Depression as a Recurrent, Progressive Illness

2018 ◽  
Author(s):  
Robert M. Post
Keyword(s):  
Bipolar Disorder ◽  
Behavioral Sensitization ◽  
Clinical Intervention ◽  
The United States ◽  
The Body ◽  
Childhood Onset ◽  
Bipolar Illness ◽  
Specific Memory ◽  
Illness Progression

Clinical Highlights and summary of Chapter• Episodes of depression and bipolar illness progress in two ways:faster recurrences as a function of number of prior episodes, andgreater autonomy (decreased need for precipitation by stressors(Episode Sensitization)• Recurrent stressors result in increased reactivity to subsequent stressors(Stress sensitization) and bouts of stimulant abuse increase in severity with repetition(Stimulant-induced behavioral sensitization)• Each type of sensitization cross-sensitizes to the others and drives illness progression• Each type of sensitization involves specific memory-like epigenetic processes as well as nonspecific cellular toxicities• Childhood onset depression and bipolar illness have a more adverse course than adult onset illness and are increasing in incidence via a cohort (year of birth) effect• As opposed to genetic vulnerability, each type of sensitization can be prevented with appropriate clinical intervention and prevention, which should lessen illness severity and progression• Seeing depression and bipolar disorder as progressive illnesses changes the therapeutic emphasis away from acute treatment and instead to long term prophylaxis• Preventing recurrent depressions will likely protect the brain, the body, and the personWord count with Named refs = 6,417>Depression and bipolar disorder are illnesses which tend to progress with each new recurrence. Stressors, mood episodes, and bouts of substance abuse each sensitize (show increased reactivity) upon their repetition and cross-sensitization to the others. These sensitization processes appear to have a memory-like and epigenetic basis, in some instances conveying lifelong increased vulnerability to illness recurrence and progression. Greater numbers of episodes are associated with faster recurrences, lesser need for stress precipitation, cognitive dysfunction, pathological changes in brain, treatment refractoriness, and loss of many years of life expectancy, predominantly from cardiovascular disease. Such a perspective emphasizes the need for greater awareness of higher incidence of psychiatric and medical comorbidities in the United States compared to many European countries, and the need for earlier intervention and more sustained long term prophylaxis to prevent illness progression and its adverse consequences on brain and body.

Neither Russia nor the United States

2017 ◽  
Author(s):  
Elizabeth S. Manley
Keyword(s):  
Gender Equity ◽  
Latin American ◽  
Body Politic ◽  
The United States ◽  
The Body ◽  
Foreign Intervention ◽  
The Face ◽  
Dominican Women ◽  
Social Upheaval

Chapter 4 addresses three inter-related strategies employed by women following the demise of the Trujillato to reconstruct the body politic in the face of drastic political transition, a second U.S. occupation, and general social upheaval. First, Dominican women again called on the rhetoric of motherhood and maternalism in support of a return to domestic tranquility and for a nation free of dictatorial politics and foreign meddling. Second, political participation by women served to demonstrate a re-envisioning of the nature of Dominican politics through their burgeoning support of full gendered equality. Third, as now long-term members of a number of inter-American organizations, women called for continental solidarity to return sovereignty to Latin American nations plagued by foreign intervention, particularly their own. These strategies demonstrate both the potential for maternal politics as a form of national healing as well is its limitations for creating true gender equity.

Who We Are: The Foundational Forces

2021 ◽  
pp. 65-80
Author(s):  
Sandro Galea
Keyword(s):  
Social Stigma ◽  
The United States ◽  
The Body ◽  
Long Term Effects ◽  
Obesity Epidemic ◽  
Race Politics ◽  
The Social ◽  
To Come ◽  
The Many

This chapter examines the foundational forces that shape health. Even without a pandemic, the United States is faced with public health threats that are shaped by foundational forces. From the political and economic roots of the obesity epidemic, to the social stigma that informs the opioid crisis, to the many structural drivers of climate change, the social, economic, political, and demographic foundations of health are central to the challenges that must be addressed, nationally and globally, in the years to come. Engaging with these forces helped inform the response to COVID-19; they can help in addressing these other challenges as well. And just as a virus can have long-term effects on the body, the pandemic reshaped the societal foundations, with lasting implications for the economy, culture, attitudes towards core issues like race, politics, and more. Whether the experience of the pandemic leads to significant long-term benefits will depend on whether Americans retain the hard lessons of that moment and apply them to foundational forces.

scholarly journals Bipolar disorder and substance misuse: pathological and therapeutic implications of their comorbidity and cross-sensitisation

2013 ◽  
Vol 202 (3) ◽  
pp. 172-176 ◽  
Author(s):  
Robert M. Post ◽  
Peter Kalivas
Keyword(s):  
Bipolar Disorder ◽  
Substance Use ◽  
Substance Misuse ◽  
Bipolar Illness ◽  
Cocaine Use ◽  
Therapeutic Implications ◽  
Positive Effects ◽  
The Common ◽  
Illness Progression

BackgroundBipolar disorder has a high co-occurrence with substance use disorders, but the pathophysiological mechanisms have not been adequately explored.AimsTo review the role of stress in the onset and recurrence of affective episodes and substance misuse.MethodWe review the mechanisms involved in sensitisation (increased responsivity) to recurrence of stressors, mood episodes and cocaine use.ResultsEvidence suggests that intermittent stressors, mood episodes and bouts of cocaine use not only show sensitisation to themselves, but cross-sensitisation to the others contributing to illness progression. Converseley, an understanding of the common mechanisms of sensitisation (such as regionally selective alterations in brain derived neurotrophic factor (BDNF) and hyperactivity of striatally based habit memories), could also result in single therapies (such as N-acetylcysteine) having positive effects in all three domains.ConclusionsThese interacting sensitisation processes suggest the importance of early intervention in attempting to prevent increasingly severe manifestations of bipolar illness and substance misuse progression.

scholarly journals Hubungan Intensitas Kebisingan Dan Lama Kerja Dengan Kejadian Hipertensi Pada Tenaga Kerja Bagian Produksi PT. Japfa Comfeed Indonesia Tbk.

2019 ◽  
Vol 15 (1) ◽  
pp. 591
Author(s):  
Andry Setiawan ◽  
Yohanes Joko Supriyadi ◽  
Maharso Maharso
Keyword(s):  
Blood Pressure ◽  
Noise Pollution ◽  
The United States ◽  
The Body ◽  
P Value ◽  
Emotional Instability ◽  
Cross Sectional ◽  
Health Checks ◽  
Moderate Relationship

The Relations Of The Intensity Of Noise And Work Term With The Hypertension Case Of The Production Parts Employees In PT. Japfa Comfeed Indonesia Tbk.. Some research results prove that one of the risk factor of stroke is high blood pressure (hypertension). Noise pollution may be associated with the occurrence of hypertention, this is supported by an epidemiological study in the United States. The results of that study mentioned that people exposed to noise tend to have unstable emotions. Emotional instability will lead to a stress. If the stress happened long enough, it will cause the narrowing of blood vessels, so it will make the heart to work harder to pump blood throughout the body. In a long term, blood pressure will rise, and this is called Hypertension. The purpose of this study is to determine the relations between the intensity of noise pollution and work term with the case of hypertension in the production parts employee of PT. Japfa Comfeed Indonesia Tbk. Tanah Laut regency in 2017. The research method used is an analytical survey with cross sectional approach. The population in this study is amounted to 57 people and the sample amounted to 57 people. The results of this study indicates that there is a moderate relationship between the intensity of noise pollution with the incidence of hypertension (p-value = 0,002 < α = 0,05 r = 0,407), and there is a low relationship between work term with the incidence of hypertension (p-value = 0,014 < α = 0,05 r = 0,323). Suggestions given to the company is to provide guidance on the use of PPE, perform routine health checks on employees and rotate the position of work on the employee of production.

Obesity in Survivors of Childhood Acute Lymphoblastic Leukemia and Lymphoma

2007 ◽  
Vol 25 (10) ◽  
pp. 1183-1189 ◽  
Author(s):  
Bassem I. Razzouk ◽  
Susan R. Rose ◽  
Suradej Hongeng ◽  
Dana Wallace ◽  
Matthew P. Smeltzer ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Adult Height ◽  
Lymphoblastic Leukemia ◽  
The United States ◽  
The Body ◽  
Intrathecal Methotrexate ◽  
High Dose ◽  
Weight Category ◽  
Cranial Radiation

Purpose We evaluated the long-term effects of treatment on the body mass index (BMI) of children with acute lymphoblastic leukemia (ALL) or lymphoblastic lymphoma who received one of three CNS-directed therapies: intrathecal methotrexate with intravenous high-dose methotrexate (1 g/m2), intrathecal methotrexate with 18 Gy cranial radiation, or intrathecal methotrexate with 24 Gy cranial radiation. Patients and Methods Between 1979 and 1984, 456 children with newly diagnosed ALL and lymphoma were enrolled onto a single protocol at St Jude Children's Research Hospital (Memphis, TN). The heights and weights of 422 of the children were measured at diagnosis, during treatment, at the end of therapy, and approximately every 6 to 12 months thereafter. Patients who had attained their adult height at the time of analysis (n = 248) were placed in weight categories based on their BMI, BMI percentile, or weight-for-length percentile depending on age. Results The overall percentage of survivors who were overweight or obese approximated rates prevalent in the general population of the United States. Young age (< 6 years) and overweight/obesity at diagnosis were the best predictors of obesity at adult height. The rate of BMI increase did not differ significantly between children who received radiation and those who did not, nor between patients who received 18 or 24 Gy of cranial radiation. Conclusion BMI weight category at diagnosis, rather than type of CNS treatment received, predicted adult weight in long-term survivors of childhood hematologic malignancies.

scholarly journals More childhood onset bipolar disorder in the United States than Canada or Europe: Implications for treatment and prevention

2017 ◽  
Vol 74 ◽  
pp. 204-213 ◽  
Author(s):  
Robert M. Post ◽  
Lori L. Altshuler ◽  
Ralph Kupka ◽  
Susan L. McElroy ◽  
Mark A. Frye ◽  
...  
Keyword(s):  
United States ◽  
Bipolar Disorder ◽  
The United States ◽  
Childhood Onset ◽  
Treatment And Prevention

Take it off! Take it all off! Drugs for weight reduction

2020 ◽  
pp. 187-216
Author(s):  
Eugene H. Cordes
Keyword(s):  
Weight Control ◽  
Good Health ◽  
The United States ◽  
The Body ◽  
Calorie Intake ◽  
Over The Counter ◽  
Effective Measure ◽  
Formidable Challenge ◽  
Efficacy Research

Obesity is a major and growing threat to good health to most parts of the world. In the United States, Xenical, marketed over the counter as Alli, is the only drug approved by the Food and Drug Administration for long-term use for weight control. There are several others—Qsymia, Contrave, Belviq, Saxenda—that are approved for short-term use. A number of others, approved earlier, have been withdrawn from the market for patient safety reasons, including the popular combination known as phen-fen. The pharmaceutical industry has found the discovery of effective and safe weight control drugs to be a formidable challenge. Xenical (tetrahydrolipstatin) is an inhibitor of an enzyme in the gut that promotes the digestion of fats. As a result, an increased fraction of ingested fat is excreted in the feces rather than being absorbed in the body, a reduction in effective calorie intake. This is a novel weight control mechanism of action. Other agents act to suppress appetite or as stimulants to calorie burning. Dietary measures to control weight take several forms, but the effective measure is calorie intake, not diet composition. The field of weight control is rife with false and unsubstantiated claims of efficacy. Research to find better drugs for weight control continues.

scholarly journals Medication nonadherence in bipolar disorder: a narrative review

2018 ◽  
Vol 8 (12) ◽  
pp. 349-363 ◽  
Author(s):  
Ibrahim Jawad ◽  
Stuart Watson ◽  
Peter M. Haddad ◽  
Peter S. Talbot ◽  
R. Hamish McAllister-Williams
Keyword(s):  
Bipolar Disorder ◽  
Therapeutic Alliance ◽  
Financial Incentives ◽  
Substance Misuse ◽  
Ethical Issues ◽  
The United States ◽  
Patient Specific ◽  
Medication Nonadherence ◽  
Long Term Treatment

A number of effective maintenance medication options exist for bipolar disorder (BD) and these are regarded as the foundation of long-term treatment in BD. However, nonadherence to medication is common in BD. For example, a large data base study in the United States of America (USA) showed that approximately half of patients with BD were nonadherent with lithium and maintenance medications over a 12 month period. Such nonadherence carries a high risk of relapse due to the recurrent nature of the illness and the fact that abrupt cessation of treatment, particularly lithium, may cause rebound depression and mania. Indeed, medication nonadherence in BD is associated with significantly increased risks of relapse, recurrence, hospitalization and suicide attempts and a decreased likelihood of achieving remission and recovery, as well as with higher overall treatment costs. Factors associated with nonadherence include adverse effects of medication, complex medication regimens, negative patient attitudes to medication, poor insight, rapid-cycling BD, comorbid substance misuse and a poor therapeutic alliance. Clinicians should routinely enquire about nonadherence in a nonjudgmental fashion. Potential steps to improve adherence include simple pragmatic strategies related to prescribing including shared decision-making, psychoeducation with a clear focus on adherence, reminders (traditional and digital), potentially using a depot rather than an oral antipsychotic, managing comorbid substance misuse and improving therapeutic alliance. Financial incentives have been shown to improve adherence to depot antipsychotics, but this approach raises ethical issues and its long-term effectiveness is unknown. Often a combination of approaches will be required. The strategies that are adopted need to be patient specific, reflecting that nonadherence has no single cause, and chosen by the patient and clinician working together.

scholarly journals Long-Term Variability in Body Weight in Relation to the Risk of Dementia: A Prospective Cohort Study

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 51-52
Author(s):  
Hui Chen ◽  
Tianjing Zhou ◽  
Yuan Ma ◽  
Changzheng Yuan
Keyword(s):  
Body Weight ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
The United States ◽  
Sociodemographic Factors ◽  
The Body ◽  
Prospective Association ◽  
Using Data

Abstract The prospective association of body weight variability with dementia remains unclear. We aimed to investigate whether long-term variability in body weight is associated with the risk of late-life dementia and to explore their potential temporal relationship using data from a nationwide prospective cohort study of the United States. A total of 5,556 participants free of dementia in 2008 (55.66% women; mean [SD] age, 71.1 [3.1] years) were followed up to 8 years for doctor-diagnosed dementia reported biennially. Body weight variability was assessed as the coefficient of variation utilizing the body weight information collected over 16 years before 2008. Cox proportion hazard model was applied to estimate hazard ratio (HR) of dementia associated with body weight variability. Higher body weight variability was associated with an increased incidence of dementia after controlling for sociodemographic factors, lifestyle, mean body weight, and body weight change. The multi-variable adjusted HR of dementia of the highest quartile of body weight variability was 2.01 (95% CI 1.01-1.87) compared with the lowest. Every 1% increment in variability was associated with a 6.2% higher risk of dementia (HR=1.06, 95%CI 1.04,1.09, p-trend&lt;0.001). Such association was observed for both Alzheimer’s disease and other types of dementia, with stronger association observed when body weight variability was assessed closer to dementia assessment.

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