Nervous System Introduction by mikesanye

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									        Chapter 3 - Part A
    Nervous System Conditions



Introduction
Chronic Degenerative Disorders
Infectious Disorders
Psychiatric Disorders
         Chapter 3 - Part A
Nervous System Conditions: Introduction
  Function:
    Nerves are bundles of fibers that carry messages to
    and from the CNS (motor vs. sensory)
  Structure:
    Each neuron has a dendrite, cell body, and axon
    Sensory neurons have long dendrites, cell bodies just
    outside the spine (dorsal root ganglia), short axons
    Motor neurons have tiny dendrites, cell bodies in spinal
    cord; long axons to muscles or glands
    Interneurons in spinal cord allow quick response to
    stimuli (reflex arc) (Fig. 3.1)
           Chapter 3 - Part A
Nervous System: Introduction, cont.
Long fibers in PNS have two layers:
  Myelin (speeds transmission, insulates; also
  present in CNS)
  Neurilemma (allows for regeneration; not present
  in CNS) (Fig. 3.2)
General neurologic problems:
  Damage to peripheral nerves (good prognosis)
  CNS damage (poorer prognosis, but maybe not as
  bleak as generally considered)
  Psychiatric disorders
Chronic Degenerative Disorders

Alzheimer’s Disease
Amyotrophic Lateral Sclerosis
Multiple Sclerosis
Parkinson’s Disease
Peripheral Neuropathy
Tremor
Alzheimer’s Disease
 Progressive degeneration of the brain,
 leading to memory loss, personality
 changes, and death
 Incidence:
   Affects 5% of the U.S. population (4.5
   million);
   50% of people over 85 years old;
   Estimated 16 million people by 2050
Alzheimer’s Disease, cont.
 Features:
   Plaques: sticky deposits of beta amyloid trigger an
   inflammatory response
   Neurofibrillary tangles: tau proteins degenerate,
   causing neurons to collapse and move out of
   relationship to each other
   Low neurotransmitters: as neurons degenerate,
   less neurotransmitters are produced; fewer
   synapses are functional
   Genetics: Some people are genetically
   predisposed, especially to the development of
   plaques
Alzheimer’s Disease, cont.
 Signs and symptoms (7 phases):
 1. No impairment
 2. Very mild decline (―pre Alzheimer’s‖)
 3. Mild dementia (some memory and word loss)
 4. Moderate dementia (loss of some skills; social
 withdrawal)
 5. Moderately severe dementia (assistance is needed
 for complex tasks)
 6. Severe dementia (profound memory loss,
 personality changes, disorientation, loss of
 bladder/bowel control)
 7. Very severe dementia (loss of language, muscle
 control)
Alzheimer’s Disease, cont.
 Diagnosis:
   Not definitive until death
   Mental tests, ruling out other causes
 Differential diagnosis:
   Vascular dementia
   Stroke/TIA
   Parkinson’s
   Other
Alzheimer’s Disease, cont.
 Treatment:
   Some drugs can slow progress, if caught early


 Massage?
   Touch is calming influence, even in advanced
   stages
   Beware of other accumulated disorders, inability to
   communicate verbally
   See Figs. 3.3a, 3.3b
Amyotrophic Lateral Sclerosis
 Progressive destruction of motor neurons in
 CNS and PNS
   Lou Gehrig’s disease
 Incidence:
   4,000 to 5,000 diagnoses per year,
   Mostly 40–70 years old
 Three types:
   Sporadic (most common)
   Familial
   Mariana Island type
Amyotrophic Lateral Sclerosis,
cont.
 Etiology (current theories):
   Neural tangles and plaque (like
   Alzheimer’s, but only on motor neurons)
   Glutamate accumulates and kills
   postsynaptic neurons
   Free radical damage (especially for familial
   ALS)
Amyotrophic Lateral Sclerosis,
cont.
 Signs and symptoms:
   Stiffness, loss of coordination, usually starts
   distally and progresses toward the core
   May become painful as muscles atrophy and the
   skeleton collapses
   No impact on intellect

 Diagnosis:
   Rule out other similar presentations; no specific
   test
Amyotrophic Lateral Sclerosis,
cont.
 Treatment:
   Palliative
   Some drugs may limit glutamate, prolong
   function
 Prognosis:
   Death within 2–10 years from pneumonia
   or renal infection
   Some survive for decades (Stephen
   Hawking)
Amyotrophic Lateral Sclerosis,
cont.
 Massage?
   This is a motor dysfunction; sensation
   stays intact
   Massage may help with pain related to
   degeneration
   Work with health care team
Multiple Sclerosis
 Inflammation, degeneration of myelin sheath
 in CNS
 Incidence:
   Most common in people who live far from the
   equator;
   Whites more than other groups
   Women more than men (2:1) in youth; more or
   less equal among older;
   Approximately 350,000 people in United States
   have MS;
   Approximately 9,000 diagnoses per year
Multiple Sclerosis, cont.
 Myelin in CNS is attacked and replaced
 with scar tissue
 Electrical insulation is lost; electrical
 impulses short-circuit
 Probably autoimmune
   Flare and remission
   Inflammation damages myelin, and
   ultimately the nerve tissue as well
Multiple Sclerosis, cont.
 Signs and symptoms:
   Weakness
   Spasm
   Changes in sensation (paresthesia, reduced sensation,
   numbness)
   Optic neuritis
   Urologic dysfunction
   Sexual dysfunction
   Difficulty walking
   Loss of cognitive function
   Depression
   Lhermitte’s sign (electrical sensation when neck is in flexion)
   Digestive disturbance
   Fatigue
Multiple Sclerosis, cont.
 Progression:
   Relapse/remitting (flare/remission)
   Primary progressive (steady decline in
   function)
   Benign MS (1 flare only)
   Malignant MS (rapidly progressive)
Multiple Sclerosis, cont.
 Diagnosis:
   Diagnostic criteria:
    • Objective evidence of at least two episodes
    • Episodes of flare are separated by at least one month
      and by location of affected function
    • No other explanation for symptoms can be found


   Differential diagnosis is a long process; can take
   years
Multiple Sclerosis, cont.
 Treatment:
   Symptomatic
   Steroids, immune suppressants
   Exercise, physical therapy for maintenance

 Massage?
   Most appropriate when in remission
   MS patients have poor tolerance for rapid changes
   in temperature; avoid heat and cold (warm and
   cool are better)
   Watch for accurate sensation; be conservative in
   numb areas
Parkinson’s Disease
 ―Shaking palsy‖: degeneration of motor center
 in brain
 Incidence:
   1%–2% of people over 50; men more than women
   (3:2); 500,000 in United States; 50,000
   diagnoses/year
 Anatomy review:
   Basal ganglia is one motor center deep in brain
    • Basal ganglia cells need dopamine
    • Dopamine is manufactured by nearby substantia nigra
      (―black stuff‖)
Parkinson’s Disease, cont.
 Etiology:
   Substantia nigra dies off; insufficient dopamine to
   basal ganglia; loss of motor function

   Causes:
    •   Mostly unknown
    •   Environmental exposures?
    •   Pugilistic parkinsonism (repeated head trauma)
    •   Premature death of substantia nigra cells
Parkinson’s Disease, cont.
 Signs and symptoms (Fig. 3.4):
   Primary:
    • Nonspecific pain, fatigue
    • Resting tremor
    • Bradykinesia (difficulty initiating movement)
    • Rigidity (especially of trunk flexors, facial
      muscles)
    • Poor postural reflexes
Parkinson’s Disease, cont.
 Signs and symptoms:
  Secondary:
   • Shuffling gait (festinating gait: loss of center of
     gravity)
   • Changes in speech
   • Changes in handwriting (―micrographia‖)
   • Sleep disorders
   • Depression
   • Mental degeneration (unclear whether part of
     disease, or part of medication side effects)
Parkinson’s Disease, cont.
 Treatment:
   Supplementing dopamine is problematic
    • Blood-brain barrier
    • Resistance
    • Different activity in different places in the brain
   Deep brain stimulation
   Surgery to alter thalamus, other structures
   Physical, speech, occupational therapy
Parkinson’s Disease, cont.
 Massage?
  May be appropriate, helpful with muscle
  stiffness and quality of life issues
   • Clients have trouble with tables
   • Elderly clients may have other conditions as
     well
   • Rigidity is safer for massage than spasticity
Peripheral Neuropathy
 A complication of other pathologic conditions
 leading to peripheral nerve damage
   Mononeuropathy/polyneuropathy
 Possible causes:
   Alcoholism
   Vitamin deficiency
   Toxic exposure
   HIV/AIDS
   Lupus
   Scleroderma
   Rheumatoid arthritis
   Mechanical pressure related to carpal tunnel syndrome, disc
   disease, thoracic outlet syndrome, etc…
Peripheral Neuropathy, cont.
 Signs and symptoms:
   Usually slow onset, often in hands or feet
   Hypersensitivity, often followed by numbness
   Motor neuron damage can lead to specific muscle
   weakness
 Treatment:
   Depends on cause
    • Pain relievers, topical applications, TENS units,
      biofeedback, acupuncture, relaxation techniques,
      massage…
Peripheral Neuropathy, cont.
 Massage?
  Depends on cause, client
   • Numbness is always a caution!
   • May exacerbate or soothe hypersensitivity
Tremor
 Rhythmic oscillation of antagonistic muscles
 in a fixed plane
 Classes of tremor
   Resting tremor
   Postural tremor (occurs when holding a limb up
   against gravity: arm in flexion)
   Kinetic tremor (occurs in large muscle groups for
   general movement)
   Activity-specific (occurs in hands for fine-motor
   control)
   Psychogenic (disappears when patient is
   distracted)
Tremor, cont.
 Further classifications:
    Physiologic (worse with stress, fear, etc.)
    Pathologic (idiopathic or related to underlying disorder)

 Types of tremor:
    Essential tremor (most common diagnosis)
     • Slowly progressive, usually appears around age 45
    Huntington’s disease
     • Hereditary degeneration of neural tissue
    Parkinson’s disease
     • Degeneration of substantia nigra and loss of basal ganglia
    Others
     • More rare causes for tremor
Tremor, cont.
 Treatment:
   Depends on cause; can include…
    • Dopamine precursors, Botox, beta blockers,
      anti-seizure medications…
    • Surgery at globus pallidus or thalamus
 Massage?
   Often useful, but should be diagnosed for
   cause
   Work with health care team for best results
      Infectious Disorders

Encephalitis
Herpes Zoster
Meningitis
Polio, Postpolio Syndrome
Encephalitis
 CNS infection, usually viral

 Used to be endemic to certain areas;
 now many are worldwide

 Incidence:
   Relatively rare, even with West Nile Virus:
   <5,000 infections/year
Encephalitis, cont.
 Etiology:
   Usually vector-borne (mosquitoes, some ticks)
   Viral attack on brain, sometimes spinal cord
   Infants, elderly, immune-suppressed are most
   vulnerable

 Signs and symptoms:
   Mild to life-threatening
   Fever, headache, irritability, stupor, coma; can
   cause personality and memory changes
Encephalitis, cont.
 Treatment:
   ―Supportive therapy‖: antivirals and good care


 Massage?
   Fever, especially with headache, contraindicates
   massage
   Clients with a history of encephalitis may be safe;
   get information about any permanent loss of
   function
West Nile Virus
 August, 1999: 6 people in Queens, NY go to
 the hospital with high fever and headache
 In nearby boroughs, birds were dying and
 horses were getting sick
 At end of season, 56 cases of WNV were
 confirmed among humans; 7 deaths (all
 people older than 68 years)
 2002: 4,000+ confirmed cases; 284 deaths
   Most develop flu-like symptoms; 1:150 develop
   neurologic symptoms
Herpes Zoster
 Viral attack on sensory dendrites in skin
   Also called ―shingles‖
 Incidence: Approximately 300,000 /year
 Etiology:
   Causative agent is Varicella zoster (same as
   chicken pox)
   Member of the herpes family; never fully expelled
   Virus is dormant in dorsal root ganglia until a drop
   in immune function; then it resurfaces as shingles
   along the affected dermatome
    • Triggers include stress, age, immune suppression, or
      other infections
Herpes Zoster, cont.
 Signs and symptoms:
   Painful blisters on a red base
   Unilateral on affected dermatome
    • Trunk and buttocks are most frequent (Fig. 3.5)
    • Can affect the face through trigeminal nerve
 Complications:
   Secondary bacterial infection of blisters
   Damage to trigeminal nerve: Ramsey-Hunt
   syndrome
   Postherpetic neuralgia
Herpes Zoster, cont.
 Treatment:
   Antiviral medication, topical anesthetics, anti-
   inflammatories, painkillers

 Massage?
   Active shingles is extremely painful!
   Communicability is an issue if the massage
   therapist has no history of chicken pox or chicken
   pox vaccine
   During recovery, be guided by tolerance of the
   client
Meningitis
 Inflammation of meninges (pia and
 arachnoid)
 Incidence:
   Mostly children < 5 years old;
   About 300 deaths/year;
   Very young, very old, and immune suppressed are
   most vulnerable
 Can be bacterial or viral
   Bacterial: Streptococcus pneumoniae or Neisseria
   meningitides; more severe infections with a high
   risk of permanent damage; responsive to
   antibiotics
   Viral: many agents, including herpes simplex;
Meningitis, cont.
 Signs and symptoms:
   High fever and chills
   Deep red or purple rash
   Extreme headache
   Aversion to bright light
   Stiff, painful neck
   More extreme:
    • Drowsiness, slurred speech, nausea, vomiting,
      delirium, convulsions, coma
Meningitis, cont.
 Diagnosis:
   Spinal tap (important to know the causative
   agent!)
 Treatment:
   Antibiotics for bacterial infection; supportive
   therapy for viral; prognosis is generally good
 Communicability:
   Mucous secretions (like cold or flu)
   Not every exposed person develops symptoms
   (1:1000)
Meningitis, cont.
 Prevention:
   Vaccine against Haemophilus influenzae (bacterial
   causative agent)
   Vaccines against meningococci recommended for
   travelers

 Massage?
   Not appropriate during acute infection
   Afterward, get information about permanent
   damage, if any
Polio, Postpolio Syndrome
 Polio: viral attack on motor neurons in spinal
 cord
   Also called infantile paralysis

 Postpolio Syndrome (PPS): progressive
 muscular weakness that may develop years
 or decades after polio infection
 Incidence:
   300,000 polio survivors in the United States;
   Approximately 25% have symptoms of PPS
   (overlap with arthritis and other orthopedic
   problems)
Polio, Post Polio Syndrome,
cont.
 Polio etiology:
   Virus enters through mouth, goes through GI tract
   and ends up in spinal cord
   1:100 people exposed develop symptoms
   Practically extinct in the wild, especially in
   Western hemisphere
   Affected motor neurons degenerate, leading to
   specific muscle weakness
    • Other motor nerves serving muscles in same groups may
      compensate (Fig. 3.6)
   Usually in lumbar spine, can affect diaphragm,
   heart
Polio, Post Polio Syndrome,
cont.
 Postpolio syndrome etiology:
   Not a resurgence of original infection
   Cumulative wear and tear leads to progressive
   muscle weakness later in life


 Postpolio syndrome symptoms:
   Sudden onset of new pattern of weakness, fatigue
   Sleep, breathing, other difficulties
   Cycles of degeneration and recovery
Polio, Post Polio Syndrome,
cont.
 Treatment:
   Motor dysfunction (not sensory):
   hydrotherapy and massage are safe and
   effective
   Adjustments to supportive tools (crutches,
   braces, etc.)
   Careful exercise to avoid over-stressing
   motor neurons and damaged muscles
Polio, Post Polio Syndrome,
cont.
 Prevention:
   Two effective vaccines
    • Need to be administered fully to avoid outbreaks of
      cultured virus
   Polio survivors need to exercise carefully,
   emphasizing uninvolved muscles
 Massage?
   Because sensation is intact, massage is safe and
   appropriate
   Work to improve nutrition, efficiency, function of
   damaged muscles
      Psychiatric Disorders

Attention Deficit Hyperactivity Disorder
Anxiety Disorders
Chemical Dependency
Depression
Eating Disorders
Attention Deficit Hyperactivity
           Disorder
Neurobiochemical disorder leading to…
   • Inattentiveness
   • Hyperactivity
   • Poor impulse control

Incidence:
  Estimates: 3%–5% of school-age children
  Statistics vary widely; underdiagnosed among
  some groups, overdiagnosed among others
  Boys diagnosed 3:1 over girls
   • Girls tend to manifest with withdrawal, not hyperactivity
  Up to 4% adults have ADHD
   • Coping skills may be better developed
   • Often raising children with ADHD as well
 Attention Deficit Hyperactivity
         Disorder, cont.
Etiology:
  Largely unknown
  Dopamine, noradrenaline pathways are disrupted
  Genetic predisposition
  Maternal exposures during pregnancy

Signs and symptoms:
  Any combination of…
   • Inattentiveness
   • Hyperactivity
   • Impulsivity
 Attention Deficit Hyperactivity
         Disorder, cont.
Diagnosis:
  By observation in different settings
  Determining what is ADHD vs. other problems vs.
  age-appropriate behavior
Differential diagnosis:
  Depression, anxiety disorders, sleep disorders,
  learning disability, fetal alcohol syndrome, etc…
Coexisting conditions:
  Oppositional defiant disorder, depression, anxiety
  disorders
Attention Deficit Hyperactivity
        Disorder, cont.
Complications:
  People with untreated ADHD have a higher
  than normal risk of…
   • Poor self esteem, poor school performance,
     difficulty maintaining relationships and jobs…
   • Substance abuse
   • Other addictive behaviors
   • Motor vehicle accidents
Attention Deficit Hyperactivity
        Disorder, cont.
Treatment:
  Psychostimulants
   • methylphenidates or dextroamphetamines
   • norepinephrine reuptake inhibitor
  Learning coping skills along with medications
Massage?
  No particular risks
  May help to improve behavior in children
  May have to adapt technique for client’s tolerance
Anxiety Disorders
 Irrational fears, sometimes connected to
 behaviors that attempt to control them
 Incidence:
   Estimates up to 19 million people
   Often cannot hold job, lowest
   socioeconomic standing
 Basic etiology:
   ―Am I safe?‖ ―Probably not.‖
Anxiety Disorders, cont.
 Stimuli are interpreted as threatening
   Hypervigilance, sympathetic state
   Affects limbic system (for memory), basal
   ganglia (movement control); frontal lobe
   (judgment, decision-making)
   Neurotransmitters involved:
    • Norepinephrine, GABA, serotonin
Anxiety Disorders, cont.
 Signs and symptoms: types of anxiety disorders (5 out of
 dozens)
    General anxiety disorder (GAD)
      • Chronic worry, anticipation of disaster
      • 4 million people, women >men, 2:1

    Panic disorder
      • Sudden onset of sympathetic reaction (pounding heart,
        dry mouth, hyperventilation, feeling of impending doom);
        lasts several minutes to hours
      • 2.4 million people, women >men, 2:1
      • Complicated by fear of having an episode, leading to
        agoraphobia
      • Treated most successfully before agoraphobia develops
Anxiety Disorders, cont.
   Posttraumatic stress disorder (PTSD)
    • 5.2 million in United States, mostly men
    • AKA ―shell shock‖
    • Persistent, visceral memories of an ordeal—as a
      participant or a witness; leads to hypervigilance
    • Can spontaneously resolve, or be a lifelong issue

   Obsessive–compulsive disorder (OCD)
    • Unwelcome thoughts (obsessions) and efforts to control
      them (compulsions)
    • 3.3 million people; men = women
    • Obsessions usually around contamination, sexuality, or
      violence
    • Compulsions include handwashing, checking locks, etc.,
      avoiding touching people, counting, and creating
      symmetry
Anxiety Disorders, cont.
   Phobias: social and specific:
    • Social phobia (social anxiety disorder):
        Fear of being judged, embarrassed
        5.3 million people
        Men more likely to seek treatment

    • Specific phobia:
        Intense, irrational fear of something not inherently
         dangerous (closed spaces, open spaces, bridges,
         elevators, feathers, the number 13…)
        6.3 million people
Anxiety Disorders, cont.
 Treatment:
   Depends on disorder
    • Medication plus therapy
    • Antidepressants, anti-anxieties, beta blockers

 Massage?
   Various relaxation techniques are recommended;
   massage can be appropriate too
   Client must perceive it to be safe and nurturing
    • This may mean altering the way the work is conducted
Chemical Dependency
 Use, abuse, dependence (addiction)
   Use: using a substance to change mood or
   physical experience
   Abuse: use of a substance in a way that is
   potentially harmful to user or people close by; use
   interferes with normal function; user’s behavior is
   unacceptable to others; use continues, in spite of
   repeated problems it incurs
   Dependence:progressive tolerance; physical
   addiction develops (withdrawal symptoms)
Chemical Dependency, cont.
 Incidence:
   19.5 million over 12 years of age use illicit
   drugs/year
   14 million abuse alcohol
 Etiology of chemical dependency:
   Most stimulants slow dopamine reuptake
   Postsynaptic neurons can become desensitized:
   takes more drug for same effect
 Etiology of alcoholism:
   Depresses CNS, but loss of inhibitions can feel
   like stimulant
   Brain chemistry ultimately changes so that it
   cannot function well without alcohol
Chemical Dependency, cont.
 Risk factors:
   Genetic predisposition
   Other mental illness (depression, anxiety
   disorders)
   Environmental factors (peer pressure,
   availability)
   Age
   Medical history (addiction to sleeping pills,
   anti-anxieties, painkillers…)
Chemical Dependency, cont.
 Types of addiction:
   Psychological: Using feels good!
   Physical: Not using feels like I’m going to die!
    • Need to avoid withdrawal symptoms

 No delineation between legal and illegal
 substances: caffeine and nicotine can create
 the same patterns as crack
 The higher the tolerance, the harder to break
 the addiction
Chemical Dependency, cont.
 Signs and symptoms (4 main):
   Persistent craving
   Unable to voluntarily control use
   Increasing tolerance
   Withdrawal symptoms
   Others:
    • Increasing time is invested in use and recovery;
      responsibilities are neglected; user lives in
      denial
Chemical Dependency, cont.
 Complications (chemical dependency):
   Vary, depending on substance
   •   Paranoia, coma, convulsions, death
   •   Increased spread of HIV
   •   Accidents (car, boat, industrial)
   •   Child abuse and neglect
Chemical Dependency, cont.
 Complications (alcoholism):
    • Digestive system: gastritis, liver damage, ulcers,
      pancreatitis, increased risk of stomach/esophageal
      cancer
    • Cardiovascular system: decreased force of heartbeat,
      arrhythmia; cardiomyopathy; agglutination of red blood
      cells; (ultimately can interfere with clotting, leading to
      bleeding)
    • Nervous system: memory loss, slowed reflexes, organic
      brain syndrome
    • Immune system: suppressed activity, vulnerability to
      infection
    • Reproductive system: reduced sex drive, fetal alcohol
      syndrome
    • Others: ½ car fatalities; 40% industrial accidents; 65%
      adult drownings; 100,000 deaths/year
Chemical Dependency, cont.
 Treatment:
   Recognize that a problem exists
   Detoxification (may be treated with other meds)
   Rehabilitation
    • New coping skills
   After-care is the most important feature
 Massage?
   Can be used to help with withdrawal symptoms
   Be careful about other conditions that may exist
    • Hepatitis B, C; HIV/AIDS, cirrhosis, etc.
   Clients who are drunk or high during a session are
   not good candidates for massage
Depression
 Genetic predisposition + CNS chemical
 imbalances + triggering event leads to
 persistent sense of loss and hopelessness

 Incidence:
   Estimates of 10%–20% of the U.S. population (not
   all seek help):
   11–19 million people/year
Depression, cont.
 Factors (all overlap each other):
   Neurotransmitter imbalance
    • Serotonin, norepinephrine, dopamine; too low? Or too
      high, leading to resistance?

   Hormonal imbalance
    • Estrogen, progesterone, endorphins, cortisol

   Hypothalamus-pituitary-adrenal axis (HPA axis)
    • Stress response system between hypothalamus,
      pituitary, adrenal gland; high CRF levels means more
      stress responses

   Atrophy in hippocampus
    • May be related to hypersecretion of cortisol
Depression, cont.
 Causes:
  Genetics
  Environmental triggers
  Personality traits
  Chronic illness
  Other
   • Hypothyroidism, chemical dependency,
     nutritional deficiencies, etc
Depression, cont.
 Signs and symptoms (6 main ones):
   Persistent sad or empty feeling
   Less enjoyment from activities
   Deep sense of guilt or disappointment with self
   Hopelessness: things will never get better
   Irritability
   Change in sleeping habits
   Others:
    • Poor concentration; weight changes; loss of energy;
      persistent physical pain (headaches, indigestion);
      suicidal thoughts or behaviors
Depression, cont.
 Types of depression (5 of many)
   Major depressive disorder
    • Severe symptoms, 2+ weeks; untreated episodes can
      last 6–18 months, with 4–6 in a lifetime (10 years of
      feeling awful!)
   Dysthymia
    • Less severe symptoms, much longer lasting (months or
      years)
   Bipolar disease
    • Aka, manic depression; cycles from mania to depression
   Seasonal affective disorder
    • Related to lack of sunlight, melatonin
   Postpartum depression
    • Combination of hormonal swings, unmet expectations,
Depression, cont.
 Treatment:
   Antidepressants:
    • SSRIs, MAOIs, tricyclics
         Can take weeks to take effect, side effects at the beginning
    • Lithium for bipolar
         ―smooth out‖ mood swings
   Psychotherapy
   Other therapies
    • Light therapy for SAD
    • Electroconvulsive therapy
    • St. John’s Wort
Depression, cont.
 Complications:
   15% of major depressives successfully commit suicide
   Correlation to other disorders:
     • Heart attack and other cardiovascular disease
 Massage?
   Improved efficiency of HPA axis
   Sympathetic to parasympathetic state
     • Reduction in cortisol, improvement in serotonin
   Changes brain activity to more balanced emotional state
   Risks:
     • Respect medications, doctor’s role in prescribing them
     • Respect appropriate boundaries with emotionally fragile clients
Eating Disorders
 Poor eating habits that ultimately can become
 life-threatening
   Anorexia nervosa
   Bulimia nervosa
   Compulsive overeating
 Incidence:
   Usually girls between adolescence and college
   (for anorexia and bulimia);
   Girls > boys by 10:1
Eating Disorders, cont.
 Etiology of anorexia and bulimia:
   Over-achievers, exerting power and control
   Serotonin disturbance (?)
   Can reach the point where it is difficult or
   impossible to return to healthy eating


 Etiology of overeating:
   Touch deprivation
   Protection (touch abuse survivors)
Eating Disorders, cont.
 Signs and symptoms:
   Anorexia:
    • Avoid eating in public
    • Distorted self image
    • Restrictive: self-starvation
    • Purge-type: barely sufficient nutrition +
      behaviors to eliminate it (vomiting, laxatives,
      excessive exercise)
    • Lanugo
Eating Disorders, cont.
 Signs and symptoms:
   Bulimia
    • Appear to eat normally; binge in private
    • Binges triggered by stress
    • Followed by purging or exercise

   Compulsive overeating
    •   Public and private eating
    •   Not compensated with purging, exercise
    •   May have rapid weight gain
    •   Long-term problems generally more manageable than
        with anorexia, bulimia
Eating Disorders, cont.
 Complications:
   Anorexia:
    • Arrhythmia, bradycardia, hypotension; infertility,
      osteoporosis; purging can cause colon dysfunction,
      esophageal damage
   Bulimia:
    • Erosion of tooth enamel; esophageal ulcers, strictures,
      rupture; colon dysfunction; electrolyte imbalances
   Compulsive overeating:
    • Cardiovascular disease, arthritis
Eating Disorders, cont.
 Treatment:
   Must focus on control issues, not eating
   Address neurotransmitter imbalances
   Address overlap with other psychiatric disorders
    • OCD, depression, etc.
 Massage?
   Can be a wonderful positive body experience
   Watch for cardiovascular problems (arrhythmia,
   etc.)

								
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