lasting a few weeks or a few months, and chronic, when it lasts more than 3 months.
Are there different types of pain?
Two types of pain include the following:
Acute pain. This pain can be from inflammation, tissue damage, injury, disease, or recent surgery. This usually lasts less than a week or two. The pain usually ends after the underlying cause is treated.
Chronic pain. Pain that persists for months or even years.
What is chronic pain?
Chronic pain is persistent pain that persists beyond the usual recovery period or occurs alongside a chronic health condition, such as arthritis, Chronic pain can be “on” and “off” or continuous. It can affect people to the point that they can no longer work, eat properly, exercise, or enjoy life.
Chronic pain is a major medical condition that can and should be treated.
What is the cause of chronic pain
There are many causes of chronic pain. You may have experienced an illness or injury that you have recovered from for a long time, but the pain remained. Or there may be an ongoing cause of pain, such as arthritis or cancer. Despite a previous injury or signs of illness, many people experience chronic pain.
There are usually three causes of chronic pain:
Inflammatory causes: example of rheumatoid arthritis. Peripheral nerve fibers are abnormally sensitive to pain.
Neuropathic causes: Neuropathic pain is the consequence of damage to the nerves and nervous system.
Central pain due to a central abnormality in the pain control system. This includes, for example, tension headaches, fibromyalgia, somatic chest pain or irritable bowel syndrome.
Pain, sleep and psychological disorders form a triad
When pain becomes such a problem that it interferes with work and normal life activities, you can become the victim of a vicious cycle. Pain can worry you, depress you, and irritate you. Depression and irritability often lead to insomnia and lassitude, resulting in more irritability, depression, and pain. The urge to stop the pain can lead some people to become addicted to drugs and can lead others to undergo repeated surgeries or resort to questionable treatments. Family members may find the situation as difficult as the sufferer is.
How is chronic pain treated?
The most effective treatment includes symptom relief and support. A multidisciplinary approach is often needed to provide the resources to manage pain.
Neurologists and Neurosurgeons
Orthopedists and orthopedic surgeons
Anesthesiologists
Oncologists
Nurses
Physiotherapists
Occupational therapists
Psychologists/psychiatrists
Special pain programs are offered in many hospitals, rehabilitation centers and pain clinics.
Rehabilitation program to manage pain
A rehabilitation program for pain management is designed to meet your needs. The schedule will depend on the specific type of pain and disease. Your active participation and that of your family is essential to the success of the program.
Pain management programs are designed to help you achieve the highest level of functioning and independence possible, while improving your overall quality of life – physically, emotionally and socially. Pain management techniques help reduce your suffering.
To help achieve these goals, pain management programs may include:
Medical management of chronic pain, including drug management:
Over-the-counter medications may include nonsteroidal anti-inflammatory drugs, aspirin, or acetaminophen.
Prescription painkillers, including opioids, may be needed to relieve pain more strongly than aspirin. However, these drugs are reserved for more severe types of pain, as they have some potential for abuse and can have unpleasant and potentially very dangerous side effects.
Prescription antidepressants can help some people. These medications increase the supply of the naturally produced neurotransmitters serotonin and norepinephrine. Serotonin is an important part of a pain control pathway in the brain.
Heat and cold treatments to reduce stiffness and pain, especially with joint problems such as arthritis
Physiotherapy and occupational therapy such as massages and whirlpool baths
Exercise to reduce spasticity, joint contractures, joint inflammation, spinal alignment problems, or weakening and shrinking of muscles to prevent other problems
Local electrical stimulation involving the application(s) of brief electrical pulses to nerve endings under the skin to relieve pain
Injection therapies, such as epidural steroid injection
Emotional and psychological support for pain, which may include the following:
Psychotherapy and group therapy
Stress management
Training on relaxation methods
Meditation
Hypnosis
Biofeedback
The philosophy common to all of these varied psychological approaches is the belief that you can do something on your own to control pain. This includes changing your attitudes, perception of being a victim, feelings or behaviors associated with pain, or understanding how unconscious forces and past events have contributed to the pain.
Additionally, treatment may include:
Operation. Surgery may be considered for chronic pain. Surgery can relieve pain, but can also destroy other sensations or become the source of new pain. The relief is not necessarily permanent and the pain may return. There are a variety of operations to relieve pain.
Acupuncture. Acupuncture is a 2000-year-old Chinese technique of inserting thin needles under the skin at selected points on the body and has shown promise in treating chronic pain. The needles are manipulated by the practitioner to produce pain relief.
Common dysfunctional beliefs
Pain is synonymous with progressive tissue damage rather than the result of a stable problem. This belief leads to more suffering.
Chronic pain decreases with prolonged rest. This belief encourages passivity
The pain is inexplicable. This belief leads the patient to minimize his ability to reduce pain.
La perte de cheveux chez les hommes est la forme la plus courante de perte de cheveux chez les hommes, affectant environ 30 à 50% à l’âge de 50 ans.
La recherche montre que la nutrition joue un rôle important dans la perte de cheveux chez les hommes. Certaines études montrent que le métabolisme du glucose peut causer la perte de cheveux.
Récemment, des chercheurs de l’Université Tsinghua, à Beijing, en Chine, ont examiné le lien entre la consommation de boissons sucrées et la perte de cheveux.
Ils ont constaté qu’une consommation plus élevée de BSR est corrélée à un risque plus élevé de perte de cheveux.
« Traditionnellement, la plupart des médecins ou des chirurgiens de restauration capillaire comprennent que les nutriments et l’alimentation jouent un rôle clé dans la santé et le bien-être globaux de nos patients », a noté le Dr Williams. « L’exercice, l’évitement des produits du tabac et des drogues illicites, une bonne nutrition et une alimentation équilibrée sont essentiels à la santé et à la longévité de nos patients. »
Boissons sucrées et perte de cheveux
Les chercheurs ont recruté 1028 étudiants et enseignants âgés en moyenne de 27,8 ans dans 31 provinces de Chine.
Les participants ont reçu un sondage dans lequel ils ont rempli des informations sur :
Informations sociodémographiques de base
État des cheveux
Apport alimentaire
mode de vie
l’état psychologique;
La consommation de boissons sucrées a été déterminée à partir des réponses à un questionnaire de consommation de boissons de 15 questions, qui examinait leur consommation de boissons au cours du dernier mois. Les boissons sucrées comprenaient :
boissons de jus sucrées
boissons gazeuses
Boissons énergisantes et pour sportifs
lait sucré
thé et café sucrés
Dans l’ensemble, 57,6 % des participants ont déclaré une perte de cheveux, alors que les autres n’en ont pas déclaré.
Les chercheurs ont constaté que les personnes atteintes de perte de cheveux étaient plus susceptibles de :
être plus âgé
être fumeur actuel ou ancien
avoir un niveau d’éducation inférieur
faire moins d’activité physique
avoir une durée de sommeil plus courte
souffrir d’anxiété sévère ou de TSPT
avoir des antécédents familiaux positifs de perte de cheveux
avoir des maladies liées à la perte de cheveux
d’avoir des cheveux teints, décolorés
Ils ont également constaté que les personnes atteintes de perte de cheveux consommaient plus d’aliments frits, de sucre et de miel, de bonbons et de crème glacée, et moins de légumes que ceux sans la condition.
Par rapport à ceux qui ne sont pas atteints de la maladie, les personnes atteintes de perte de cheveux chez les hommes consomment en moyenne 4,3 litres de boissons sucrées par semaine.
Ils ont également constaté que les antécédents de la maladie influençaient le lien entre la prise de boisson sucrée et la perte de cheveux. Ils ont par ailleurs noté un lien entre la fréquence de la consommation de boissons sucrées et du trouble anxieux, et le trouble anxieux et la perte de cheveux chez les hommes.
Les chercheurs ont noté que l’association entre la consommation de boissons sucrées et la perte de cheveux existait même après la prise en compte des facteurs sociodémographiques, l’apport alimentaire et l’état psychologique.
L’effet de la consommation de sucre sur les cheveux.
Les scientifiques suggèrent qu’une consommation plus élevée de sucre augmente la concentration de sucre dans le sang, ce qui déclenche des voies de polyol, qui convertissent le glucose en d’autres sucres.
Des études montrent que ce processus réduit la quantité de sucre dans les follicules pileux, ce qui peut conduire à une perte de cheveux. Elle a ajouté que la consommation de sucre s’accompagne souvent d’un apport excessif en lipides, qui est également lié à la perte de cheveux.
Le Dr Zhao a mentionné que des études antérieures ont montré qu’une consommation élevée de sucre est liée à des problèmes de santé mentale. Selon une méta-analyse, ceux qui boivent l’équivalent de trois canettes de cola par jour ont un risque de dépression 25% plus élevé que ceux qui ne le font pas.
Limites de l’étude
Comme l’a noté le Dr Zhao, leurs résultats sont limités, car ils se sont appuyés sur des données autodéclarées plutôt que sur des diagnostics cliniques. Les chercheurs ont également noté qu’ils n’avaient pas recueilli de données sur la consommation d’autres produits sucrés et qu’ils ne pouvaient pas distinguer la gravité de la perte de cheveux.
Le Dr George Cotsarelis, professeur de dermatologie à l’Université de Pennsylvanie et directeur des cliniques capillaires et du cuir chevelu de l’Université de Pennsylvanie, non impliqué dans l’étude, a déclaré :
« L’étude ne montre qu’une corrélation entre les boissons sucrées et la calvitie. Je doute qu’il s’agisse d’une corrélation réelle, car il est difficile d’imaginer comment les boissons sucrées pourraient avoir un impact sur la calvitie. De plus, parmi les hommes qu’ils ont étudiés, le groupe chauve avait un pourcentage plus élevé d’hommes ayant des antécédents familiaux de calvitie.
Le Dr Williams a noté que l’étude est détaillée et bien conçue. Cependant, il a ajouté qu’il ne recommande pas nécessairement d’éliminer toutes les boissons contenant du sucre.
Je recommande de toujours avoir une alimentation équilibrée et de consommer des groupes d’aliments sains et des sources nutritionnelles. Évitez les produits du tabac, les drogues et la consommation excessive d’alcool, a-t-il conclu.
Diabetes has detrimental consequences on brain function and mental state in the elderly, since it accelerates cognitive decline and increases the risk of the onset of depressive symptoms and cerebrovascular accidents (CVA) of ischemic origin in the elderly.
In the general population, diabetes prevalence is around 5% and 10% in subjects over 65, with an increasing proportion as the population ages (25% in those over 75 ).
However, with the improvement of our lifestyle and the existence of effective preventive measures against stroke, diabetics are able to live longer with fewer major complications.
Diabetes decreases the faculties of the brain
There is growing evidence that diabetes impairs brain function.
Diabetes increases the risk (by about 100%) of seeing decline in cognitive functions, compared to non-diabetics.
The association between diabetes and arterial hypertension – which is associated with a more pronounced decline in cognitive abilities – being very frequent, it is difficult to assess the exact role of diabetes.
In 2014, researchers found that people who develop diabetes or hypertension between the ages of 40 and 64 are more likely to have neuronal loss and/or cognitive disorders (memory problems, thought disorders)
According to one of the study authors (Mayo Clinic), « if we prevent diabetes and hypertension, we can prevent or delay brain damage that occurs decades later ».
To reach this conclusion, the researchers recruited 1,437 people with an average age of 80 who underwent neuroimaging examinations to detect markers associated with brain damage.
Results: people with diabetes have an average brain volume 3% smaller than that of non-diabetic subjects. Such a reduction in volume is also observed in patients who suffer from hypertension.
The researchers conclude that these diseases take decades to produce their deleterious effects on the brain, leading to cognitive impairments that affect memory and thinking.
In the same year, another group showed that type two diabetes could be associated with premature brain aging, according to a study carried out on 614 patients (average age = 62 years) followed for an average of 10 years.
This conclusion is in line with previous studies that reported a link between type 2 diabetes and ischemia affecting small vessels, a disease during which the brain does not receive enough oxygenated blood.
« These patients show less brain tissue, suggesting the presence of cerebral atrophy, » said one of the study’s authors.
The authors used the magnetic resonance imaging technique to assess the patients’ brain volume. The results further reported a positive association between duration of diabetes and loss of brain volume, particularly in gray matter. More specifically, the results suggest that a person with diabetes for 10 years exhibits premature brain aging (of a period of 2 years) compared to a non-diabetic patient.
These results are in line with those of previous longitudinal studies, confirming that the cognitive functions of diabetics deteriorate more rapidly.
In a six-year follow-up study of a group of 9679 women over the age of 65, diabetics whose disease had been evolving for more than 15 years had a 57 to 114% increased risk of presenting with cognitive decline.
Several hypotheses have been put forward to explain this link:
Hyperglycemia affects neurons in the hippocampus, a key brain region involved in learning and remembering events.
Diabetes is accompanied by inflammation in the brain – called neuroinflammation – which also damages neurons.
Dysregulation of glucose levels affects neurons in the brain that produce a neurotransmitter called acetylcholine. This neurotransmitter is necessary to obtain a memory.
The microalbuminuria (low amounts of albumin in the urine) present in diabetics reflects a dysfunction of the vascular system which prevents poor oxygenation of the brain.
Research is investigating the possible beneficial effects of treating diabetes with insulin in preventing cognitive decline. This is particularly the case of intranasal insulin injections which would provide protection to the brain.
Watch out for hypoglycaemia
The brain is particularly sensitive to changes in blood sugar – especially hypoglycemia. The consequences of hypoglycaemia can be serious in elderly diabetics. Thus, elderly people with diabetes are five times more likely to be hospitalized than younger people due to a greater risk of hypoglycaemia.
A study suggests that hypoglycemia, which occurs frequently in patients with diabetes, can negatively influence cognitive performance. These cognitive disorders will in turn compromise the management of diabetes and lead to hypoglycemia.
These are the conclusions of an American study (University of California, San Francisco) involving 783 adults (average age 74 years) with diabetes. After 12 years of follow-up, 8% had a reported episode of hypoglycaemia and 19% developed dementia.
Patients who had a hypoglycemic event had a twice as high risk of developing dementia compared to those who did not (34% versus 17%).
In addition, elderly diabetics who have developed dementia have a greater risk of subsequently having an episode of hypoglycemia compared to patients who have not developed dementia (14% versus 6%).
Obtaining a normal blood sugar level would improve – or at least maintain – his cognitive performance.
Dementias
Diabetes: arisk factor for vascular dementia?
Diabetes is a risk factor for cerebrovascular accident (CVA) which promotes the development of vascular dementia, with a risk multiplied by 2 to 2.6 according to studies. If the individual has suffered a stroke, this risk can be multiplied by eight. The presence of hypertension in diabetics plays an important role in this increase.
Alzheimer’s disease
Diabetes could also be a cardiovascular risk factor in the onset of Alzheimer’s dementia, with an estimated increased risk of between 45% and 90% depending on the studies.
However, this link is questioned by other studies.
Better prevention of dementia would be possible thanks to a normalization of blood sugar, in the same way as arterial hypertension.
The Depression
Depression can be mistaken for dementia or, conversely, can be one of the first symptoms of Alzheimer’s disease. It is therefore important to detect it, which is often difficult.
According to scientific data, about 20 to 30% of elderly diabetics suffer from depression, including 10% from major depression. There would be at least one depressive symptom in half of elderly diabetics.
According to a study conducted in 2015 on people with diabetes (average age = 54 years), they have difficulties with family functioning and a lower quality of life.
Stroke
Diabetes is usually considered one of the major risk factors for stroke, with an increased risk of 50% to 100%. The risk of stroke is all the higher when the subject is hypertensive, has atrial fibrillation, carotid stenosis or a history of stroke. In addition, the occurrence of a stroke in a diabetic is strongly associated with a high risk of disability and higher mortality.
In 2016, researchers showed that type 2 diabetics have a greater risk (+60%) of developing dementia, compared to those without diabetes. Additionally, women with type 2 diabetes have a much higher risk of developing vascular dementia than men with diabetes. Indeed, the risk of vascular dementia is multiplied by 2.3 in women and by 1.7 times in men, compared to those who do not have diabetes. The analysis included data from 14 studies with more than 2.3 million people and more than 100,000 cases of dementia.
These results suggest that diabetes increases the risk of developing vascular dementia and that women with diabetes are particularly vulnerable. A previous study reported that people with diabetes had a 70% increased risk of dementia. However, these results are limited by the fact that most cases of dementia were reported in people of Asian origin.
The researchers were unable to analyze the links between the duration of diabetes, glycemic control and dementia. They suggest, however, that treatment differences in diabetes management – particularly poor care for women – may play a role in these results.
Further physiological studies are needed to examine how blood sugar interacts with the vasculature and whether there are notable gender differences.
On the other hand, diabetes seems to protect against the occurrence of hemorrhagic strokes, with a risk of stroke of hemorrhagic origin reduced by a factor of 4 to 10.
Prevention
Stroke prevention is possible through risk factor control and better blood sugar control. Controlling blood pressure is an essential part of stroke prevention. However, too great a decrease in blood pressure can lead to a stroke through a drop in cerebral circulation.
The use of statins is also found to be very beneficial. Thus, simvastatin (40 mg) or atorvastatin (10 mg) can reduce strokes by 25% to 50%.
In addition, antiplatelet drugs are recommended to reduce the risk of stroke. Aspirin is very frequently used in elderly diabetics at high risk of stroke.
The surgical management of carotid stenosis does not differ from that of non-diabetic subjects. The occurrence of a stroke and the operative risk are higher, but the benefit of an intervention is greater in diabetics. The indication for surgery must therefore be established according to the general condition of the elderly subject and the severity of the stenosis.
Diabetes increases the risk of heart and brain disease
The risk of developing cardiovascular disease is almost twice as high in patients who develop type 2 diabetes before age 40, compared to those who develop the disease later. The age of diagnosis of type 2 diabetes is getting younger around the world, mainly due to rising rates of obesity.
“Given the increasingly frequent onset of type 2 diabetes at an early age, it is hardly surprising that cardiovascular complications also appear earlier and earlier due to an increasingly unfavorable environment. a long time,” explains the lead author of the study.
The researchers used a large diabetes database, with participation from 630 hospitals and 222,773 patients. The average age of the cohort is 58.3 years. Patients who had early-onset diabetes were on average 34 years old, compared to 55 for those who developed diabetes later in life.
Early-onset type 2 diabetes was associated with a greater risk (+91%) of diseases associated with the brain and heart system (coronary heart disease and stroke), compared to late-onset diabetes.
According to some experts, the best way to measure risk in young patients with type 2 diabetes is to identify and treat cardiovascular risk factors. A very high proportion – around 80% – of young people with type 2 diabetes have at least two cardiovascular risk factors.
Septuagenarians are healthier than their elders
Americans with diabetes born in the 1940s live longer without major complications and with fewer disabilities than those born 10 years earlier.
These major complications are heart attack, stroke and amputations.
The three types of disability were reduced mobility, inability to carry out activities of daily living and total or partial inability to carry out essential activities (use of the telephone, shopping, meal preparation, etc.).
The messages of the medical authorities aiming to sensitize the individuals to have a better hygiene of life are undoubtedly for something.
This health improvement also concerns people who are not necessarily diabetic. The data analysis focused on Americans born in the 1930s and 1940s, more than 10% of whom had diabetes.
However, this improvement may not last in the United States due to rising obesity rates and poorer lifestyles. In this country, the incidence of type 2 diabetes has more than doubled in the last 20 years
Diabetes and brain disease article references
Barbagallo M and Dominguez LJ. Type 2 diabetes mellitus and Alzheimer’s disease. World J Diabetes 2014 December 15; 5(6): 889-893
Bardenheier BH et al. Compression of disability between two birth cohorts of US adults with diabetes, 1992–2012: a prospective longitudinal analysis. The Lancet Diabetes and Endorinology, June, 2016.
Bryan RN et al. Effect of diabetes on brain structure: the action to control cardiovascular risk in diabetes MR imaging baseline data. Radiology. July 2014: 210-6.
Chatterjee S et al. Type 2 Diabetes as a Risk Factor for Dementia in Women Compared With Men: A Pooled Analysis of 2.3 Million People Comprising More Than 100,000 Cases of Dementia. Diabetes care, December 2015.
Huo X et al. Risk of non-fatal cardiovascular diseases in early-onset versus late-onset type 2 diabetes in China: a cross-sectional study. The Lancet Diabetes & Endocrinology, Volume 4, No. 2, p115–124, February 2016.
Roberts RO et al. Association of type 2 diabetes with brain atrophy and cognitive impairment. Neurology, 2014.
Saedi E et al. Diabetes mellitus and cognitive impairments. World J Diabetes 2016 September 15; 7(17): 412-422.
Wang J et al. Depressive Symptoms, Family Functioning and Quality of Life in Chinese Patients with Type 2 Diabetes. Can J Diabetes 39 (2015).
Yaffe K et al. Association Between Hypoglycemia and Dementia in a Biracial Cohort of Older Adults With Diabetes Mellitus, Hypoglycemia and Dementia in Older Adults With DM. JAMA Internal Medicine, June 2013.
Depression in the elderly is different from depression in a young person. Older people have more somatic complaints and minimize their state of sadness. They are often hypochondriac and have an increased risk of chronic diseases.
Depression is one of the forms of mood disorders that are generally classified as follows:
major depression which causes the individual to work normally, sleep well and eat well, concentrate and enjoy the pleasures of life. A person usually has several episodes of major depression;
dysthymia, with less severe symptoms but lasting longer (at least two years);
minor depression, with symptoms of less severe intensity than in the two previous cases and which are temporary.
Mood disorders are the most common mental disorders in the elderly. Indeed, old age is a period of vulnerability conducive to the onset of mood disorders.
Here are some risk factors that may trigger depression in the elderly:
Loneliness (or feelings of loneliness) and social isolation.
Consequences of retirement (e.g. feeling useless, loss of activity).
Interpersonal conflicts.
Death of close friends.
Anniversary date of the bereavement.
Loss of autonomy due to physical illnesses.
Hormonal disruption due to dysregulation of melanin or thyroid hormones.
To be female.
Suffer from a chronic disease (cancer, diabetes, heart disease).
Restless sleep.
Have a family history of depression.
Take certain medications.
Consuming too much alcohol.
Leading a stressful life (caring for someone with a chronic illness).
Major depression in the elderly is not properly taken care of because those around you mistakenly believe that it is normal to be sad because you have lost a loved one or because you are losing your autonomy. However, in the case of depression, the sadness persists.
Prevalence of depression
The prevalence of depression in people aged 65 and over is estimated at around 1%, while 5% of people over 65 suffer from depressed mood. Here are the prevalence percentages according to age categories.
Population
Percentage
Male (55-75 years old)
2.6
Female (55-75 years old)
6.6
All 15-75 years old
7.8
Etiologies
Genetic causes : Having a first-degree relative who suffers from recurrent depression increases the risk of suffering from depression by two to four. Studies with homozygous twins confirm the role of heredity, with an increased risk of around 40%.
Physiological causes : activation of the hypothalamic-pituitary axis associated with an abnormally high level of cortisol is observed in patients with major depression, leading to inhibition of growth factors (including BDNF) and dysregulation of monoaminergic neurotransmitters (noradrenaline, serotonin, and dopamine).
Psychological causes : A certain view of life (tendency to a negative view of oneself, events and a pessimistic approach to the future)
Social causes : acute stress caused by different events: job loss, poverty, social exclusion, family conflicts, excessive demands, physical health problems, death of a loved one can be the cause of depression, as well than harmful experiences during childhood or adolescence.
Diagnostic criteria
The diagnostic criteria are those taken from the American psychiatry manual DSM IV and the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10, World Health Organization). However, classifications of depression are not entirely suitable for older people because they tend not to express their sadness verbally.
DSM V Criteria
A: at least 5 symptoms during the same 2-week period and represent a change from normal functioning; at least one of the following symptoms: One of the following symptoms:
depressed mood;
anhedonia (loss of interest or pleasure)
significant weight loss or gain (5%) or increased or decreased appetite almost daily;
insomnia or hypersomnia;
psychomotor agitation or retardation;
fatigue or loss of energy;
feeling of worthlessness or excessive or inappropriate guilt;
loss of concentration;
recurrent thoughts of death, suicidal ideation or attempted suicide.
B: Symptoms cause significant distress and impairment of daily functioning.
C: The symptomatology is not attributable to the physiological effects of a substance or a medical condition.
D: the onset of the depressive episode is not explained by schizophrenia or delusional disorder.
E: no previous manic or hypomanic episode.
ICD-10 criteria
In the ICD-10 manual (2003), mood disorders are divided into seven parts. Most of these disorders tend to be recurrent. The onset of individual episodes can often be related to stressful situations or events. The change in mood is usually accompanied by a change in overall activity level.
1. Manic episode 1.a Hypomania. 1.b Mania without psychotic symptoms. 1.c Mania with psychotic symptoms (delusions, hallucinations, agitation, or hyperactivity).
2. Bipolar affective disorder The mood and level of activity of the subject are profoundly disturbed, sometimes in the sense of elevation (hypomania or mania), sometimes in the direction of depression (depression). 2.a Subject is currently hypomanic, and has had at least one other affective episode in the past. 2.b Subject is currently manic with no psychotic symptoms. 2.c Subject is currently manic, with psychotic symptoms. 2.d The subject is currently depressed, such as during a depressive episode of mild or moderate intensity. 2.e The subject is currently depressed, such as during a depressive episode of severe intensity without psychotic symptoms. 2.f Subject is currently depressed, such as during a depressive episode of severe intensity with psychotic symptoms. 2.g Simultaneous or alternating presence of manic and depressive symptoms. 2.h Bipolar affective disorder, currently in remission.
3. Depressive episodes 3.a Mild depressive episode. The subject remains, most often, able to continue most of its activities. 3.b Moderate depressive episode. The subject experiences considerable difficulty in continuing his or her usual activities. 3.c Severe depressive episode without psychotic symptoms. Suicidal thoughts and acts are common, and several “somatic” symptoms are usually present. 3.d Severe depressive episode with psychotic symptoms (hallucinations, delusions) or psychomotor retardation or stupor. Usual social activities are impossible. Risk of suicide, dehydration, or malnutrition.
4. Recurrent Depressive Disorder 4.a A disorder characterized by the repeated occurrence of depressive episodes, the current episode being mild, moderate, or severe in intensity, in the absence of any history of mania and without psychotic symptoms. 4.b Disorder characterized by the repeated occurrence of depressive episodes, the current episode of severe intensity with psychotic symptoms. 4.c Recurrent depressive disorder, currently in remission (F33-4)
5. Persistent Mood Disorders 5.a Persistent and usually fluctuating mood disorders in which most individual episodes are not severe enough to warrant a diagnosis of hypomanic episode or mild depressive episode. 5.b Cyclothymia: Persistent instability of mood, including numerous periods of depression or slight elation (F34-0). 5.c Dysthymia : chronic low mood.
6. Other mood disorders
7. Mood disorder, unspecified
Depression in the elderly is different from depression in a young person. Older people have more somatic complaints and minimize their state of sadness. They are often hypochondriac and have an increased risk of chronic diseases.
Depression is one of the forms of mood disorders that are generally classified as follows:
major depression which causes the individual to work normally, sleep well and eat well, concentrate and enjoy the pleasures of life. A person usually has several episodes of major depression;
dysthymia, with less severe symptoms but lasting longer (at least two years);
minor depression, with symptoms of less severe intensity than in the two previous cases and which are temporary.
Mood disorders are the most common mental disorders in the elderly. Indeed, old age is a period of vulnerability conducive to the onset of mood disorders.
Here are some risk factors that may trigger depression in the elderly:
Loneliness (or feelings of loneliness) and social isolation.
Consequences of retirement (e.g. feeling useless, loss of activity).
Interpersonal conflicts.
Death of close friends.
Anniversary date of the bereavement.
Loss of autonomy due to physical illnesses.
Hormonal disruption due to dysregulation of melanin or thyroid hormones.
To be female.
Suffer from a chronic disease (cancer, diabetes, heart disease).
Restless sleep.
Have a family history of depression.
Take certain medications.
Consuming too much alcohol.
Leading a stressful life (caring for someone with a chronic illness).
Major depression in the elderly is not properly taken care of because those around you mistakenly believe that it is normal to be sad because you have lost a loved one or because you are losing your autonomy. However, in the case of depression, the sadness persists.
Here are some clinical features of depression in the elderly that are sometimes the same as in younger subjects:
persistent feelings of sadness and hopelessness.
Pessimism.
Inability to find a pleasant life as before.
Disturbed sleep (sleeps little or not enough).
Unexplained crying spells.
Change in appetite and weight.
Disinterest in sexuality.
Fatigue, lack of energy.
Clothing or bodily negligence.
Feelings of worthlessness and guilt.
Psychomotor restlessness or retardation.
Loss of interest in things.
Suicidal thoughts.
Loss of self-esteem.
Anxiety which is often the mask of depression.
Hypochondriacal and delusional symptoms.
Irritability and hostility.
Inability to take pleasure in doing an activity, eating, etc. (anhedonia)
Difficulty concentrating and remembering.
Difficulties making decisions.
Diagnosis and assessment of severity
The Geriatric Depression Scale (or GDS): This is a test to diagnose depression in an older person.
The Hamilton Depression Scale : This is the most widely used test to assess the intensity of depressive symptoms.
Before starting treatment with an antidepressant, it is important to pay attention to the symptoms, with particular attention to the following:
Dysphoric restlessness
Suicidal risk
Psychotic symptoms
Possible comorbidity
Depression in the elderly associated with certain chronic diseases
Older people with depression have an increased risk of cardiovascular disease, Parkinson’s disease and Alzheimer’s disease. On the other hand, elderly people suffering from a chronic illness (diabetes, high blood pressure, heart problem) are two to four times more likely to have major depression than others of the same age and in good health.
Depression and somatic complaints
Somatic complaints are an integral part of depression in the elderly. Indeed, a depressed person can express his suffering through pain in his body. It is estimated that half to three quarters of depressed people who consult have somatic symptoms such as gastrointestinal disorders, joint pain or cardiovascular symptoms.
Treatment
Antidepressants. When the diagnosis of major depression is made in the elderly, studies report that the effectiveness of an antidepressant is recognized compared to a placebo, which is not the case if the depression is minor.
It is common for older people to try several antidepressants before finding the right drug, leading to a remission rate of over 80%. Combinations of antidepressants are not recommended.
It is important not to stop treatment without the advice of your doctor. Treatment should be continued for several months even if the beneficial effects are felt.
Electroconvulsive therapy (ECT) is sometimes used in severe depression in subjects refractory to antidepressants, at the rate of two to three sessions per week under general anesthesia for about a month. ECT is a therapy that involves stimulating the brain directly with electricity, magnets or implants. Some of these treatments are still in the experimental stage. If the depression persists despite medication, or if the depression is so severe that the individual is unable to eat or develops false beliefs (delusions) about their illness, the doctor may recommend ECT as the best option. Although it has been used for almost 80 years, the electroconvulsive therapy remains the most powerful and fastest treatment in severe depression.
Although ECT is effective and safe in the elderly, many misconceptions remain among patients and healthcare professionals. Admittedly, ECT can cause side effects such as confusion and memory loss that are usually temporary.
