Wednesday, May 28, 2014

Burnout and Karoshi

Author: Dr Peremarty MD: Sleep and general medicine

A syndrome at the turning point between tiredness and depression?

Burnout is a human relationship disease, close to depressive state, preceded by a heavy load of stress combined with a lot of personal frustration.
Its evolution, which remains silent over a long period, can end in suicide (in case of depression) or induce health endangering behaviours (tobacco, alcohol, drugs and medication abuse).
In Japan, Karoshi, (or Karushi - literally: death (shi) from overwork (karu) - describes a decease (no matter the cause of death itself) related to an excessive work schedule
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Hypersomnia

Author: Dr Peremarty MD: Sleep and general medicine

In October, the marmot enters a period of hibernation, which lasts about six months. Here, the need for sleep is more important than in average sleepers (more than 10 hours).
No matter how intense his/her « stress level » can be, that subject will never know the dread of insomnia.
He/she is under a constant excessive sleep pressure and takes advantage of every opportunity to « doze off a little ». (And is teased by friends how consider him/her like a « marmot »).
If possible, the person will adopt fitted out work schedules which leave opportunities to satisfy his/her need for sleep.
The diagnosis requires that pseudo-hypersomnias and secondary hypersomnias are taken into account.
Sleep insufficiency because of an excessive need ...

Monday, May 26, 2014

Non-celiac gluten sensitivity

Authors:  Umberto Volta; Maria Teresa Bardella; Riccardo Troncone; Gino Roberto Corazza. BMC medicine. 2014

Non-celiac gluten sensitivity (NCGS) is still an undefined syndrome with several unsettled issues despite the increasing awareness of its existence.

In recent years, a growing number of subjects worldwide have reported that ingestion of wheat and, to a lesser extent, of other cereals such as barley, rye, and spelt cause them intestinal and extraintestinal symptoms without the diagnostic features of celiac disease (CD) or wheat allergy (WA). This self-reported wheat sensitivity has fueled the debate on the possible existence of a new syndrome, which has been recently named as non-celiac gluten sensitivity (NCGS) to differentiate it from Celiac Disease.

Saturday, May 24, 2014

FODMAP

Source: Peter R Gibson and Susan J Shepherd. Journal of Gastroenterology and Hepatology. 2009.

Functional gastrointestinal symptoms are common and their management is often a difficult clinical problem. The link between food intake and symptom induction is recognized.

The low FODMAP diet provides an effective approach to the management of patients with functional gut symptoms. The evidence base is now sufficiently strong to recommend its widespread application.The restriction of their intake globally (as opposed to individually) reduces functional gut symptoms, an effect that is durable and can be reversed by their reintroduction into the diet.

Functional gastrointestinal disorders

Source: Christine Dalton, PA. University North Carolina. "What is a Functional GI disorder?"

Functional gastrointestinal disorders (FGIDs) are common disorders that are characterized by persistent and recurring GI symptoms. These occur as a result of abnormal functioning of the GI tract. They are not caused by structural (tumors or masses) or biochemical abnormalities.

As a result, many routine medical tests attempting to diagnose an FGID, such as x  rays, CT scans, blood tests and endoscopic exams can have essentially normal/negative (non disease) results.

More than 20 functional GI disorders have been identified. They can affect any part of the GI tract, including the esophagus, stomach, bile duct and/or intestines.

The most common and best researched FGID is Irritable Bowel Syndrome (IBS): abdominal pain associated with altered bowel habits of diarrhea, constipation or alternating between both.

Other common FGIDs include functional dyspepsia (pain or discomfort in the upper abdominal area, feeling of fullness, bloating or nausea), functional vomiting, functional abdominal pain, and functional constipation or diarrhea.

It is important to understand that these are not psychiatric disorders, although stress and psychological difficulties can make FGID worse.

Approximately 25 million Americans have functional GI disorders. 50 - 80% of people with FGID symptoms do not consult a physician, although they may take over the counter medications and report significantly more job absenteeism and disability than people without these symptoms. It has been reported that IBS is the second leading cause, after the common cold, for missing work or school

Frontotemporal dementia / Pick disease

Source:  Julie Snowden, PhD; David Neary, MD and David M. A. Mann, PhD. Manchester. UK. The British Journal of Psychiatry.2002.

Frontotemporal dementia is the most common form of primary degenerative dementia after Alzheimer's disease that affects people in middle age, accounting for up to 20% of presenile dementia cases. Onset occurs most commonly between the ages of 45 and 65 years, although the disorder can present before the age of 30 years as well as in the elderly. There is an equal incidence in men and women. The mean duration of illness is 8 years, ranging from 2 years to 20 years. A family history of dementia is present in about half of cases.

Monday, May 19, 2014

Orthorexia

Authors:  Márta Varga1, Barna Konkolÿ Thege, Szilvia Dukay-Szabó and al. BMC Psychiatry. 2014
When eating healthy is not healthy.
Orthorexia nervosa (ON) is an alleged eating disorder in which the person is excessively preoccupied with healthy food.

Thursday, May 15, 2014

Depression: symptoms, treatments and causes

Author: Bruno Dubuc. Canada. Neurobiology. The brain from top to bottom

Daily events and the way that we react to them can sometimes trouble our peace of mind. Anyone can go through a period when they feel sad and lonely every day. But when feelings like this go on for weeks or even months, they may be the first signs of depression.
An estimated 1 out of 5 women and 1 out of 10 men will experience depression at some time in their lives, which makes this a very common ailment. Depression can prevent people from coping with their normal activities, their work, and their relationships, thus seriously compromising their sense of well-being and their ability to live their lives. 

Tuesday, May 13, 2014

Yellow fever

Authors:   Tini Garske,  Maria D. Van Kerkhove,  Sergio Yactayo and al. PLOS medicine. 2014-05-06

Yellow fever is a flavivirus infection that is transmitted to people and to non-human primates through the bites of infected mosquitoes. This serious viral disease affects people living in and visiting tropical regions of Africa and Central and South America. In rural areas next to forests, the virus typically causes sporadic cases or even small-scale epidemics (outbreaks) but, if it is introduced into urban areas, it can cause large explosive epidemics that are hard to control. Although many people who contract yellow fever do not develop any symptoms, some have mild flu-like symptoms, and others develop a high fever with jaundice (yellowing of the skin and eyes) or hemorrhaging (bleeding) from the mouth, nose, eyes, or stomach. Half of patients who develop these severe symptoms die. Because of this wide spectrum of symptoms, which overlap with those of other tropical diseases, it is hard to diagnose yellow fever from symptoms alone. However, serological tests that detect antibodies to the virus in the blood can help in diagnosis. There is no specific antiviral treatment for yellow fever but its symptoms can be treated.
Eradication of yellow fever is not feasible because of the wildlife reservoir for the virus but there is a safe, affordable, and highly effective vaccine against the disease.

Sunday, May 11, 2014

Chronic Fatigue Syndrome

Author: Dr Peremarty MD. Chronic fatigue syndrome.

An invisible sleep pathology, "wake up more tired than the day before"
An illness on the border between psychology and physiology...

Definition:
CFS is a clinical chart which combines, since at least six months :
  • a sensation of intense tiredness, of infectious kind, (with, sometimes, a feeling of a little fever or swollen ganglions), carrying with it a significant reduction (at least 50 %) of daily activity;
  • memory, concentration, and mood disorders, which can remind of a depressive or generalized anxiety chart;

Saturday, May 10, 2014

Measure your daytime sleepiness

Source:  A New Method For Measuring Daytime Sleepiness: The Epworth Sleepiness Scale  Murray W. Johns. Sleep 1991.

How likely are you to doze off or fall asleep in the following situations, in contrast to feeling just tired? This refers to your usual way of life in recent times. Even if you have not done some of these things recently try to work out how they would have affected you. Use the following scale to choose the most appropriate number for each situation.
The Epworth sleepiness scale (ESS) is a simple, self-administered questionnaire which is shown to provide a measurement of the subject's general level of daytime sleepiness.

Thursday, May 8, 2014

Insomnia

Authors
-Dr. Charles M. Morin, Laval University, Quebec, Canada
-Dr. Geneviève Belleville, Université du Québec à Montréal, Montréal, Canada. Scholarpedia

Insomnia entails a spectrum of complaints reflecting dissatisfaction with the quality, duration, or continuity of sleep. These complaints may involve problems with falling asleep initially at bedtime (initial insomnia), waking up in the middle of the night and having difficulty going back to sleep (middle insomnia), waking up too early in the morning with an inability to sleep until planned rise time (late insomnia), or a perception of non restorative sleep. Insomnia may be transient, episodic, or persistent over time (Morin & Espie, 2003). Approximately one third of the adult population reports insomnia symptoms, whereas about 10% suffer from an insomnia disorder (Ohayon, 2002).
Along with subjective complaints of poor sleep, individuals with insomnia are often distressed about their sleep and also report significant fatigue and impairments of their daytime functioning. Common sleep-loss related daytime problems include difficulties with attention, concentration, memory, and completion of tasks, and negative mood. Chronic insomnia is also associated with reduced quality of life, decreased productivity, increased absenteeism from work, and increased risk for depression.

Yawning

Source: Olivier Walusinski MD. baillement.com  2014/05/08

Yawning is a stereotyped behaviour present in most mammals from rodents to humans and has been described since antiquity. Hippocrates considered yawning to be an exhaustion of the fumes preceding fever. Modern medicine did not pay much attention to it until the 1980s, when, with advances in neuropharmacology, yawning proved to be a valuable tool for the assessing dopaminergic activity and the pharmacological properties of new drugs. However, its precise role in human physiology is still unknown and its mechanisms remain unclear.

Fibromyalgia

Author: Dr Peremarty MD: Sleep and general medicine
2014/05/08

Fibromyalgia is a chronic muscular skeletic pathology described as «functional» [1], characterized mainly by diffuse pains, disabling and unexplained.
Tiredness is, here, often in the background. It results, according to the sick person, from the difficulty to face daily life with pains (of needle or burning sensation type) coming from any part of the body.
Recent studies tend to establish a parallel between fibromyalgia and chronic fatigue syndrome which could share a common physiopathological mechanism.
"Clinophilia" [2], that need to lie down in order to get some rest as often as possible, leads, sooner or later, to insomnia("wanting to sleep").
Statistics put forward an illness in which 80% of the sick persons are women, of late appearance, which would affect 2 to 3% of the population.
In our opinion, these numbers underestimate the existence of male or infantile forms of the disease that escape the actual recruitment criteria.
NB : "Fibromyalgia can evolve during years with a constant painful background punctuated with outbursts which often cause an important functional disturbance. Yet, according to the French Society of Rheumatology, its frequence decreases in a marked manner after 60 years to become exceptional after 70 years".