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Symptoms

Dual Diagnosis
National Library of Medicine
What is dual diagnosis?

A person with dual diagnosis has both a mental disorder and an alcohol or drug problem. These conditions occur together frequently. About half of people who have a mental disorder will also have a substance use disorder at some point in their lives and vice versa. The interactions of the two conditions can worsen both.

Why do substance use disorders and mental disorders occur together?

Although these problems often occur together, this does not mean that one caused the other, even if one appeared first. In fact, it can be hard to figure out which came first. Researchers think that there are three possibilities as to why they occur together:

  • Common risk factors may contribute to both mental disorders and substance use disorders. These factors include genetics, stress, and trauma.
  • Mental disorders can contribute to drug use and substance use disorders. For example, people with mental disorders may use drugs or alcohol to try to feel better temporarily. This is known as self-medication. Also, mental disorders may change the brain to make it more likely you will become addicted.
  • Substance use and addiction can contribute to the development of a mental disorder. Substance use may change the brain in ways that make you more likely to develop a mental disorder.
What are the treatments for dual diagnosis?

Someone with a dual diagnosis must treat both conditions. For the treatment to be effective, you need to stop using alcohol or drugs. Treatments may include behavioral therapies and medicines. Also, support groups can give you emotional and social support. They are also a place where people can share tips about how to deal with day-to-day challenges.

NIH: National Institute on Drug Abuse


Diagnosis, Dual (Psychiatry)
Mental Health and Behavior
Substance Abuse Problems
What is dual diagnosis? A person with dual diagnosis has both a mental disorder and an alcohol or drug problem. These conditions occur ...
Chronic Fatigue Syndrome
National Library of Medicine
CFS
ME/CFS
Myalgic Encephalomyelitis
SEID
Systemic Exertion Intolerance Disease
What is chronic fatigue syndrome?

Chronic fatigue syndrome (CFS) is a serious, long-term illness that affects many body systems. Another name for it is myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). CFS can often make you unable to do your usual activities. Sometimes you may not even be able to get out of bed.

What causes chronic fatigue syndrome?

The cause of CFS is unknown. There may be more than one thing that causes it. It is possible that two or more triggers might work together to cause the illness.

Who is at risk for chronic fatigue syndrome?

Anyone can get CFS, but it is most common in people between 40 and 60 years old. Adult women have it more often that adult men. Whites are more likely than other races to get a diagnosis of CFS, but many people with CFS have not been diagnosed with it.

What are the symptoms of chronic fatigue syndrome?

CFS symptoms can include

  • Severe fatigue that is not improved by rest
  • Sleep problems
  • Post-exertional malaise (PEM), where your symptoms get worse after any physical or mental activity
  • Problems with thinking and concentrating
  • Pain
  • Dizziness

CFS can be unpredictable. Your symptoms may come and go. They may change over time - sometimes they might get better, and other times they may get worse.

How is chronic fatigue syndrome diagnosed?

CFS can be difficult to diagnose. There is no specific test for CFS, and other illnesses can cause similar symptoms. Your health care provider has to rule out other diseases before making a diagnosis of CFS. He or she will do a thorough medical exam, including

  • Asking about your medical history and your family's medical history
  • Asking about your current illness, including your symptoms. Your doctor will want to know how often you have symptoms, how bad they are, how long they have lasted, and how they affect your life.
  • A thorough physical and mental status exam
  • Blood, urine or other tests
What are the treatments for chronic fatigue syndrome?

There is no cure or approved treatment for CFS, but you may be able to treat or manage some of your symptoms. You, your family, and your health care provider should work together to decide on a plan. You should figure out which symptom causes the most problems, and try to treat that first. For example, if sleep problems affect you the most, you might first try using good sleep habits. If those do not help, you may need to take medicines or see a sleep specialist.

Strategies such as learning new ways to manage activity can also be helpful. You need to make sure that you do not "push and crash." This can happen when you feel better, do too much, and then get worse again.

Since the process of developing a treatment plan and attending to self-care can be hard if you have CFS, it is important to have support from family members and friends.

Don't try any new treatments without talking to your health care provider. Some treatments that are promoted as cures for CFS are unproven, often costly, and could be dangerous.

Centers for Disease Control and Prevention


Fatigue Syndrome, Chronic
Bones, Joints and Muscles
Infections
What is chronic fatigue syndrome? Chronic fatigue syndrome (CFS) is a serious, long-term illness that affects many body systems. Another name for it is ...
Dementia
National Library of Medicine
Senility
What is dementia?

Dementia is a loss of mental functions that is severe enough to affect your daily life and activities. These functions include

  • Memory
  • Language skills
  • Visual perception (your ability to make sense of what you see)
  • Problem solving
  • Trouble with everyday tasks
  • The ability to focus and pay attention

It is normal to become a bit more forgetful as you age. But dementia is not a normal part of aging. It is a serious disorder which interferes with your daily life.

What are the types of dementia?

The most common types of dementia are known as neurodegenerative disorders. These are diseases in which the cells of the brain stop working or die. They include

  • Alzheimer's disease, which is the most common form of dementia among older people. People with Alzheimer's have plaques and tangles in their brain. These are abnormal buildups of different proteins. Beta-amyloid protein clumps up and forms plaques in between your brain cells. Tau protein builds up and forms tangles inside the nerve cells of your brain. There is also a loss of connection between nerve cells in the brain.
  • Lewy body dementia, which causes movement symptoms along with dementia. Lewy bodies are abnormal deposits of a protein in the brain.
  • Frontotemporal disorders, which cause changes to certain parts of the brain:
    • Changes in the frontal lobe lead to behavioral symptoms
    • Changes in the temporal lobe lead to language and emotional disorders
  • Vascular dementia, which involves changes to the brain's blood supply. It is often caused by a stroke or atherosclerosis (hardening of the arteries) in the brain.
  • Mixed dementia, which is a combination of two or more types of dementia. For example, some people have both Alzheimer's disease and vascular dementia.

Other conditions can cause dementia or dementia-like symptoms, including

  • Creutzfeldt-Jakob disease, a rare brain disorder
  • Huntington's disease, an inherited, progressive brain disease
  • Chronic traumatic encephalopathy (CTE), caused by repeated traumatic brain injury
  • HIV-associated dementia (HAD)
Who is at risk for dementia?

Certain factors can raise your risk for developing dementia, including

  • Aging. This is the biggest risk factor for dementia.
  • Smoking
  • Uncontrolled diabetes
  • High blood pressure
  • Drinking too much alcohol
  • Having close family members who have dementia
What are the symptoms of dementia?

The symptoms of dementia can vary, depending on which parts of the brain are affected. Often, forgetfulness is the first symptom. Dementia also causes problems with the ability to think, problem solve, and reason. For example, people with dementia may

  • Get lost in a familiar neighborhood
  • Use unusual words to refer to familiar objects
  • Forget the name of a close family member or friend
  • Forget old memories
  • Need help doing tasks that they used to do by themselves

Some people with dementia cannot control their emotions and their personalities may change. They may become apathetic, meaning that they are no longer interested in normal daily activities or events. They may lose their inhibitions and stop caring about other peoples' feelings.

Certain types of dementia can also cause problems with balance and movement.

The stages of dementia range from mild to severe. In the mildest stage, it is just beginning to affect a person's functioning. In the most severe stage, the person is completely dependent on others for care.

How is dementia diagnosed?

To make a diagnosis, your health care provider

  • Will ask about your medical history
  • Will do a physical exam
  • Will check your thinking, memory, and language abilities
  • May do tests, such as blood tests, genetic tests, and brain scans
  • May do a mental health evaluation to see whether a mental disorder is contributing to your symptoms
What are the treatments for dementia?

There is no cure for most types of dementia, including Alzheimer's disease and Lewy body dementia. Treatments may help to maintain mental function longer, manage behavioral symptoms, and slow down the symptoms of disease. They may include

  • Medicines may temporarily improve memory and thinking or slow down their decline. They only work in some people. Other medicines can treat symptoms such as anxiety, depression, sleep problems, and muscle stiffness. Some of these medicines can cause strong side effects in people with dementia. It is important to talk to your health care provider about which medicines will be safe for you.
  • Occupational therapy to help find ways to more easily do everyday activities
  • Speech therapy to help with swallowing difficulties and trouble speaking loudly and clearly
  • Mental health counseling to help people with dementia and their families learn how to manage difficult emotions and behaviors. It can also help them plan for the future.
  • Music or art therapy to reduce anxiety and improve well-being
Can dementia be prevented?

Researchers have not found a proven way to prevent dementia. Living a healthy lifestyle might influence some of your risk factors for dementia.


Dementia
Mental Health and Behavior
Older Adults
Brain and Nerves
What is dementia? Dementia is a loss of mental functions that is severe enough to affect your daily life and activities. These functions include Memory ...
Eating Disorders
National Library of Medicine
Anorexia Nervosa
Binge Eating
Bulimia
Pica
What are eating disorders?

Eating disorders are serious mental health disorders. They involve severe problems with your thoughts about food and your eating behaviors. You may eat much less or much more than you need.

Eating disorders are medical conditions; they are not a lifestyle choice. They affect your body's ability to get proper nutrition. This can lead to health issues, such as heart and kidney problems, or sometimes even death. But there are treatments that can help.

What are the types of eating disorders?

Common types of eating disorders include

  • Binge-eating, which is out-of-control eating. People with binge-eating disorder keep eating even after they are full. They often eat until they feel very uncomfortable. Afterward, they usually have feelings of guilt, shame, and distress. Eating too much too often can lead to weight gain and obesity. Binge-eating disorder is the most common eating disorder in the U.S.
  • Bulimia nervosa. People with bulimia nervosa also have periods of binge-eating. But afterwards, they purge, by making themselves throw up or using laxatives. They may also over-exercise or fast. People with bulimia nervosa may be slightly underweight, normal weight, or overweight.
  • Anorexia nervosa. People with anorexia nervosa avoid food, severely restrict food, or eat very small quantities of only certain foods. They may see themselves as overweight, even when they are dangerously underweight. Anorexia nervosa is the least common of the three eating disorders, but it is often the most serious. It has the highest death rate of any mental disorder.
What causes eating disorders?

The exact cause of eating disorders is unknown. Researchers believe that eating disorders are caused by a complex interaction of factors. These include genetic, biological, behavioral, psychological, and social factors.

Who is at risk for eating disorders?

Anyone can develop an eating disorder, but they are more common in women. Eating disorders frequently appear during the teen years or young adulthood. But people can also develop them during childhood or later in life.

What are the symptoms of eating disorders?

The symptoms of eating disorders vary, depending on the disorder:

The symptoms of binge-eating include

  • Eating unusually large amounts of food in a specific amount of time, such as a 2-hour period
  • Eating even when you're full or not hungry
  • Eating fast during binge episodes
  • Eating until you're uncomfortably full
  • Eating alone or in secret to avoid embarrassment
  • Feeling distressed, ashamed, or guilty about your eating
  • Frequently dieting, possibly without weight loss

The symptoms of bulimia nervosa include the same symptoms as binge-eating, plus trying to get rid of the food or weight after binging by

  • Purging, making yourself throw up or using laxatives or enemas to speed up the movement of food through your body
  • Doing intensive and excessive exercise
  • Fasting

Over time, bulimia nervosa can cause health problems such as

  • Chronically inflamed and sore throat
  • Swollen salivary glands in the neck and jaw area
  • Worn tooth enamel and increasingly sensitive and decaying teeth. This is caused by the exposure to stomach acid every time you throw up.
  • GERD (acid reflux) and other gastrointestinal problems
  • Severe dehydration from purging
  • Electrolyte imbalance, which could be too low or too high levels of sodium, calcium, potassium and other minerals. This can lead to a stroke or heart attack.

The symptoms of anorexia nervosa include

  • Eating very little, to the point of starving yourself
  • Intensive and excessive exercise
  • Extreme thinness
  • Intense fear of gaining weight
  • Distorted body image - seeing yourself as overweight even when you are severely underweight

Over time, anorexia nervosa can cause health problems such as

  • Thinning of the bones (osteopenia or osteoporosis)
  • Mild anemia
  • Muscle wasting and weakness
  • Thin, brittle hair and nails
  • Dry, blotchy, or yellowish skin
  • Growth of fine hair all over the body
  • Severe constipation
  • Low blood pressure
  • Slowed breathing and pulse.
  • Feeling cold all the time because of a drop in internal body temperature
  • Feeling faint, dizzy, or weak
  • Feeling tired all the time
  • Infertility
  • Damage to the structure and function of the heart
  • Brain damage
  • Multiorgan failure

Anorexia nervosa can be fatal. Some people with this disorder die of complications from starvation, and others die of suicide.

Some people with eating disorders may also have other mental disorders (such as depression or anxiety) or problems with substance use.

How is eating disorders diagnosed?

Because eating disorders can be so serious, it is important to seek help if you or a loved one thinks that you might have a problem. To make a diagnosis, your health care provider

  • Will take a medical history and ask about your symptoms. It is important to be honest about your eating and exercise behaviors so your provider can help you.
  • Will do a physical exam
  • May do blood or urine tests to rule out other possible causes of your symptoms
  • May do other tests to see whether you have any other health problems caused by the eating disorder. These can include kidney function tests and an electrocardiogram (EKG or ECG).
What are the treatments for eating disorders?

Treatment plans for eating disorders are tailored to individual needs. You will likely have a team of providers helping you, including doctors, nutritionists, nurses, and therapists. The treatments may include

  • Individual, group, and/or family psychotherapy. Individual therapy may include cognitive behavioral approaches, which help you to identify and change negative and unhelpful thoughts. It also helps you build coping skills and change behavioral patterns.
  • Medical care and monitoring, including care for the complications that eating disorders can cause
  • Nutrition counseling. Doctors, nurses, and counselors will help you eat healthy to reach and maintain a healthy weight.
  • Medicines, such as antidepressants, antipsychotics, or mood stabilizers, may help treat some eating disorders. The medicines can also help with the depression and anxiety symptoms that often go along with eating disorders.

Some people with serious eating disorders may need to be in a hospital or in a residential treatment program. Residential treatment programs combine housing and treatment services.

NIH: National Institute of Mental Health


Feeding and Eating Disorders
Mental Health and Behavior
Food and Nutrition
What are eating disorders? Eating disorders are serious mental health disorders. They involve severe problems with your thoughts about food and your eating ...
Eosinophilic Esophagitis
National Library of Medicine
EoE
Eosinophilic Oesophagitis
What is eosinophilic esophagitis (EoE)?

Eosinophilic esophagitis (EoE) is a chronic disease of the esophagus. Your esophagus is the muscular tube that carries food and liquids from your mouth to the stomach. If you have EoE, white blood cells called eosinophils build up in your esophagus. This causes damage and inflammation, which can cause pain and may lead to trouble swallowing and food getting stuck in your throat.

EoE is rare. But because it is a newly recognized disease, more people are now getting diagnosed with it. Some people who think that they have reflux (GERD) may actually have EoE.

What causes eosinophilic esophagitis (EoE)?

Researchers are not certain about the exact cause of EoE. They think that it is an immune system/allergic reaction to foods or to substances in your environment, such as dust mites, animal dander, pollen, and molds. Certain genes may also play a role in EoE.

Who is at risk for eosinophilic esophagitis(EoE)?

EoE can affect anyone, but it is more common in people who

  • Are male
  • Are Caucasian
  • Have other allergic diseases, such as hay fever, eczema, asthma and food allergies
  • Have family members with EoE
What are the symptoms of eosinophilic esophagitis (EoE)?

The most common symptoms of EoE can depend on your age.

In infants and toddlers:

  • Feeding problems
  • Vomiting
  • Poor weight gain and growth
  • Reflux that does not get better with medicines

In older children:

  • Vomiting
  • Abdominal pain
  • Trouble swallowing, especially with solid foods
  • Reflux that does not get better with medicines
  • Poor appetite

In adults:

  • Trouble swallowing, especially with solid foods
  • Food getting stuck in the esophagus
  • Reflux that does not get better with medicines
  • Heartburn
  • Chest pain
How is eosinophilic esophagitis (EoE) diagnosed?

To diagnose EoE, your doctor will

  • Ask about your symptoms and medical history. Since other conditions can have the same symptoms of EoE, it is important for your doctor to take a thorough history.
  • Do an upper gastrointestinal (GI) endoscopy. An endoscope is a long, flexible tube with a light and camera at the end of it. Your doctor will run the endoscope down your esophagus and look at it. Some signs that you might have EoE include white spots, rings, narrowing, and inflammation in the esophagus. However, not everyone with EoE has those signs, and sometimes they can be signs of a different esophagus disorder.
  • Do a biopsy. During the endoscopy, the doctor will take small tissue samples from your esophagus. The samples will be checked for a high number of eosinophils. This is the only way to make a diagnosis of EoE.
  • Do other tests as needed. You may have blood tests to check for other conditions. If you do have EoE, you may have blood or other types of tests to check for specific allergies.
What are the treatments for eosinophilic esophagitis (EoE)?

There is no cure for EoE. Treatments can manage your symptoms and prevent further damage. The two main types of treatments are medicines and diet.

Medicines used to treat EoE are

  • Steroids, which can help control inflammation. These are usually topical steroids, which you swallow either from an inhaler or as a liquid. Sometimes doctors prescribe oral steroids (pills) to treat people who have serious swallowing problems or weight loss.
  • Acid suppressors such as proton pump inhibitors (PPIs), which may help with reflux symptoms and decrease inflammation.

Dietary changes for EoE include

  • Elimination diet. If you are on an elimination diet, you stop eating and drinking certain foods and beverages for several weeks. If you are feeling better, you add the foods back to your diet one at a time. You have repeat endoscopies to see whether or not you are tolerating those foods. There are different types of elimination diets:
    • With one type, you first have an allergy test. Then you stop eating and drinking the foods you are allergic to.
    • For another type, you eliminate foods and drinks that commonly cause allergies, such as dairy products, egg, wheat, soy, peanuts, tree nuts and fish/shellfish.
  • Elemental diet. With this diet, you stop eating and drinking all proteins. Instead, you drink an amino acid formula. Some people who do not like the taste of the formula use a feeding tube instead. If your symptoms and inflammation go away completely, you may be able to try adding foods back one at a time, to see whether you can tolerate them.

Which treatment your health care provider suggests depends on different factors, including your age. Some people may use more than one kind of treatment. Researchers are still trying to understand EoE and how best to treat it.

If your treatment is not working well enough and you have narrowing of the esophagus, you may need dilation. This is a procedure to stretch the esophagus. This makes it easier for you to swallow.


Eosinophilic Esophagitis
Digestive System
Blood, Heart and Circulation
Immune System
What is eosinophilic esophagitis (EoE)? Eosinophilic esophagitis (EoE) is a chronic disease of the esophagus. Your esophagus is the muscular tube that carries ...
Fibromyalgia
National Library of Medicine
FMS
Fibro
What is fibromyalgia?

Fibromyalgia is chronic condition that causes pain all over the body, fatigue, and other symptoms. People with fibromyalgia may be more sensitive to pain than people who don't have it. This is called abnormal pain perception processing.

What causes fibromyalgia?

The exact cause of fibromyalgia is unknown. Researchers think that certain things might contribute to its cause:

  • Stressful or traumatic events, such as car accidents
  • Repetitive injuries
  • Illnesses such as viral infections

Sometimes, fibromyalgia can develop on its own. It can run in families, so genes may play a role in the cause.

Who is at risk for fibromyalgia?

Anyone can get fibromyalgia, but it is more common in

  • Women; they are twice as likely to have fibromyalgia
  • Middle-aged people
  • People with certain diseases, such as lupus, rheumatoid arthritis, or ankylosing spondylitis
  • People who have a family member with fibromyalgia
What are the symptoms of fibromyalgia?

Common symptoms of fibromyalgia include

  • Pain and stiffness all over the body
  • Fatigue and tiredness
  • Problems with thinking, memory, and concentration (sometimes called "fibro fog")
  • Depression and anxiety
  • Headaches, including migraines
  • Irritable bowel syndrome
  • Numbness or tingling in the hands and feet
  • Pain in the face or jaw, including disorders of the jaw know as temporomandibular joint syndrome (TMJ)
  • Sleep problems
How is fibromyalgia diagnosed?

Fibromyalgia can be hard to diagnose. It sometimes takes visits to several different health care providers to get a diagnosis. One problem is that there isn't a specific test for it. And the main symptoms, pain and fatigue, are common in many other conditions. Health care providers have to rule out other causes of the symptoms before making a diagnosis of fibromyalgia. This is called making a differential diagnosis.

To make a diagnosis, your health care provider

  • Will take your medical history and ask detailed questions about your symptoms
  • Will do a physical exam
  • May do x-rays and blood tests to rule out other conditions
  • Will consider the guidelines for diagnosing fibromyalgia, which include
    • A history of widespread pain lasting more than 3 months
    • Physical symptoms including fatigue, waking unrefreshed, and cognitive (memory or thought) problems
    • The number of areas throughout the body in which you had pain in the past week
What are the treatments for fibromyalgia?

Not all health care providers are familiar with fibromyalgia and its treatment. You should see a doctor or team of health care providers who specialize in the treatment of fibromyalgia.

Fibromyalgia is treated with a combination of treatments, which may include medicines, lifestyle changes, talk therapy, and complementary therapies:

  • Medicines
    • Over-the-counter pain relievers
    • Prescription medicines that were specifically approved to treat fibromyalgia
    • Prescription pain medicines
    • Certain antidepressants, which may help with pain or sleep problems
  • Lifestyle changes
    • Getting enough sleep
    • Getting regular physical activity. If you have not already been active, start slowly and gradually increase how much activity you get. You may want to see a physical therapist, who can help you create a plan that is right for you.
    • Learning how to manage stress
    • Eating a healthy diet
    • Learning to pace yourself. If you do too much, it can make your symptoms worse. So you need to learn to balance being active with your need for rest.
  • Talk therapy, such as cognitive behavioral therapy (CBT), can help you learn strategies to deal with pain, stress, and negative thoughts. If you also have depression along with your fibromyalgia, talk therapy can help with that too.
  • Complementary therapies have helped some people with the symptoms of fibromyalgia. But researchers need to do more studies to show which ones are effective. You could consider trying them, but you should check with your health care provider first. These therapies include
    • Massage therapy
    • Movement therapies
    • Chiropractic therapy
    • Acupuncture

Fibromyalgia
Bones, Joints and Muscles
What is fibromyalgia? Fibromyalgia is chronic condition that causes pain all over the body, fatigue, and other symptoms. People with fibromyalgia may ...
Lewy Body Dementia
National Library of Medicine
Dementia with Lewy Bodies
LBD
Lewy Body Disease
Parkinson's disease dementia
What is Lewy body dementia (LBD)?

Lewy body dementia (LBD) is one of the most common types of dementia in older adults. Dementia is a loss of mental functions that is severe enough to affect your daily life and activities. These functions include

  • Memory
  • Language skills
  • Visual perception (your ability to make sense of what you see)
  • Problem solving
  • Trouble with everyday tasks
  • The ability to focus and pay attention
What are the types of Lewy body dementia (LBD)?

There are two types of LBD: dementia with Lewy bodies and Parkinson's disease dementia.

Both types cause the same changes in the brain. And, over time, they can cause similar symptoms. The main difference is in when the cognitive (thinking) and movement symptoms start.

Dementia with Lewy bodies causes problems with thinking ability that seem similar to Alzheimer's disease. Later, it also causes other symptoms, such as movement symptoms, visual hallucinations, and certain sleep disorders. It also causes more trouble with mental activities than with memory.

Parkinson's disease dementia starts as a movement disorder. It first causes the symptoms of Parkinson's disease: slowed movement, muscle stiffness, tremor, and a shuffling walk. Later on, it causes dementia.

What causes Lewy body dementia (LBD)?

LBD happens when Lewy bodies build up in parts of the brain that control memory, thinking, and movement. Lewy bodies are abnormal deposits of a protein called alpha-synuclein. Researchers don't know exactly why these deposits form. But they do know that other diseases, such as Parkinson's disease, also involve a build-up of that protein.

Who is at risk for Lewy body dementia (LBD)?

The biggest risk factor for LBD is age; most people who get it are over age 50. People who have a family history of LBD are also at higher risk.

What are the symptoms of Lewy body dementia (LBD)?

LBD is a progressive disease. This means that the symptoms start slowly and get worse over time. The most common symptoms include changes in cognition, movement, sleep, and behavior:

  • Dementia, which is a loss of mental functions that is severe enough to affect your daily life and activities
  • Changes in concentration, attention, alertness, and wakefulness. These changes usually happen from day to day. But sometimes they can also happen throughout the same day.
  • Visual hallucinations, which means seeing things that are not there
  • Problems with movement and posture, including slowness of movement, difficulty walking, and muscle stiffness. These are called parkinsonian motor symptoms.
  • REM sleep behavior disorder, a condition in which a person seems to act out dreams. It may include vivid dreaming, talking in one's sleep, violent movements, or falling out of bed. This may be the earliest symptom of LBD in some people. It can appear several years before any other LBD symptoms.
  • Changes in behavior and mood, such as depression, anxiety, and apathy (a lack of interest in normal daily activities or events)

In the early stages of LBD, symptoms can be mild, and people can function fairly normally. As the disease gets worse, people with LBD need more help due to problems with thinking and movement. In the later stages of the disease, they often cannot care for themselves.

How is Lewy body dementia (LBD) diagnosed?

There isn't one test that can diagnose LBD. It is important to see an experienced doctor to get a diagnosis. This would usually be specialist such as a neurologist. The doctor will

  • Do a medical history, including taking a detailed account of the symptoms. The doctor will talk to both the patient and caregivers.
  • Do physical and neurological exams
  • Do tests to rule out other conditions that could cause similar symptoms. These could include blood tests and brain imaging tests.
  • Do neuropsychological tests to evaluate memory and other cognitive functions

LBD can be hard to diagnose, because Parkinson's disease and Alzheimer's disease cause similar symptoms. Scientists think that Lewy body disease might be related to these diseases, or that they sometimes happen together.

It's also important to know which type of LBD a person has, so the doctor can treat that type's particular symptoms. It also helps the doctor understand how the disease will affect the person over time. The doctor makes a diagnosis based on when certain symptoms start:

  • If cognitive symptoms start within a year of movement problems, the diagnosis is dementia with Lewy bodies
  • If cognitive problems start more than a year after the movement problems, the diagnosis is Parkinson's disease dementia
What are the treatments for Lewy body dementia (LBD)?

There is no cure for LBD, but treatments can help with the symptoms:

  • Medicines may help with some of the cognitive, movement, and psychiatric symptoms
  • Physical therapy can help with movement problems
  • Occupational therapy may help find ways to more easily do everyday activities
  • Speech therapy may help with swallowing difficulties and trouble speaking loudly and clearly
  • Mental health counseling can help people with LBD and their families learn how to manage difficult emotions and behaviors. It can also help them plan for the future.
  • Music or art therapy may reduce anxiety and improve well-being

Support groups can also be helpful for people with LBD and their caregivers. Support groups can give emotional and social support. They are also a place where people can share tips about how to deal with day-to-day challenges.

NIH: National Institute of Neurological Disorders and Stroke


Lewy Body Disease
Brain and Nerves
What is Lewy body dementia (LBD)? Lewy body dementia (LBD) is one of the most common types of dementia in older adults. Dementia is a loss of mental functions ...
Reflux in Infants
National Library of Medicine
GER in Infants
GERD in infants
Pediatric Gastroesophageal Reflux
What are reflux (GER) and GERD?

The esophagus is the tube that carries food from your mouth to your stomach. If your baby has reflux, his or her stomach contents come back up into the esophagus. Another name for reflux is gastroesophageal reflux (GER).

GERD stands for gastroesophageal reflux disease. It is a more serious and long-lasting type of reflux. Babies may have GERD if their symptoms prevent them from feeding or if the reflux lasts more than 12 to 14 months.

What causes reflux and GERD in infants?

There is a muscle (the lower esophageal sphincter) that acts as a valve between the esophagus and stomach. When your baby swallows, this muscle relaxes to let food pass from the esophagus to the stomach. This muscle normally stays closed, so the stomach contents don't flow back into the esophagus.

In babies who have reflux, the lower esophageal sphincter muscle is not fully developed and lets the stomach contents back up the esophagus. This causes your baby to spit up (regurgitate). Once his or her sphincter muscle fully develops, your baby should no longer spit up.

In babies who have GERD, the sphincter muscle becomes weak or relaxes when it shouldn't.

How common are reflux and GERD in infants?

Reflux is very common in babies. About half all babies spit up many times a day in the first 3 months of their lives. They usually stop spitting up between the ages of 12 and 14 months.

GERD is also common in younger infants. Many 4-month-olds have it. But by their first birthday, only 10 percent of babies still have GERD.

What are the symptoms of reflux and GERD in infants?

In babies, the main symptom of reflux and GERD is spitting up. GERD may also cause symptoms such as

  • Arching of the back, often during or right after eating
  • Colic - crying that lasts for more than 3 hours a day with no medical cause
  • Coughing
  • Gagging or trouble swallowing
  • Irritability, especially after eating
  • Poor eating or refusing to eat
  • Poor weight gain, or weight loss
  • Wheezing or trouble breathing
  • Forceful or frequent vomiting

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

How do doctors diagnose reflux and GERD in infants?

In most cases, a doctor diagnoses reflux by reviewing your baby's symptoms and medical history. If the symptoms do not get better with feeding changes and anti-reflux medicines, your baby may need testing.

Several tests can help a doctor diagnose GERD. Sometimes doctors order more than one test to get a diagnosis. Common tests include

  • Upper GI series, which looks at the shape of your baby's upper GI (gastrointestinal) tract. Your baby will drink or eat a contrast liquid called barium. The barium is mixed in with a bottle or other food. The health care professional will take several x-rays of your baby to track the barium as it goes through the esophagus and stomach.
  • Esophageal pH and impedance monitoring, which measures the amount of acid or liquid in your baby's esophagus. A doctor or nurse places a thin flexible tube through your baby's nose into the stomach. The end of the tube in the esophagus measures when and how much acid comes up into the esophagus. The other end of the tube attaches to a monitor that records the measurements. Your baby will wear this for 24 hours, most likely in the hospital.
  • Upper gastrointestinal (GI) endoscopy and biopsy, which uses an endoscope, a long, flexible tube with a light and camera at the end of it. The doctor runs the endoscope down your baby's esophagus, stomach, and first part of the small intestine. While looking at the pictures from the endoscope, the doctor may also take tissue samples (biopsy).
What feeding changes can help treat my infant's reflux or GERD?

Feeding changes may help your baby's reflux and GERD:

  • Add rice cereal to your baby's bottle of formula or breastmilk. Check with the doctor about how much to add. If the mixture is too thick, you can change the nipple size or cut a little "x" in the nipple to make the opening larger.
  • Burp your baby after every 1 to 2 ounces of formula. If you breastfeed, burp your baby after nursing from each breast.
  • Avoid overfeeding; give your baby the amount of formula or breast milk recommended.
  • Hold your baby upright for 30 minutes after feedings.
  • If you use formula and your doctor thinks that your baby may be sensitive to milk protein, your doctor may suggest switching to a different type of formula. Do not change formulas without talking to the doctor.
What treatments might the doctor give for my infant's GERD?

If feeding changes do not help enough, the doctor may recommend medicines to treat GERD. The medicines work by lowering the amount of acid in your baby's stomach. The doctor will only suggest medicine if your baby still has regular GERD symptoms and

  • You already tried some feeding changes
  • Your baby has problems sleeping or feeding
  • Your baby does not grow properly

The doctor will often prescribe a medicine on a trial basis and will explain any possible complications. You shouldn't give your baby any medicines unless the doctor tells you to.

Medicines for GERD in babies include

  • H2 blockers, which decrease acid production
  • Proton pump inhibitors (PPIs), which lower the amount of acid the stomach makes

If these don't help and your baby still has severe symptoms, then surgery might be an option. Pediatric gastroenterologists only use surgery to treat GERD in babies in rare cases. They may suggest surgery when babies have severe breathing problems or have a physical problem that causes GERD symptoms.


Gastroesophageal Reflux
Digestive System
Children and Teenagers
What are reflux (GER) and GERD? The esophagus is the tube that carries food from your mouth to your stomach. If your baby has reflux, his or her stomach ...
Vaginitis
National Library of Medicine
Bacterial Vaginosis
Vaginal Yeast Infection
What is vaginitis?

Vaginitis, also called vulvovaginitis, is an inflammation or infection of the vagina. It can also affect the vulva, which is the external part of a woman's genitals. Vaginitis can cause itching, pain, discharge, and odor.

Vaginitis is common, especially in women in their reproductive years. It usually happens when there is a change in the balance of bacteria or yeast that are normally found in your vagina. There are different types of vaginitis, and they have different causes, symptoms, and treatments.

What causes vaginitis?

Bacterial vaginosis (BV) is the most common vaginal infection in women ages 15-44. It happens when there is an imbalance between the "good" and "harmful" bacteria that are normally found in a woman's vagina. Many things can change the balance of bacteria, including

  • Taking antibiotics
  • Douching
  • Using an intrauterine device (IUD)
  • Having unprotected sex with a new partner
  • Having many sexual partners

Yeast infections (candidiasis) happen when too much candida grows in the vagina. Candida is the scientific name for yeast. It is a fungus that lives almost everywhere, including in your body. You may have too much growing in the vagina because of

  • Antibiotics
  • Pregnancy
  • Diabetes, especially if it is not well-controlled
  • Corticosteroid medicines

Trichomoniasis can also cause vaginitis. Trichomoniasis is a common sexually transmitted disease. It is caused by a parasite.

You can also have vaginitis if you are allergic or sensitive to certain products that you use. Examples include vaginal sprays, douches, spermicides, soaps, detergents, or fabric softeners. They can cause burning, itching, and discharge.

Hormonal changes can also cause vaginal irritation. Examples are when you are pregnant or breastfeeding, or when you have gone through menopause.

Sometimes you can have more than one cause of vaginitis at the same time.

What are the symptoms of vaginitis?

The symptoms of vaginitis depend on which type you have.

With BV, you may not have symptoms. You could have a thin white or gray vaginal discharge. There may be an odor, such as a strong fish-like odor, especially after sex.

Yeast infections produce a thick, white discharge from the vagina that can look like cottage cheese. The discharge can be watery and often has no smell. Yeast infections usually cause the vagina and vulva to become itchy and red.

You may not have symptoms when you have trichomoniasis. If you do have them, they include itching, burning, and soreness of the vagina and vulva. You may have burning during urination. You could also have gray-green discharge, which may smell bad.

How is the cause of vaginitis diagnosed?

To find out the cause of your symptoms, your health care provider may

  • Ask you about your medical history
  • Do a pelvic exam
  • Look for vaginal discharge, noting its color, qualities, and any odor
  • Study a sample of your vaginal fluid under a microscope

In some cases, you may need more tests.

What are the treatments for vaginitis?

The treatment depends on which type of vaginitis you have.

BV is treatable with antibiotics. You may get pills to swallow, or cream or gel that you put in your vagina. During treatment, you should use a condom during sex or not have sex at all.

Yeast infections are usually treated with a cream or with medicine that you put inside your vagina. You can buy over-the-counter treatments for yeast infections, but you need to be sure that you do have a yeast infection and not another type of vaginitis. See your health care provider if this is the first time you have had symptoms. Even if you have had yeast infections before, it is a good idea to call your health care provider before using an over-the-counter treatment.

The treatment for trichomoniasis is usually a single-dose antibiotic. Both you and your partner(s) should be treated, to prevent spreading the infection to others and to keep from getting it again.

If your vaginitis is due to an allergy or sensitivity to a product, you need to figure out which product is causing the problem. It could be a product that you started using recently. Once you figure it out, you should stop using the product.

If the cause of your vaginitis is a hormonal change, your health care provider may give you estrogen cream to help with your symptoms.

Can vaginitis cause other health problems?

It is important to treat BV and trichomoniasis, because having either of them can increase your risk for getting HIV or another sexually transmitted disease. If you are pregnant, BV or trichomoniasis can increase your risk for preterm labor and preterm birth.

Can vaginitis be prevented?

To help prevent vaginitis

  • Do not douche or use vaginal sprays
  • Use a condom when having sex
  • Avoid clothes that hold in heat and moisture
  • Wear cotton underwear

Vaginitis
Vulvovaginitis
Women
Female Reproductive System
What is vaginitis? Vaginitis, also called vulvovaginitis, is an inflammation or infection of the vagina. It can also affect the vulva, which is the external ...
Delirium
National Library of Medicine
What is delirium?

Delirium is a mental state in which you are confused, disoriented, and not able to think or remember clearly. It usually starts suddenly. It is often temporary and treatable.

There are three types of delirium:

  • Hypoactive, where you are not active and seem sleepy, tired, or depressed
  • Hyperactive, where you are restless or agitated
  • Mixed, where you change back and forth between being hypoactive and hyperactive
What causes delirium?

There are many different problems that can cause delirium. Some of the more common causes include

  • Alcohol or drugs, either from intoxication or withdrawal. This includes a serious type of alcohol withdrawal syndrome called delirium tremens. It usually happens to people who stop drinking after years of alcohol abuse.
  • Dehydration and electrolyte imbalances
  • Dementia
  • Hospitalization, especially in intensive care
  • Infections, such as urinary tract infections, pneumonia, and the flu
  • Medicines. This could be a side effect of a medicine, such as sedatives or opioids. Or it could be withdrawal after stopping a medicine.
  • Metabolic disorders
  • Organ failure, such as kidney or liver failure
  • Poisoning
  • Serious illnesses
  • Severe pain
  • Sleep deprivation
  • Surgeries, including reactions to anesthesia
Who is at risk for delirium?

Certain factors put you at risk for delirium, including

  • Being in a hospital or nursing home
  • Dementia
  • Having a serious illness or more than one illness
  • Having an infection
  • Older age
  • Surgery
  • Taking medicines that affect the mind or behavior
  • Taking high doses of pain medicines, such as opioids
What are the symptoms of delirium?

The symptoms of delirium usually start suddenly, over a few hours or a few days. They often come and go. The most common symptoms include

  • Changes in alertness (usually more alert in the morning, less at night)
  • Changing levels of consciousness
  • Confusion
  • Disorganized thinking, talking in a way that doesn't make sense
  • Disrupted sleep patterns, sleepiness
  • Emotional changes: anger, agitation, depression, irritability, overexcitement
  • Hallucinations and delusions
  • Incontinence
  • Memory problems, especially with short-term memory
  • Trouble concentrating
How is delirium diagnosed?

To make a diagnosis, the health care provider

  • Will take a medical history
  • Will do physical and neurological exams
  • Will do mental status testing
  • May do lab tests
  • May do diagnostic imaging tests

Delirium and dementia have similar symptoms, so it can be hard to tell them apart. They can also occur together. Delirium starts suddenly and can cause hallucinations. The symptoms may get better or worse and can last for hours or weeks. On the other hand, dementia develops slowly and does not cause hallucinations. The symptoms are stable and may last for months or years.

What are the treatments for delirium?

Treatment of delirium focuses on the causes and symptoms of delirium. The first step is to identify the cause. Often, treating the cause will lead to a full recovery. The recovery may take some time - weeks or sometimes even months. In the meantime, there may be treatments to manage the symptoms, such as

  • Controlling the environment, which includes making sure that the room is quiet and well-lit, having clocks or calendars in view, and having family members around
  • Medicines, including those that control aggression or agitation and pain relievers if there is pain
  • If needed, making sure that the person has a hearing aid, glasses, or other devices for communication
Can delirium be prevented?

Treating the conditions that can cause delirium may reduce the risk of getting it. Hospitals can help lower the risk of delirium by avoiding sedatives and making sure that the room is kept quiet, calm, and well-lit. It can also help to have family members around and to have the same staff members treat the person.


Delirium
Mental Health and Behavior
Brain and Nerves
... pain medicines, such as opioids What are the symptoms of delirium? The symptoms of delirium usually start ...