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Psychiatric disorders

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Related Terms
  • Abrasions, anal fissure, autolytic debridement, bed sore, Clostridium sp., collagen, collagen matrix, cuts, debridement, decubitus ulcer, diabetic ulcers, electrotherapy, epithelial, epithelialization phase, extravasation, gangrene, gas gangrene, human growth factors, hydrocolloid, hyperbaric oxygen, incision wounds, incontinence, infected surgical wounds, infectious arthritis, inflammatory phase, injuries, laceration, macrophages, mechanical debridement, microvascular, minor injuries, myonecrosis, necrotizing fasciitis, pressure ulcers/wound care, proliferative phase, puncture wound, remodeling phase, scrapes, scratches, sepsis, septic arthritis, skin damage caused by incontinence, skin graft healing (split thickness), skin ulcer, surgical skin flap ischemia, skin wounds, squamous, stitches, superficial, suture, vulnerary, wound care, wound healing.

Background
  • A wound is a break in the outer layer of the skin, called the epidermis. Wounds are usually caused by cuts or scrapes. Different kinds of wounds may be treated differently from one another, depending upon how they happened and how serious they are. Other wounds include puncture wounds, lacerations (cuts), pressure sores, anal fissures, extravasations (a drug accidentally going outside of a vein causing tissue damage), skin damage caused by incontinence (lack of bladder control), skin graft healing (split thickness), diabetic ulcers, and surgical skin flap ischemia (lack of blood flow to surgically attached skin).
  • Healing is a response to the injury that sets into motion a sequence of events. With the exception of bone, all tissues heal with some external scarring. The object of proper care is to minimize the possibility of infection and scarring.
  • There are basically four phases to the healing process: the inflammatory phase, proliferative phase, remodeling phase, and epithelialization phase.
  • The inflammatory phase begins with the injury itself. In the inflammatory phase, there is bleeding, immediate narrowing of the blood vessels, clot formation, and release of various chemical substances into the wound that will begin the healing process. Specialized cells (macrophages) clear the wound of debris over the course of several days.
  • Next is the proliferative phase in which a matrix or latticework of cells forms. On this matrix, new skin cells and blood vessels will form. It is the new small blood vessels (known as capillaries) that give a healing wound its pink or purple-red appearance. These new blood vessels will supply the rebuilding cells with oxygen and nutrients to sustain the growth of the new cells and support the production of proteins (primarily collagen). The collagen acts as the framework upon which the new tissues build. Collagen is the dominant substance in the final scar.
  • The remodeling phase begins after 2-3 weeks. The framework (collagen) becomes more organized making the tissue stronger. The blood vessel density becomes less, and the wound begins to lose its pinkish color. Over the course of six months, the area increases in strength, eventually reaching 70% of the strength of uninjured skin.
  • Epithelialization is the process of laying down new skin, or epithelial, cells. The skin forms a protective barrier between the outer environment and the body. Its primary purpose is to protect against excessive water loss and bacteria. Reconstruction of this layer begins within a few hours of the injury and is complete within 24-48 hours in a clean, sutured (stitched) wound. Open wounds may take 7-10 days because the inflammatory process is prolonged, which contributes to scarring. Scarring occurs when the injury extends beyond the deep layer of the skin (into the dermis, which is the second layer of skin).

Complications
  • Complications from a lack of wound care can lead to other health problems.
  • Cellulitis: Cellulitis is a potentially serious bacterial infection of the skin. Cellulitis appears as a swollen, red area of skin that feels hot and tender, and it may spread rapidly. Skin on the face or lower legs is most commonly affected by this infection, though cellulitis can occur on any part of the body. Cellulitis may only affect the surface of the skin. However, cellulitis may also affect the tissues underlying skin and can spread to lymph nodes and the bloodstream. Left untreated, the spreading bacterial infection may rapidly turn into a life-threatening condition.
  • Bone and joint infections: Bone and joint infections develop when the infection from a bedsore burrows deep into the joints and bones. Joint infections (called septic or infectious arthritis) can damage cartilage and tissue within days, whereas bone infections (osteomyelitis) may develop over years if not treated. Eventually, bone infections can lead to bone death, reduced function of the joints and limbs, and amputation.
  • Necrotizing fasciitis: Necrotizing fasciitis is a rapidly spreading infection that destroys the layers of tissue that surround the muscles. Initial signs and symptoms include fever, pain, and massive swelling. Without treatment, death can occur in as little as 12-24 hours.
  • Gas gangrene (myonecrosis): Gas gangrene is a rare and severe form of gangrene. Gas gangrene develops suddenly and dramatically and spreads so rapidly that changes in tissue are noticeable within minutes. The bacteria responsible for gas gangrene (Clostridium sp.) produce toxins that completely destroy affected muscle tissue and cause potentially fatal systemic problems.
  • Sepsis: Sepsis (a whole body response to an infection) can occur from a wound such as advanced pressure sores. Sepsis occurs when bacteria from a massive infection enter the bloodstream and spread throughout the body. Sepsis is a rapidly progressing, life-threatening condition that can cause shock and organ failure.
  • Skin cancer: Cancer resulting from poor wound healing may occur. This type of cancer is usually an aggressive carcinoma affecting the skin's squamous cells.
  • Fistulas: A fistula is an abnormal connection between an organ, vessel, or intestine and another structure. Fistulas are usually the result of a wound from an injury or surgery. They may also result from infection or inflammation.

Integrative therapies
  • Unclear or conflicting scientific evidence:
  • Aloe: Transparent gel from the pulp of the meaty leaves of Aloe vera has been used topically for thousands of years to treat wounds, skin infections, burns, and numerous other dermatologic conditions. Study results of aloe on wound healing are mixed with some studies reporting positive results and others showing no benefit or potential worsening of the condition. Early studies suggest that aloe may help heal skin ulcers. High-quality studies comparing aloe alone with placebo are needed.
  • Avoid if allergic to aloe or other plants of the Liliaceae family (garlic, onions, tulips). Avoid injecting aloe. Do not apply to open skin, surgical wounds or pressure ulcers. Avoid taking by mouth with diarrhea, bowel blockage, intestinal diseases, bloody stools or hepatitis. Avoid with a history of irregular heartbeat (arrhythmia), electrolyte imbalances, diabetes, heart disease or kidney disease. Avoid taking by mouth if pregnant or breastfeeding.
  • Alpha-lipoic acid: Alpha-lipoic acid (ALA) may reduce tissue damage that is often caused by long-term exposure to high levels of oxygen. While early studies are promising, more research is needed to fully understand how ALA might work for wound healing in patients undergoing hyperbaric oxygen therapy.
  • Avoid if allergic to alpha-lipoic acid (ALA). Use cautiously with diabetes and thyroid diseases. Avoid with thiamine deficiency or alcoholism. Avoid if pregnant or breastfeeding.
  • Arginine: Arginine, or L-arginine, is considered a semi-essential amino acid, because although it is normally synthesized in sufficient amounts by the body, supplementation is sometimes required (for example, due to inborn errors of urea synthesis, protein malnutrition, excess ammonia production, excessive lysine intake, burns, infection, peritoneal dialysis, rapid growth, or sepsis). Arginine has been suggested to improve the rate of wound healing in elderly individuals. A randomized, controlled clinical trial reported improved wound healing after surgery in head and neck cancer patients, following the use of an enteral diet supplemented with arginine and fiber. Arginine has also been used topically (on the skin) to attempt to improve wound healing. Early studies suggest that arginine may also help treat chronic anal fissures. Additional studies are needed.
  • Avoid if allergic to arginine, or with a history of stroke, liver, or kidney disease. Avoid if pregnant or breastfeeding. Use caution if taking blood-thinning drugs (like warfarin or Coumadin®) and blood pressure drugs or herbs or supplements with similar effects. Blood potassium levels should be monitored. L-arginine may worsen symptoms of sickle cell disease. Caution is advised in patients taking prescription drugs to control sugar levels.
  • Aromatherapy: Aromatherapy is a technique in which essential oils from plants are used with the intention of preventing or treating illness, reducing stress, or enhancing well-being. Preliminary data from one small study suggests aromatherapy may contribute to reduced pain intensity during dressing changes in wound care. Data are insufficient for forming any opinion for or against this application.
  • Essential oils should only be used on the skin in areas without irritation. Essential oils should be administered in a carrier oil to avoid toxicity. Avoid with a history of allergic dermatitis. Use cautiously if driving or operating heavy machinery. Avoid consuming essential oils. Avoid direct contact of undiluted oils with mucous membranes. Use cautiously if pregnant.
  • Ayurveda: There is some evidence that a traditional Ayurvedic treatment using specially prepared alkaline threads (ksharasutra or Ayurvedic setons) to achieve gradual cauterization may provide an effective alternative to surgery in patients being treated for anal fissures. Further research is needed to confirm these results.
  • Ayurvedic herbs should be used cautiously. Some herbs imported from India have been reported to contain high levels of toxic metals. Ayurvedic herbs can interact with other herbs, foods and drugs. A qualified healthcare professional should be consulted before taking. Use guggul cautiously with peptic ulcer disease. User should avoid sour food, alcohol and heavy exercise. Mahayograj guggul should not be taken for long periods of time. Pippali (Piper longum) should be taken with milk and avoided with asthma. Avoid sweet flag, and avoid amlaki (Emblica officinalis) at bedtime. Avoid Terminalia hebula (harda) if pregnant. Avoid Ayurveda with traumatic injuries, acute pain, advanced disease stages and medical conditions that require surgery.
  • Bovine cartilage: Reduction in inflammation and edema (swelling) and enhancement of the healing of wounds were effects that appeared in the medical literature of bovine cartilage during the 1950s and 1960s. In a preliminary comparison of potential wound healing effects with a commercially available ointment of 10% powdered bovine cartilage (Catrix® 10 Ointment) or Aquaphor® original formula in post-operative facial skin care with a laser resurfacing agent, Catrix® 10 Ointment was better. However, this study was a pilot study so its results need confirmation by follow-up clinical studies that clearly have the appropriate randomization and are double-blinded, given that such were in absence in this study. Also lacking in this study was a definition of primary outcome that therapeutically differentiated Catrix® 10 Ointment.
  • Avoid if allergic or hypersensitive to bovine cartilage or any of its constituents. Use cautiously with cancer, renal (kidney) failure, or hepatic (liver) failure. Avoid if pregnant or breastfeeding.
  • Calendula: Calendula (Calendula officinalis), also known as pot marigold, has been widely used on the skin to treat minor wounds, skin infections, burns, bee stings, sunburn, warts, and cancer. Calendula is commonly used topically (on the skin) to treat minor skin wounds. Reliable human research is necessary before a firm conclusion can be drawn regarding the use of calendula for wound healing.
  • Avoid if allergic to plants in the Aster/Compositae family, such as ragweed, chrysanthemums, marigolds, and daisies. Use cautiously in patients taking sedatives, blood pressure medications, cholesterol medications, blood sugar-altering agents, and immunomodulators. Use cautiously with diabetes and in children. Avoid if pregnant or breastfeeding.
  • Chamomile: Chamomile (Matricaria recutita, Chamaemelum nobile) has been used medicinally for thousands of years, and is widely used in Europe. There is promising preliminary evidence supporting the topical use of chamomile for wound healing. However, the available literature is not adequate to support the use of chamomile for this indication.
  • Avoid if allergic to chamomile. Anaphylaxis, throat swelling, skin allergic reactions and shortness of breath have been reported. Chamomile eyewash can cause allergic conjunctivitis (pinkeye). Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk, and do not use immediately after these procedures. Use cautiously if driving or operating machinery. Avoid if pregnant or breastfeeding.
  • Chitosan: There is limited evidence on the effects of chitosan in wound healing. Better studies are needed.
  • Avoid if allergic or sensitive to chitosan or shellfish. Use cautiously with diabetes or bleeding disorders. Use cautiously if taking drugs, herbs, or supplements that lower blood sugar or increase the risk of bleeding. Chitosan may decrease absorption of fat and fat-soluble vitamins from foods. Chitosan is not recommended during pregnancy or breastfeeding.
  • Dimethylsulfoxide (DMSO): Dimethylsulfoxide (DMSO) is a sulfur-containing organic compound. DMSO occurs naturally in vegetables, fruits, grains, and animal products. DMSO applied to the skin may prevent tissue death after extravasation of anticancer agents. It can be applied alone or with steroids. Limited available study also suggests that DSMO improves lack of blood flow in surgical skin flap ischemia. Currently, there is not enough scientific evidence available for the use of topical DMSO for diabetic ulcers.
  • Avoid if allergic or hypersensitive to DMSO. Use caution with urinary tract cancer or liver and kidney dysfunction. Avoid if pregnant or breastfeeding.
  • Eucalyptus oil: Eucalyptus (Eucalyptus globulus) oil contains 70-85% 1,8-cineole (eucalyptol), which is also present in other plant oils. Limited evidence suggests that eucalyptus essential oil may be beneficial for patients with skin ulcers when combined with antibiotics. More studies are needed to confirm these early findings.
  • Case reports describe allergic rash after exposure to eucalyptus oil, either alone or as an ingredient in creams. Avoid if allergic to eucalyptus oil or with a history of seizure, diabetes, asthma, heart disease, abnormal heart rhythms, intestinal disorders, liver disease, kidney disease, or lung disease. Use caution if driving or operating machinery. Avoid with a history of acute intermittent porphyria. Avoid if pregnant or breastfeeding. A strain of bacteria found on eucalyptus may cause infection. Toxicity has been reported with oral and inhaled use.
  • Gotu kola: Gotu kola, Centella asiatica (formerly known as Hydrocotyle asiatica), has a long history of use, dating back to ancient Chinese and Ayurvedic medicine. Preliminary study has demonstrated the ability of Centella asiatica extracts to promote wound healing, possibly through the stimulation of collagen synthesis. However, additional human study is needed in this area.
  • Avoid if allergic to gotu kola, asiaticoside, asiatic acid, or madecassic acid. Avoid with a history of high cholesterol, cancer, or diabetes. Avoid if pregnant or breastfeeding.
  • Honey: Honey is a sweet, viscid fluid produced by honeybees (Apis melliflera) from the nectar of flowers. The primary studied use of honey is for wound management, particularly in promoting rapid wound healing, deodorizing, and debriding necrotic tissue. The types of wounds studied are varied; most are non-healing wounds such as chronic ulcers, postoperative wounds, and burns. Currently, there is insufficient human evidence to support the use of honey for skin graft healing. Although honey has apparent antibacterial effects, more human study is needed in this area.
  • Avoid if allergic or hypersensitive to honey, pollen, celery, or bees. Honey is generally considered safe in recommended doses. Avoid honey from the genus Rhododendron because it may cause a toxic reaction. Avoid in infants younger than 12 months of age. Use cautiously with antibiotics. Potentially harmful contaminants (like C. botulinum or grayanotoxins) can be found in some types of honey and should be used cautiously in pregnant or breastfeeding women.
  • Hydrotherapy: Hydrotherapy is broadly defined as the external application of water in any form or temperature (hot, cold, steam, liquid, ice) for healing purposes. It may include immersion in a bath or body of water (such as the ocean or a pool), use of water jets, douches, application of wet towels to the skin, or water birth. These approaches have been used for the relief of various diseases and injuries, or for general well being. Hydrotherapy has been used in patients with pressure ulcers, and preliminary research suggests that daily whirlpool baths may reduce the time for wound healing. Better research is necessary in this area before a firm conclusion can be drawn.
  • There is a risk of infection from contaminated water if sanitary conditions are not maintained. Avoid sudden or prolonged exposure to extreme temperatures in baths, wraps, saunas, or other forms of hydrotherapy, particularly with heart disease, lung disease, or if pregnant. Avoid with implanted medical devices like pacemakers, defibrillators, or hepatic (liver) infusion pumps. Vigorous use of water jets should be avoided with fractures, known blood clots, bleeding disorders, severe osteoporosis, open wounds, or during pregnancy. Use cautiously with Raynaud's disease, chilblains, acrocyanosis, erythrocyanosis, and impaired temperature sensitivity, such as neuropathy. Use cautiously if pregnant or breastfeeding. Hydrotherapy should not delay the time to diagnosis or treatment with more proven techniques or therapies, and should not be used as the sole approach to illnesses. Patients with known illnesses should consult their physician(s) before starting hydrotherapy.
  • Iodine: It is not clear if healing of wounds or skin ulcers is improved with the application of topical iodine solutions. Iodine solutions may assist with sterilization as a part of a larger approach to the wound healing process.
  • Reactions can be severe, and deaths have occurred with exposure to iodine. Avoid iodine-based products if allergic or hypersensitive to iodine. Do no use for more than 14 days. Avoid Lugol solution and saturated solution of potassium iodide (SSKI, PIMA) with hyperkalemia (high amounts of potassium in the blood), pulmonary edema (fluid in the lungs), bronchitis, or tuberculosis. Use cautiously when applying to the skin because it may irritate/burn tissues. Use sodium iodide cautiously with kidney failure. Avoid sodium iodide with gastrointestinal obstruction. Iodine is safe in recommended doses for pregnant or breastfeeding women. Avoid povidone-iodine for perianal preparation during delivery or postpartum antisepsis.
  • Magnet therapy: The use of magnets to treat illness has been described historically in many civilizations. In modern times, magnetic fields play an important role in Western medicine, including use for magnetic resonance imaging (MRI), pulsed electromagnetic fields, and experimental magnetic stimulatory techniques. Early scientific evidence suggests that the time to heal wounds, including ulcers, may decrease with the use of static magnets. Better quality studies are needed before a firm recommendation can be made for wound healing.
  • Avoid with implantable medical devices, such as heart pacemakers, defibrillators, insulin pumps, or hepatic artery infusion pumps. Avoid with myasthenia gravis or bleeding disorders. Avoid if pregnant or breastfeeding. Magnet therapy is not advised as the sole treatment for potentially serious medical conditions, and it should not delay the time to diagnosis or treatment with more proven methods. Patients are advised to discuss magnet therapy with a qualified healthcare provider before starting treatment.
  • Pantothenic acid (vitamin B5): Pantothenic acid (vitamin B5) is essential to all life and is a component of Coenzyme A (CoA), a molecule that is necessary for numerous vital chemical reactions to occur in cells. Pantothenic acid is essential to the metabolism of carbohydrates, proteins, and fats, as well as for the synthesis of hormones and cholesterol. In animal research, oral and topical pantothenic acid has been associated with accelerated skin wound healing. However early human study results conflict. Additional evidence is necessary before a clear conclusion can be reached regarding this use of pantothenic acid or dexpanthenol.
  • Avoid if allergic or hypersensitive to pantothenic acid or dexpanthenol. Avoid with gastrointestinal blockage. Pantothenic acid is generally considered safe in pregnant and breastfeeding women when taken at recommended doses.
  • Papain: Papain is an enzyme that breaks protein bonds and has been used in Africa for treating burns. In standard western medical care, papain-containing debridement agents are commonly used to remove necrotic tissue and slough in burns, postoperative wounds, pilonidal cyst wounds, carbuncles, trauma wounds, infected wounds, and chronic lesions, such as pressure ulcers, and varicose and diabetic ulcers. According to reviews and clinical trials, papain may be very useful for wound debridement and for stimulating wound healing. More high-quality research is needed in this area.
  • Use cautiously in patients sensitive to papain. Use cautiously in patients being treated for prostatitis. Use Wobenzym®, which contains papain, cautiously, especially in those with bleeding disorders or taking anticoagulants or antiplatelets. Use cautiously as an adjuvant to radiation therapy. Avoid in patients with gastroesophageal reflux disease. Avoid in patients using immunosuppressive therapy.
  • Physical therapy: Physical therapy techniques, such as laser treatment, have been used to clean and heal wounds. Early evidence also suggests that high voltage stimulation or pulsed electrical stimulation may speed the healing of some types of skin ulcers. More research with similar outcome measures is needed to better understand the role of physical therapy for wound care.
  • Not all physical therapy programs are suited for everyone, and patients should discuss their medical history with a qualified healthcare professional before beginning any treatments. Physical therapy may aggravate pre-existing conditions. Persistent pain and fractures of unknown origin have been reported. Physical therapy may increase the duration of pain or cause limitation of motion. Pain and anxiety may occur during the rehabilitation of patients with burns. Both morning stiffness and bone erosion have been reported in the literature although causality is unclear. Erectile dysfunction has also been reported. Physical therapy has been used in pregnancy and although reports of major adverse effects are lacking in the available literature, caution is advised nonetheless. All therapies during pregnancy and breastfeeding should be discussed with a licensed obstetrician/gynecologist before initiation.
  • Psyllium: Psyllium, also referred to as ispaghula, is derived from the husks of the seeds of Plantago ovata. Psyllium contains a high level of soluble dietary fiber, and is the chief ingredient in many commonly used bulk laxatives. Results from human study suggest that psyllium may reduce the number of surgeries necessary to heal anal fissures. Further evidence is necessary.
  • Avoid if allergic or hypersensitive to psyllium, ispaghula, or English plantains (Plantago lanceolata). Avoid in patients with esophageal disorders, gastrointestinal atony, fecal impaction, gastrointestinal tract narrowing, swallowing difficulties, and previous bowel surgery. Avoid ingestion of psyllium-containing products in individuals with repeated or prolonged psyllium exposure who have not manifested allergic or hypersensitive symptoms. Prescription drugs should be taken one hour before or two hours after psyllium. Adequate fluid intake is required when taking psyllium-containing products. Use cautiously with blood thinners, antidiabetic agents, carbamazepine, lithium, potassium-sparing diuretics, salicylates, tetracyclines, nitrofurantoin, calcium, iron, vitamin B12, other laxatives, tricyclic antidepressants (amitriptyline, doxepin, and imipramine), antigout agents, anti-inflammatory agents, hydrophilic agents, and chitosan. Use cautiously with diabetes and kidney dysfunction. Use cautiously if pregnant or breastfeeding.
  • Rose hip: Rose hips are the fruits that develop from the blossoms of the wild rose (Rosa spp.). They are typically orange to red in color, but some species may be purple or black. When applied topically, the volatile oils of aromatic plants may have physiological effects that will facilitate wound healing. Rose hips contain several vitamins and minerals, including vitamin C, vitamin B1, vitamin E, calcium, zinc, and carotenoids, which could potentially promote wound healing when applied to the skin. Much larger and high quality clinical trials are needed to establish the therapeutic efficacy of rose hip and rose oil preparations in the topical treatment of surgical wounds and ulcers.
  • Use cautiously in patients who are avoiding immune system stimulants. Use cautiously in patients who are taking anticoagulant or anti-platelet aggregating agents, antibiotics, antineoplastics, antiretrovirals, anti-inflammatory agents, "Long-Life CiLi", antilipemics, aluminum-containing antacids, salicylates, or laxatives. Avoid in patients who are allergic to rose hips, rose pollen, its constituents, or members of the Rosaceae family.
  • TENS: Transcutaneous electrical nerve stimulation (TENS) is a non-invasive technique in which a low-voltage electrical current is delivered through wires from a small power unit to electrodes located on the skin. Electrodes are temporarily attached with paste in various patterns, depending on the specific condition and treatment goals. TENS is often used to treat pain, as an alternative or addition to pain medications. Therapy sessions may last from minutes to hours. TENS is often used in conjunction with acupuncture therapy. TENS has been tested for its effects on blood flow to skin flaps used in plastic surgery procedures such as breast reconstruction. TENS has also been evaluated in patients with skin ulcers, diabetic foot ulcers, and chronic ulcers of various causes. More research is needed in this area.
  • Avoid with implantable devices, like defibrillators, pacemakers, intravenous infusion pumps, or hepatic artery infusion pumps. Use cautiously with decreased sensation, like neuropathy, and with seizure disorders. Avoid if pregnant or breastfeeding.
  • Therapeutic touch: Although some studies report an improvement in wound healing with therapeutic touch, others show no benefits.
  • Therapeutic touch is believed to be safe for most people. Therapeutic touch should not be used for potentially serious conditions in place of more proven therapies. Avoid with fever or inflammation, and on body areas with cancer.
  • Vitamin A: In preliminary study, retinol palmitate significantly reduced rectal symptoms of radiation proctopathy, perhaps because of wound healing effects. Further research is needed to confirm these results.
  • Avoid if allergic or hypersensitive to vitamin A. Vitamin A toxicity can occur if taken at high dosages. Use cautiously with liver disease or alcoholism. Smokers who consume alcohol and beta-carotene may be at an increased risk for lung cancer or heart disease. Vitamin A appears to be safe in pregnant women if taken at recommended doses; however, vitamin A excess, as well as deficiency, has been associated with birth defects. Excessive doses of vitamin A have been associated with central nervous system malformations. Use cautiously if breastfeeding because the benefits or dangers to nursing infants are not clearly established.
  • Zinc: Although zinc is frequently cited as having beneficial effects on healing of incision wounds, few studies have investigated this use. Further research is needed. There are conflicting findings regarding the potential benefit of zinc for healing leg ulcers. Available studies reported no or few adverse effects.
  • Preliminary evidence suggests that topical zinc oxide oil may help manage perianal and buttock skin damage in incontinent patients. Further research is needed to better understand the role of zinc for treatment of skin damage caused by incontinence.
  • Zinc is generally considered to be safe when taken at the recommended dosages. Avoid zinc chloride since studies have not been done on its safety or effectiveness. Avoid with kidney disease. Use cautiously if pregnant or breastfeeding.
  • Fair negative scientific evidence:
  • Aloe: A well-designed human trial found no benefit of topical acemannan hydrogel (a component of aloe gel) in the treatment of pressure ulcers.
  • Avoid if allergic to aloe or other plants of the Liliaceae family (garlic, onions, tulips). Avoid injecting aloe. Do not apply to open skin, surgical wounds or pressure ulcers. Avoid taking by mouth with diarrhea, bowel blockage, intestinal diseases, bloody stools or hepatitis. Avoid with a history of irregular heartbeat (arrhythmia), electrolyte imbalances, diabetes, heart disease or kidney disease. Avoid taking by mouth if pregnant or breastfeeding.

Prevention
  • In order to prevent wounds from occurring, healthcare providers recommend that individuals: take care when using sharp objects such as knives, scissors, saws, and trimmers; wear shoes or boots on the feet; use helmets when riding a bicycle; use helmets, kneepads, wrist protectors, and elbow pads when using in-line skates or skateboards; and avoid picking up broken pieces of glass and handling razor blades.
  • If bedridden or immobile with diabetes, circulation problems, incontinence, or mental disabilities, healthcare providers recommend that the individual be checked for pressure sores every day. Also, look for reddened areas that, when pressed, do not turn white. Also look for blisters, sores, or craters. In addition, take the following steps: change position at least every two hours to relieve pressure; use items that can help reduce pressure such as pillows, sheepskin, foam padding, and powders from medical supply stores; eat healthy, well-balanced meals; exercise daily, including range-of-motion exercises for immobile patients; and keep skin clean and dry. Incontinent people need to take extra steps to limit moisture.
  • Individuals with diabetes should check their feet daily for blisters, sores, or other wounds in order to prevent serious infection and possibly amputation.

Author information
  • This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
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  2. American Academy of Pediatrics. .
  3. Arnold M, Barbul A. Nutrition and wound healing. Plast Reconstr Surg. 2006;117(7 Suppl):42S-58S.
  4. Centers for Disease Control and Prevention. .
  5. Dini V, Bertone M, Romanelli M. Prevention and management of pressure ulcers. Dermatol Ther. 2006;19(6):356-64.
  6. Langemo D, Anderson J, Hanson D, et al. Nutritional considerations in wound care. Adv Skin Wound Care. 2006;19(6):297-8, 300, 303.
  7. de Laat EH, Schoonhoven L, Pickkers P, et al. Epidemiology, risk and prevention of pressure ulcers in critically ill patients: a literature review. J Wound Care. 2006;15(6):269-75.
  8. Natural Standard: The Authority on Integrative Medicine. .
  9. National Institute of Allergy and Infectious Diseases. .
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  11. Wu SC, Driver VR, Wrobel JS, et al. Foot ulcers in the diabetic patient, prevention and treatment. Vasc Health Risk Manag. 2007;3(1):65-76.

Types of psychiatric disorders
  • Anxiety disorders:
  • Overview: Anxiety is an unpleasant complex combination of emotions often accompanied by physical sensations, such as heart irregular heartbeat (palpitations), nausea, angina (chest pain), shortness of breath, tension headache, and nervousness.
  • Unlike the relatively mild, brief anxiety that can be caused by a stressful event, such as testing, a job interview, or the death of a loved one, anxiety disorders last at least six months and can worsen if not treated.
  • Causes: Anxiety disorders tend to run in families. Studies suggest that an imbalance of the brain's chemical messengers (neurotransmitters), such as serotonin, gamma-amino butyric acid (GABA), epinephrine, and norepinephrine, may contribute to anxiety disorders. An anxiety disorder may also develop in response to a traumatic event, such as a car accident, a marital separation, or abuse. Some prescription and non-prescription medications, such as caffeine, amphetamine, and decongestants, may cause symptoms of anxiety. Many medical conditions, such as diabetes, asthma, epilepsy, migraine headaches, bipolar disorder, and depression, may cause or mimic symptoms of anxiety disorders. Nutritional deficiencies stemming from poor diet and/or digestion may also contribute to anxiety.
  • Symptoms: Physical symptoms may include irregular heart beat (palpitations), angina (chest pain), hot flashes or chills, cold and clammy hands, nausea, frequent urination, diarrhea, shortness of breath, sweating, dizziness, tremors, muscle tension or aches, fatigue, and insomnia. Emotional or psychological symptoms may include apprehension, uneasiness, dread, impaired concentration or selective attention, restlessness, nightmares, irritability, confusion, behavioral problems (especially in children and adolescents), nervousness, jumpiness, self-consciousness, insecurity, fear of dying or going crazy, and a strong desire to escape. These symptoms vary in severity and duration, depending on the specific type of anxiety disorder.
  • Generalized anxiety disorder (GAD) is characterized by excessive, unrealistic worry that lasts six months or more. In adults, the anxiety may focus on issues such as health, money, or career. Physical symptoms may also appear such as nervousness or heart palpitations. Depression commonly accompanies this anxiety disorder.
  • Patients with obsessive compulsive disorder (OCD) are plagued by persistent, recurring thoughts (obsessions) that reflect exaggerated anxieties or fears. Typical obsessions include worrying about being contaminated with germs or fears of behaving improperly or acting violently. The obsessions may lead an individual to perform a ritual or routine (compulsions), such as washing the hands, repeating phrases, or hoarding.
  • Panic disorder is characterized by repeated, unexpected panic attacks. These panic attacks strike without warning and usually last about 15-30 minutes. Panic disorder may also be accompanied by agoraphobia, which is a fear of being in places where escape or help would be difficult in the event of a panic attack. Agoraphobia is characterized by individuals likely to avoid public places (e.g. shopping malls) or confined spaces (e.g. airplanes).
  • Post-traumatic stress disorder (PTSD) can follow an exposure to a traumatic event, such as a sexual or physical assault, witnessing a death, the unexpected death of a loved one, or fighting in combat. There are three main symptoms associated with PTSD. 1) Patients typically relive the traumatic event in flashbacks or nightmares. 2) Patients typically avoid people, places, and things related to the trauma and are emotionally detached from others. 3) Patients feel physiologically aroused and often have difficulty sleeping, poor concentration, or feel irritable.
  • A phobia is an unrealistic or exaggerated fear of a specific object, activity, or situation that actually presents little to no danger. Common phobias include fear of animals (e.g. spiders or snakes), fear of flying, and fear of heights. In the case of a severe phobia, one might go to extreme lengths to avoid the thing that is feared.
  • Separation anxiety is a normal part of child development. It consists of crying and distress when a child is separated from a parent or away from home. If separation anxiety persists beyond a certain age or interferes with daily activities, then it may be a sign of separation anxiety disorder.
  • Social anxiety disorder (SAD) is characterized by extreme anxiety about being judged by others or behaving in a way that might cause embarrassment or ridicule. This intense anxiety may lead to avoidance behavior. Physical symptoms associated with this disorder include heart palpitations, faintness, blushing, and profuse sweating. Performance anxiety, better known as stage fright, is the most common type of social phobia.
  • Diagnosis: GAD is diagnosed when an individual spends at least six months worrying excessively about everyday problems.
  • Panic disorder, or panic attack, is diagnosed when a patient either has four attacks within four weeks or one or more attacks followed by at least one month of persistent fear of having another attack. Also, a minimum of four of the symptoms listed for panic disorders must have developed during at least one of the attacks.
  • Phobia is associated with extreme anxiety with exposure to the object or situation. The individual recognizes that his or her fear is excessive or unreasonable and finds that normal routines, social activities, or relationships are significantly impaired as a result of these fears.
  • A mental health professional will diagnose obsessive-compulsive disorder after a thorough evaluation. Criteria are based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), a clinical book of mental illness diagnoses. OCD diagnosis is based on recurrent and persistent thoughts, impulses, or images that are intrusive and cause distress. Patients have thoughts that are not simply excessive worries about real problems. Individuals recognize that these thoughts, images, or impulses are a product of the mind and attempt to ignore or suppress them. Compulsions must meet specific criteria, including repetitive behaviors (e.g. hand washing) or repetitive mental acts (e.g. counting silently) that the individual feels driven to perform.
  • Although many of the symptoms of PTSD may be an appropriate initial response to a traumatic event, they are considered part of a disorder when they persist beyond three months.
  • Treatment: Patients with anxiety disorders generally receive a combination of medications and psychotherapy.
  • Psychotherapy involves talking with a trained mental health professional, such as a psychiatrist, psychologist, social worker, or counselor, to discover what is causing the anxiety disorder and how to deal with its symptoms. Many therapists use a combination of cognitive and behavioral therapies, this is often referred to as CBT (cognitive-behavioral therapy). CBT is based on the scientific fact that thoughts cause feelings and behaviors. The benefit of this fact is that an individual can change the way they think to feel and act better even if the situation causing the problem does not change.
  • Patients may also take medications called benzodiazepines. These drugs are fast-acting sedatives that typically relieve anxiety symptoms within 30 minutes to one hour. The rapid relief makes these drugs very effective when taken during a panic attack or another overwhelming anxiety episode. Unfortunately, benzodiazepines can be addictive. If taken regularly for more than a couple of weeks, then physical and psychological addiction is likely to occur. Benzodiazepine may create tolerance, leading to larger doses needed to achieve the same effect, and serious withdrawal symptoms can occur when going off the medication, including increased anxiety, depression, and insomnia. Therefore, these medications should only be used short term.
  • A benzodiazepine, called clonazepam (Klonopin®), is commonly used to treat social phobia and GAD. Lorazepam (Ativan®) is often used to treat panic disorder, and alprazolam (Xanax®) is useful for both panic disorder and GAD.
  • Anti-anxiety drugs, called azapirones, are commonly prescribed for GAD and OCD. Compared to benzodiazepines, the azapirones are slow acting, taking from two to four weeks to provide anxiety symptom relief.
  • Medications, called antidepressants, may help reduce feelings of depression, anxiety, and OCD. Commonly prescribed antidepressants include fluoxetine (Prozac®), paroxetine (Paxil®), sertraline (Zoloft®), citalopram (Celexa®), and fluvoxamine (Luvox®). Side effects may include, but are not limited to, nausea, sexual dysfunction (including reduced sexual desire or orgasm difficulties), headache, diarrhea, agitation, nervousness, rash, restlessness, increased sweating, weight gain, drowsiness, or insomnia.
  • Mood disorders:
  • Overview: Mood disorders occur when patients experience episodes of depression, mania, and/or hypomania. Mood disorders can significantly interfere with an individual's thoughts, behavior, mood, activity, and physical health. Two of the most common mood disorders are depression and mania.
  • Causes: Mood disorders tend to run in families. Studies suggest that a low or high level of neurotransmitters, such as serotonin, norepinephrine, or dopamine, cause mood disorders. Alcohol, smoking, and drug abuse may lead to mood disorders. Stressful life events, particularly a loss or threatened loss of a loved one or a job, can trigger symptoms of mood disorders. Long-term use of certain medications, such as some drugs used to control high blood pressure, sleeping pills, or birth control pills, may cause symptoms of depression in some people. Women experience depression about twice as much as men, which leads researchers to believe hormonal factors may play a role in the development of depression.
  • Symptoms: Symptoms of major depression may include overwhelming feelings of sadness and grief, loss of interest or pleasure in activities usually enjoyed, and feelings of worthlessness or guilt. This type of depression may result in poor sleep, a change in appetite, severe fatigue, and difficulty concentrating. Severe depression may increase the risk of suicide.
  • Individuals with atypical depression, as opposed to major depression, experience improved mood when something good happens. In addition, patients tend to have an increase in appetite or weight gain (as opposed to the reduced appetite or weight loss of "typical" depression), excessive sleeping (as opposed to insomnia), leaden paralysis (a severe form of fatigue or tiredness), and sensitivity to rejection.
  • Dysthymia is a less severe type of depression (mild to moderate) than major depression. However, dysthymia is a long-term form of depression. Signs and symptoms are not usually disabling, and periods of mild depression can alternate with short periods of feeling normal.
  • Having recurrent episodes of depression and elation (mania) is characteristic of bipolar disorder. Because this condition involves emotions at both extremes (poles), it's called bipolar disorder or manic-depressive disorder. Mania affects judgment, causing individuals to make unwise decisions. Some people have bursts of increased creativity and productivity during the manic phase. The number of episodes at either extreme may not be equal. Some people may have several episodes of depression before having another manic phase, or vice versa.
  • Seasonal affective disorder (SAD) is a pattern of depression related to changes in seasons and a lack of exposure to sunlight. SAD usually occurs during the winter months. It may cause headaches, irritability, and a low energy level. SAD is not a chronic (long-term) depressive disorder.
  • Postpartum depression is a more severe form of depression that can develop within the first six months after giving birth. For women with postpartum depression, feelings, such as sadness, anxiety, and restlessness, can be so strong that they interfere with daily tasks. Rarely, a more extreme form of depression known as postpartum psychosis can develop. Symptoms of this psychosis include a fear of harming oneself or one's baby, confusion, disorientation, hallucinations, delusions, and paranoia.
  • Premenstrual dysphoric disorder (PMDD) occurs when depressive symptoms, such as crying, tiredness, and sadness, occur one week before menstruation and disappear after menstruation.
  • Diagnosis: A diagnosis of depressive disorder is based on the criteria found in the Diagnostic and Statistical Manual of Mental Disorders-IV-TR (DSM-IV-TR), which was developed by the American Psychiatric Association. Blood tests may also be performed to determine if the levels of neurochemicals (brain chemicals), including serotonin, dopamine, and norepinephrine, are healthy.
  • Treatment: Antidepressants are commonly used to reduce symptoms of depression.
  • Serotonin-reuptake inhibitors (SSRIs) are commonly prescribed antidepressants. These drugs increase the amount of the neurochemical serotonin in the brain. This helps improve the patient's mood and energy levels. Commonly prescribed SSRIs include fluoxetine (Prozac®), paroxetine (Paxil®), sertraline (Zoloft®), citalopram (Celexa®), and fluvoxamine (Luvox®). Side effects of SSRIs may include: sexual dysfunction (including reduced sexual desire or orgasm difficulties), headache, diarrhea, agitation, nervousness, rash, restlessness, increased sweating, weight gain, drowsiness, and insomnia.
  • Monoamine oxidase inhibitors (MAOIs) are less commonly prescribed antidepressants because they can cause serious side effects, including high blood pressure. MAOIs elevate the levels of neurochemicals in the brain synapses by inhibiting an enzyme called monoamine oxidase. Monoamine oxidase breaks down neurochemicals, including norepinephrine. When monoamine oxidase is inhibited, the norepinephrine is not broken down. As a result, higher levels of norepinephrine are present in the brain. Commonly prescribed MAOIs include phenelzine (Nardil®) and tranylcypromine (Parnate®).
  • The most serious side effect associated with MAOIs is high blood pressure. An even more serious reaction, called hypertensive crisis, may occur if foods containing tyramine (e.g. aged cheese or wine) are consumed with MAOIs. Other side effects may include drowsiness, constipation, nausea, diarrhea, stomach upset, fatigue, dry mouth, dizziness, low blood pressure, lightheadedness, decreased urine output, decreased sexual function, sleep disturbances, muscle twitching, weight gain, blurred vision, headache, increased appetite, restlessness, trembling, weakness, and increased sweating.
  • Adjustment disorders:
  • Overview: Adjustment disorders occur when an individual has a severe emotional reaction to a stressful event. The disorder may affect the patient's emotions, thoughts, and/or behavior. In essence, patients have difficulty adjusting to changes in their lives. This disorder usually lasts about six months.
  • Adjustment disorders can affect patients of all ages. However, among adults, women are likely than men to suffer from adjustment disorders.
  • Causes: Although stress is known to trigger symptoms of adjustment disorders, the exact cause of the condition remains unknown. Researchers believe that several factors, including genetics, life experiences, and chemical changes in the brain, may contribute to the condition.
  • Symptoms: Emotional symptoms of adjustment disorders typically include feelings of hopelessness, lack of enjoyment, frequent crying, nervousness, suicidal thoughts, anxiety, feelings of desperation, difficulty concentrating, and feeling overwhelmed. Behavioral symptoms may include increased aggression, reckless driving, avoiding family or friends, and poor performance at work or school.
  • Diagnosis: Patients are diagnosed with adjustments disorders after a thorough psychological examination is performed to evaluate the patient's signs and symptoms. Patients must meet certain criteria that are explained in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Criteria include: 1) Emotional or behavioral symptoms within three months of a stressful event. 2) Severe symptoms that include the inability of the patient to function in daily life and distress. 3) Symptoms improve six months after the stressful event.
  • Treatment: Patients with adjustment disorders typically receive a combination of psychotherapy and medications.
  • Psychotherapy is an interactive process between a patient and a qualified mental health professional. The patient explores thoughts, feelings, and behaviors to help them with problem solving. The goal of therapy is to help patients learn how to understand and cope with their disorders. This includes learning how to maintain healthy relationships and prevent relapses in the future. Therapy may also provide emotional support to the patient. Psychotherapy is conducted in private individual, couple, group, or family sessions. Sessions range from 50 minutes for individuals to 90 or 120 minutes for groups.
  • Anti-anxiety drugs, such as buspirone (Buspar®), or antidepressants, such as fluoxetine (Prozac®), sertraline (Zoloft®), escitalopram (Lexapro®), paroxetine (Paxil®), or citalopram (Celexa®), may also be prescribed to reduce symptoms and prevent relapses.
  • Developmental disorders:
  • Overview: Developmental disorders are illnesses of the brain that develop during infancy or childhood. Common developmental psychological disorders include autism and intellectual disability (mental retardation).
  • Autism, also called Kanner's syndrome, is a brain disorder that is associated with a wide range of developmental problems, especially in communication and social interaction. The severity of symptoms varies among patients. Some patients may be able to live independently as adults, while others may require lifelong support. Patients with severe autism may be unable to communicate or interact with other people. The most severe autism occurs when the patient is completely unable to communicate or interact with others. Children with autism may develop normally during the first few months or years of life. Then, usually before the age of three, patients become less responsive to others.
  • Intellectual disability is a condition that causes significantly impaired cognitive functioning from birth or early infancy that ultimately limits the individual's ability to perform normal daily activities. In the past, intellectual disability was commonly called mental retardation. However, since the term has acquired a negative social stigma over the years, it is now more commonly referred to as intellectual disability.
  • Causes: Although developmental disorders appear to be related to abnormalities in the brain, the exact cause of these conditions remains unknown. Several theories have been suggested as possible causes. Most researchers believe that several factors, including genetics and co-existing medical conditions, contribute to developmental disorders. In some patients, autism has been linked to other medical conditions, such as fragile X syndrome, tuberous sclerosis, epilepsy, and Tourette's syndrome. In addition, problems during pregnancy (e.g. infection or a mother who drinks or uses drugs during pregnancy), the baby not getting enough oxygen during delivery, and disease (e.g. whooping cough, measles, or meningitis) may lead to the development of intellectual disabilities.
  • Symptoms: Autistic patients generally experience developmental problems that affect their behavior, social skills, and language. The severity of symptoms varies among patients.
  • Autistic patients may move constantly and/or perform repetitive movements, such as spinning or rocking. Patients typically develop specific routines or rituals and become highly disturbed if their schedules are even slightly changed. Autistic patients may be unusually sensitive to touch, sound, or light. Some patients may be aggressive. Patients (adults and children) may throw temper tantrums. Patients may have short attention spans, abnormalities in eating or sleeping habits, or extreme overactivity or underactivity.
  • Autistic patients may appear deaf because they may not respond to their name or they may appear to not hear others talking. An autistic patient may avoid eye contact with others or be unable to properly use body language, facial expressions, or gestures. Autistic patients may resist cuddling and holding, appear unaware of others' feelings, or seem to prefer playing alone.
  • Emotional symptoms vary considerably among autistic patients. Some patients may be unaware of others' feelings or be unable to express their own emotions. Some patients may be noticeably anxious or become depressed or frustrated when they are unable to communicate to others. Patients who express affection towards others may express this feeling indiscriminately.
  • Most children with autism are slow to learn new things or develop new skills. However, an estimated 25% of patients have normal to high intelligence. Autistic patients with normal to high intelligence are quick learners, but still have difficulty communicating to others and applying their knowledge to everyday life.
  • Autistic children usually say their first words later than normal. Patients may lose the ability to say words or sentences that they were able to say in early childhood. Some patients may speak with an abnormal tone or rhythm. Patients may be unable to start or maintain conversations with others. Patients may repeat words or phrases but be unable to understand how to use them.
  • Patients with mild intellectual disabilities have intelligence quotients (IQs) of 52-69. From birth to age six, patients are able to develop social and communication skills, but motor coordination is slightly impaired. By late adolescence, patients are able to learn until about a sixth-grade level. They are generally able to learn appropriate social skills. Adults are usually able to work and support themselves. Some patients may need help during times of social or financial stress.
  • Patients with moderate intellectual disabilities have IQs of 36-51. Children younger than six years old are able talk or communicate with others, but social awareness is generally poor. The patient's motor coordination is typically fair. Adolescents are able to learn some occupational and social skills. They may be able to learn how to travel alone in familiar places. Adults may be able to support themselves with a job. They usually require guidance and assistance during mild social or financial stress.
  • Patients with severe intellectual disabilities have IQs of 20-35. Young children can say a few words, but their speech is limited. Motor coordination is generally poor. Adolescents can usually talk or communicate with others. They are able to learn simple habits. Adults typically require lifelong assistance and guidance with daily activities.
  • Patients with profound intellectual disabilities have IQs of 19 or lower. Children younger than six years old have very little motor coordination and may require nursing care. Adolescents typically have limited motor and communication skills. Adults usually require lifelong nursing care.
  • Diagnosis: There is currently no specific test designed to diagnose autism. Instead, a diagnosis is made after the healthcare provider evaluates the patient's signs and symptoms. Some healthcare providers use screening tests, including the checklist for autism in toddlers (CHAT) or the autism screening questionnaire to determine whether or not a patient has autism. CHAT is a 16-question survey, in which parents or caregivers respond "yes" or "no" to questions about their children's behavior. This test helps healthcare providers diagnose autism in patients who are 18 months old or younger. The autism screening questionnaire, also called the pervasive development disorder (PDD) assessment scale, is a brief survey, in which parents or caregivers rate the patient's developmental difficulties as nonexistent, resolved, mild, moderate, or severe. This test helps healthcare providers diagnose autism in patients who are four years old or older.
  • Doctors diagnose intellectual disability after a medical history, physical examination, and intellectual quotient (IQ) test. If a patient does not show signs of adaptive behavior and scores well below average on the IQ test, then a positive diagnosis is made. To measure the patient's adaptive behavior, professionals compare the patient's abilities to other children of his or her age. Many skills, including daily living skills (e.g. getting dressed, feeding oneself, and using the bathroom), communication skills (understanding what is being said and being able to respond), and social skills are important to adaptive behavior. Patients with mild intellectual disabilities have intelligence quotients (IQs) of 52-69. Patients with moderate intellectual disabilities have IQs of 36-51. Patients with severe intellectual disabilities have IQs of 20-35. Patients with profound intellectual disabilities have IQs of 19 or lower.
  • Treatment: The foundation of autism treatment is behavioral therapy. For more than 30 years, several different types of behavioral therapy have helped autistic patients improve their communication and social skills, as well as their learning abilities and adaptive behaviors. Behavioral therapy has been shown to reduce inappropriate behavior, including aggression, in autistic children. Evidence suggests that behavioral therapy is the most effective if it is started early in life when the patient is three to four years old or younger.
  • Antipsychotic drugs have also been used to help treat aggressive, repetitive, and hyperactive behaviors in autistic patients. Autistic patients may take risperidone (Risperdal®), olanzapine (Zyprexa®), or quetiapine (Seroquel®).
  • Antidepressants may help reduce repetitive behaviors, tantrums, aggression, and irritability in autistic patients. Serotonin-reuptake inhibitors (SSRIs) are commonly prescribed antidepressants. These drugs increase the amount of the neurochemical serotonin in the brain. This helps improve the patient's mood and energy levels. Commonly prescribed SSRIs include fluoxetine (Prozac®), paroxetine (Paxil®), sertraline (Zoloft®), citalopram (Celexa®), and fluvoxamine (Luvox®). SSRIs may cause side effects, such as nausea, sexual dysfunction (including reduced sexual desire or orgasm difficulties), headache, diarrhea, agitation, nervousness, rash, restlessness, increased sweating, weight gain, drowsiness, or insomnia.
  • Many patients with intellectual disabilities (mental retardation) need help improving their adaptive skills, which are needed to live, work, and function in the community. Teachers, parents, and caregivers can help patients work on their daily living skills, communication skills, and social skills.
  • Patients with developmental disorders that affect learning must have the option of receiving education that is tailored to their specific strengths and weaknesses. According to the Individuals with Disabilities Education Act, all children with disabilities, including autism and intellectual disabilities, must receive free and appropriate education. According to the law, members of the patient's school should consult with the patient's parents or caregivers to design and write an individualized education plan. Once all parties agree with the plan, the educational program should be started. The school faculty should document the child's progress in order to ensure that the child's needs are being met.
  • Educational programs vary among patients. In general, most experts believe that children with disabilities should be educated alongside their non-disabled peers. The idea is that non-disabled students will help the patient learn appropriate behavior, as well as social and language skills. Therefore, some patients are educated in mainstream classrooms. Other patients attend public schools but take special education classes. If the disability is severe or profound, then patients may benefit from specialized schools that are designed to teach children with disabilities.
  • Somatoform disorders:
  • Overview: Somatoform disorders occur when patients experience physical symptoms that cannot be attributed to a specific disease or disorder. In order to be diagnosed with a somatoform disorder, symptoms must interfere with an individual's daily life.
  • There are many different types of somatoform disorders, including conversion disorder, somatization disorder, and body dysmorphic disorder, all of which have unique symptoms.
  • Causes: Several factors, including stress, parental upbringing, cultural influences, and biological makeup, may be involved in the development of somatoform disorders.
  • Symptoms: Conversion disorder, formerly called hysteria, is a rare mental illness that occurs when a patient has physical symptoms, such as inability to speak or sudden blindness, which are caused by emotional distress. For instance, patients who witness a terrifying or traumatic event may suddenly lose their vision. These symptoms appear suddenly and involuntarily. Symptoms may include one or more of the following: inability to speak, difficulty or inability to walk, inability to swallow, blindness, deafness, paralyzed body part, non-epileptic seizures, hallucinations, numbness, loss of balance, loss of touch or pain sensation, abnormal gait, vomiting, diarrhea, and inability to urinate. Conversion disorder is different than other somatoform disorders because it primarily affects sensory and motor functions, which can normally be controlled. Conversion disorder is considered a temporary condition that usually resolves on its own in about one month.
  • Somatization disorder, formerly called Briquet's syndrome, occurs when patients experience symptoms in many different organ systems that cannot be explained. Patients with somatization disorder experience at least four symptoms of pain, two symptoms in the digestive tract, one symptom involving the nervous system (brain and spinal cord), and one symptom affecting the reproductive tract. Symptoms of somatization disorder usually develop before the age of 30 and last throughout the patient's life. For unknown reasons, females are more likely to develop this disorder than males.
  • Body dysmorphic disorder occurs when a patient becomes preoccupied with an exaggerated or imagined defect in his/her appearance. Patients may seek out plastic surgery or other procedures in an effort to correct their perceived bodily defects. Although most patients believe they have defects in facial features, individuals may become preoccupied with any body part. Symptoms of body dysmorphic disorder usually develop during adolescence. Symptoms usually fluctuate throughout the patient's life. Men and women are affected equally by body dysmorphic disorder.
  • Diagnosis: Somatoform disorders are diagnosed after a physical and psychological examination. The healthcare provider will perform tests to determine whether or not there is a physical basis for the symptoms. If there appears to be no physical cause for the patient's condition, then a mental health professional is recommended.
  • Patients must meet several criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM) to be diagnosed with conversion disorder. 1) Symptoms must affect the patient's voluntary motor or sensory functions. 2) Symptoms can be linked to psychological factors or stressors that occurred before the condition developed. 3) The patient has no voluntary control over the symptoms. 4) There appears to be no physiological factor that is causing the symptoms. In other words, the patient does not suffer from any medical conditions that may cause symptoms. 5) Symptoms must cause significant distress or impairment. 6) Symptoms are not limited to pain or sexual dysfunction, and they cannot be attributed to another type of mental illness.
  • Patients with somatization disorder must have at least four symptoms of pain, two symptoms in the digestive tract, one symptom involving the nervous system (brain and spinal cord), and one symptom affecting the reproductive tract to be diagnosed with the condition.
  • A mental professional will use the Body Dysmorphic Disorder Questionnaire (BDDQ) to diagnose body dysmorphic disorder. Patients will respond to multiple questions regarding their thoughts and feelings about their personal appearance. A mental health professional may also ask a series of questions during a Body Dysmorphic Disorder Examination (BDDE). These questions are tailored to help determine if the patient is preoccupied with his/her physical appearance, is self conscious in public, avoids social situations and physical contact with others, overvalues appearance as a measurement of self-worth, goes to extreme lengths to change or improve his/her appearance, and frequently checks his/her appearance in mirrors or seeks approval from others.
  • Treatment: Patients with somatoform disorders may receive antidepressants or anti-anxiety medications if they suffer from mood or anxiety disorders. However, most patients do not received medications because they have an increased risk of becoming psychologically dependent on drugs.
  • Patients typically undergo group therapy and/or family therapy to help reduce symptoms of the disorder. This type of therapy may provide support to the patient and help friends and family members learn how to cope with the disorder.
  • Cognitive behavioral therapy (CBT) may also be beneficial. This therapy involves teaching the patient how to think about problems in a new way in order to improve emotional and behavioral responses. The mental health professional will first help the patient identify unhealthy negative beliefs and behaviors. These negative behaviors or beliefs are then replaced with positive ones.
  • Patients with somatoform disorders may also benefit from suggestive therapy. This involves having a healthcare provider suggest or state that the patient's symptoms will resolve on their own and their muscles and organs are not damaged. This reassures the patient and may help reduce feelings of nervousness or anxiety. However, healthcare providers should not discredit the patient's symptoms. Although there is no physical basis for their symptoms, the patient cannot voluntarily control them.
  • Dissociative disorders:
  • Overview: Dissociative disorders occur when individuals involuntarily try to escape from reality. For instance, patients may suppress troubling memories or even take on alternative identities. There are four main types of dissociative disorders: dissociative amnesia, dissociative identity disorder, dissociative fugue, and depersonalization disorder.
  • Causes: Dissociative disorders usually develop in response to traumatic experiences. It appears to be a coping mechanism to keep troubling memories at bay. Dissociative disorders are most common among children who have been emotionally, physically, or sexually abused. In some cases, the disorder may develop in children who are raised in frightening or unpredictable environments. This is because a patient's personality is still developing during childhood. During these years, a child is more capable of stepping outside of reality to observe traumatic events as if it is happening to someone else. As a result, children are more susceptible than adults to developing these disorders. Once a child develops a dissociative disorder, he/she may use this coping mechanism throughout life.
  • Symptoms: In general, dissociative disorders cause symptoms, such as blurred sense of identity, depression, anxiety, sense of being detached from oneself (depersonalization), perception that things and people are unreal (derealization), and memory loss (amnesia) of certain time periods, events, or people. Additional symptoms depend on the specific type of dissociative disorder.
  • Dissociative amnesia causes unexplained memory loss of traumatic events that took place earlier in the patient's life.
  • Dissociative identity disorder, also called multiple personality disorder, causes the patient to switch to alternate identities in stressful situations. Some patients believe they hear one or more people talking inside their heads. Each identity may have its own name and characteristics, including gender and voice. Patients with dissociative identity disorder usually have dissociative amnesia at the same time.
  • Patients with dissociative fugue typically put a physical distance between themselves and their identity. For instance, patients may travel to a new location where they adopt an entirely new identity. Episodes may last anywhere from a few hours to several months. When the episodes ends, patients often feel disoriented and may have no recollection of what happened during the fugue.
  • Depersonalization disorder causes patients to feel as though they are observing themselves from a distance. Patients might feel like they are watching themselves in a movie. In addition, some patients may have distorted views of the shape and size of their own bodies and things around them. It may feel like people are moving in slow motion or time is slowing down. People and things may seem unreal. Episodes usually only last a few minutes. Symptoms may come and go over several years.
  • Diagnosis: During a physical examination, a healthcare provider may perform tests, such as a magnetic resonance imaging (MRI) scan of the brain, to rule out other possible causes of the symptoms. If a dissociative disorder is suspected, then a mental health professional will be recommended. The condition is diagnosed after a detailed psychological evaluation.
  • Treatment: The primary treatment of dissociative disorders is psychotherapy. Psychotherapy involves talking with a trained mental health professional, such as a psychiatrist, psychologist, social worker, or counselor, to discover what is causing the anxiety disorder and how to deal with its symptoms.
  • Cognitive behavioral therapy (CBT) may also be beneficial. This therapy involves teaching the patient how to think about problems in a new way in order to improve emotional and behavioral responses. The mental health professional will first help the patient identify unhealthy negative beliefs and behaviors. These negative behaviors or beliefs are then replaced with positive ones.
  • In addition, some patients may also take antidepressants, anti-anxiety medications, or sedative to help reduce symptoms associated with dissociative disorders.
  • Personality disorders:
  • Overview: Personality disorders cause patients to feel or behave in socially distressing ways that impair their abilities to function, especially in relationships with others.
  • There are 10 main personality disorders, which are categorized into three major groups. The first group, called cluster A, includes personality disorders that are characterized by odd behavior. This group includes paranoid, schizoid, and schizotypal personality disorders. Cluster B personality disorders are characterized by dramatic or emotional behavior. This group includes histrionic, narcissistic, antisocial, and borderline personality disorders. Patients with cluster C personality disorders are generally fearful and anxious. This group includes patients who are obsessive-compulsive, avoidant, and excessively dependent.
  • Causes: Researchers believe several factors, including the patient's personal history and genetics, may lead to the development of personality disorders.
  • Symptoms: Cluster A personality disorders include paranoid personality disorder, schizoid personality disorder, and schizotypal personality disorder. Symptoms of paranoid personality disorder may include hostility or aggression towards others, emotional detachment, inability to work collaboratively with others, as well as misconceptions that others are lying, cheating, or behaving maliciously to harm the patient. Symptoms of schizoid personality disorder include extreme introversion, fantasizing, emotional detachment, and fixation on the patient's own thoughts or feelings. Symptoms of schizotypal personality disorder may include indifference to and detachment from others, odd style of dressing or interacting with others, and having suspicious or paranoid ideas. Patients typically believe that their thoughts can influence people and events.
  • Cluster B personality disorders include histrionic personality disorder, narcissistic personality disorder, antisocial personality disorder, and borderline personality disorder. Common symptoms of histrionic personality disorder include sensitivity to others' approval, false sense of intimacy with others, frequent mood swings, and attention-grabbing behavior. Symptoms of narcissistic personality disorder often include inflated ego, inability to empathize with others, excessive shame or anger in response to criticism, selfish behavior, and attention-grabbing behavior. Symptoms of antisocial personality disorder include frequent lying and stealing, lack of guilt after hurting others, lack of concern for others' feelings or wellbeing, irresponsibility, unreliability, and aggressive behavior. Symptoms of borderline personality disorder may include difficulty controlling emotions or impulses, dramatic changes in moods or opinions, aggressive behavior, fear of being alone, and suicidal thoughts.
  • Cluster C personality disorders include avoidant personality disorder, dependent personality disorder, and obsessive-compulsive personality disorder. Common symptoms of avoidant personality disorder include voluntary isolation from others, extreme shyness, and hypersensitivity to criticism. Symptoms of dependent personality disorder typically include dependence on others to meet physical and emotional needs, tolerance of poor or even abusive treatment in order to maintain relationships, and fear of being alone. Symptoms of obsessive-compulsive personality disorder may include excessive concern with order and schedules, perfectionism, inflexible with change or disorder, and compulsive devotion to work.
  • Diagnosis: Currently, there are no laboratory tests to diagnose personality disorders. A healthcare provider typically makes a diagnosis after reviewing the patient's medical history and performing a psychological exam. The healthcare provider may also ask friends and family members questions about the patient's behavior. Most healthcare professionals believe that a diagnosis should not be made until the patient is an adult. This is because many adolescents may appear to have symptoms of personality disorders when they do not actually have the disorder.
  • Treatment: Psychotherapy, also called counseling or talk therapy, is the main treatment for personality disorders. Psychotherapy is an interactive process between a patient and a qualified mental health professional. The patient will explore thoughts, feelings, and behavior to help them with problem solving. The goal of therapy is to help patients learn how to cope with their condition. This includes learning how to maintain healthy relationships and prevent relapses in the future. Therapy may also provide emotional support to the patient. Psychotherapy is conducted in private individual, couple, group, or family sessions. Sessions range from 50 minutes for individuals to 90 or 120 minutes for groups.
  • A type of psychotherapy called cognitive behavioral therapy may also help treat personality disorders. This therapy involves teaching the patient how to think about problems in a new way in order to improve emotional and behavioral responses. The mental health professional will first help the patient identify unhealthy, negative beliefs and behaviors. These negative behaviors or beliefs are then replaced with positive ones.
  • Patients may also receive antidepressants, anti-anxiety medications, or sedatives to help reduce symptoms of personality disorders.
  • Anticonvulsants may be prescribed to suppress impulsive and aggressive behavior, which is often associated with personality disorders. Commonly prescribed anticonvulsants include carbamazepine (Carbatrol® or Tegretol®) and valproic acid (Depakote®).
  • Psychotic disorders:
  • Overview: Psychotic disorders, also called psychosis, occur when patients are unable to differentiate between what is real and unreal. Psychotic symptoms may include hallucinations, irrational thoughts and fears, disorganized thoughts, and bizarre or inappropriate behavior.
  • There are several different types of psychotic disorders, including schizophrenia, schizoaffective disorder, schizophreniform disorder, and brief psychotic disorder.
  • Causes: Researchers are still trying to identify the cause of psychotic disorders. It is thought that genetics may play a role because an estimated 10% of patients with family histories of schizophrenia develop the disorder compared to one percent of the general population. Chemical abnormalities in the brain may also contribute to the development of psychotic disorders.
  • Symptoms: Schizophrenia is a brain disorder that causes patients to suffer from delusions and hallucinations for more than six months. Delusions occur when patients lose touch with reality. Common symptoms of schizophrenia include social withdrawal, intense anxiety, feelings of being unreal, loss of appetite, loss of hygiene, difficulty processing information, poor memory, depressed mood, and sense of being controlled by outside forces. The behavior of schizophrenic patients varies widely. In men, symptoms of schizophrenia usually develop when patients are in their teens or 20s. Women usually develop the disorder when they are 20-30 years old.
  • Patients with schizoaffective disorder have symptoms of schizophrenia, as well as serious mood or affective disorder (e.g. depression bipolar disorder, or mania).
  • Patients with schizophreniform disorder suffer from symptoms of schizophrenia. However, unlike schizophrenia, symptoms last six months or less.
  • Brief psychotic disorder is an illness that occurs when patients have short periods of psychotic behavior, usually in response to stressful events, such as a death in the family. Patients usually recover in less than one month.
  • Diagnosis: There is no clinical test available to diagnose psychotic disorders. Patients will first undergo a physical examination. The healthcare provider will rule out other possible causes of the symptoms, such as seizure disorders, metabolic disorders, brain tumors, or thyroid dysfunction. Once these conditions are ruled out, a psychological evaluation is recommended. The mental health professional diagnoses the specific psychotic disorder after reviewing the patient's symptoms and personal and medical history.
  • Treatment: Patients with psychotic disorders usually receive a combination of psychotherapy and medications, called antipsychotics. In addition, rehabilitations programs and applied behavior analysis therapy may also be beneficial.
  • Psychotherapy is an interactive process between a patient and a qualified mental health professional. The patient explores thoughts, feelings, and behaviors to help them with problem solving. The goal of therapy is to help patients learn how to cope with their disorders. This includes learning how to maintain healthy relationships and prevent relapses in the future. Therapy may also provide emotional support to the patient. Psychotherapy is conducted in private individual, couple, group, or family sessions. Sessions range from 50 minutes for individuals to 90 or 120 minutes for groups.
  • A type of psychotherapy, called family therapy, may be a beneficial treatment for both psychiatric patients and their family members. This type of therapy helps the family understand and learn how to cope with the patient's illness. Family members will learn how to identify possible situations that may trigger an episode in the patient. It may also provide emotional support to the patient.
  • Patients with psychotic disorders may benefit from rehabilitation programs. These programs, which usually last several months, are tailored to the patient's individual needs. Rehabilitation programs typically include training in vocational and social skills to help the patient live independently and maintain a job.
  • Antipsychotics (neuroleptics) are typically taken to reduce symptoms of psychosis. In order to be effective, these drugs must be taken regularly. Although these drugs cannot prevent relapses from occurring, they can help reduce the frequency of relapses. Commonly prescribed antipsychotics include clozapine (Clozaril®), risperidone (Risperdal®), olanzapine (Zyprexa®), quetiapine (Seroquel®), ziprasidone (Geodon®), and aripiprazole (Abilify®). According to the American Diabetes Association, some of these drugs may increase the risk of diabetes, obesity, and high blood pressure. Because nicotine interferes with antipsychotics, smokers may need to take higher doses of medications.
  • In addition, anticonvulsants may be prescribed to suppress impulsive and aggressive behavior, which may be associated with psychotic disorders. Commonly prescribed anticonvulsants include carbamazepine (Carbatrol® or Tegretol®) and valproic acid (Depakote®). Side effects vary depending on the specific type of medication prescribed. The most common side effects associated with anticonvulsants include lethargy, nausea, dizziness, and anemia.

Tips for friends and family members
  • Support groups: Support groups can provide emotional support to friends and family members of patients with psychiatric disorders. Individuals are able to share their problems and provide support for one another.
  • Education: Friends, family members, and caregivers should educate themselves about the patient's psychiatric illness. The more a caregiver knows about the condition, the better they can help the patient. Being educated on the illness may also help the caregiver learn how to communicate better with the patient.

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

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