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Health and Disease

Physical Inactivity: A Petty Problem or a Serious Health Concern?

By Lily Kangas

Published 9:27 EST, Sun August 22, 2021

In today’s digital age, many swap their jump ropes and exercise shoes for the newest iPad or cellular device. While some argue that this is simply an inevitable product of our developing society, others emphasize the health risks this new lifestyle poses.

Abstract

As sedentarism sweeps through today’s world, we must be cognizant of the damage we are doing to our minds and bodies. Not only does physical inactivity deplete your brain of crucial hormones needed for well-being, therefore increasing the risk of mental illness, but it also wreaks havoc on your physical health and is an increasingly large cause of mortality. Fortunately, it is not too late to fix your lifestyle and put a stop to the harm inactivity is inflicting on your body. 

Mental Consequences

The notion that a sedentary lifestyle poses risks for one’s physical health is widely accepted, however the mental and emotional drawbacks of inactivity are often overlooked. In a number of studies, researchers have identified a link between brain health and physical activity levels, specifically with depression and anxiety. In fact, sedentary adolescents have ~10% higher chance of developing depressive symptoms before they become adults (Thomas 1). This increased risk can be chalked up to an absence of feel-good hormones, such as serotonin, that one would typically receive during exercise. Regular physical activity has been shown to increase serotonin levels within the brain, and because many mental illnesses stem from a serotonin deficit, exercise is thought to be among the most effective methods to combat these mental disorders. Therefore, when one completely cuts physical activity out of their daily life, they are losing an essential part of brain hormone stabilization. Additionally, lack of activity is often synonymous with staying indoors, meaning less exposure to sunlight and nature, which is also important in boosting serotonin and is needed to get adequate levels of vitamin D. In fact, conditions like seasonal affective disorder (SAD) and vitamin D deficiency both have substantial impacts on one’s psyche, and both arise specifically as a result of lack of sunlight. Consequently, there is a higher prevalence of the condition in sedentary individuals (Danahy 1). 

Physical Consequences

When one becomes sedentary, their physical health will inevitably decline. In fact, according to a study conducted by the Lancet, those who are in the worst shape as determined by a treadmill test, had a 500% higher chance of premature death than those who are more fit. As the body adapts to reflect its sedentary lifestyle, changes can be seen in a multitude of ways. The first, more surface-level changes can be seen with weight gain and muscle decomposition, as well as increased fatigue, breathlessness, and even bone brittleness. One may also suffer insomnia and sleep deprivation, which, if continued long-term, can heighten the risk of developing more severe health conditions such as diabetes and heart disease (Csatari 1). Not only that, but one may suffer high blood sugar because exercise is needed to regulate glucose and since cardio-respiratory fitness worsens without activity. On top of these already striking concerns, inactive individuals run the risk of heart damage, with lower levels of HDL cholesterol a.k.a “the good cholesterol” and an 18% increased risk of total heart failure (ahajournals.org). And, although there are no controlled studies determining the impact of sedentarism on cancer, independent stories lead scientists to believe that the two are linked. All of these factors come together to increase the risk of premature death by 5 times.

Solutions 

So, what can be done? While the solution seems simple, many lack the motivation or time to fit exercise into their daily routines. For those individuals, it may be beneficial to look for simple yet effective ways to get moving, such as biking rather than driving to work, or opting for a standing desk. One might also consider taking up more “fun” forms of exercise such as dancing, trampolining, or joining a recreational youth or adult sports team. Health experts recommend at least 30 minutes of physical activity a day, so even taking a walk around the neighborhood for half an hour each morning has the potential to substantially boost one’s physical and mental health. 

Lily Kangas, Youth Medical Journal 2021

Sources

Csatari, Jeff. “What Can Happen To Your Body If You Don’t Exercise.” Eat This Not That, 8 Sept. 2020, http://www.eatthis.com/side-effects-not-exercising.

Florido, Roberta, et al. “Six-Year Changes in Physical Activity and the Risk of Incident Heart Failure.” Circulation, vol. 137, no. 20, 2018, pp. 2142–51. Crossref, doi:10.1161/circulationaha.117.030226.

Thomas, Liji. “A Sedentary Lifestyle Increases the Risk of Adolescent Depression.” News-Medical.Net, 12 Feb. 2020, http://www.news-medical.net/news/20200211/A-sedentary-lifestyle-increases-the-risk-of-adolescent-depression.aspx#:%7E:text=The%20findings&text=Correlating%20the%20physical%20activity%20with,time%20they%20entered%20early%20adulthood.

Ulery, Gina. “Seasonal Affective Disorder: Diet and Lifestyle Interventions.” Pdresources.Org, 19 Nov. 2015, blog.pdresources.org/seasonal-affective-disorder-diet-and-lifestyle-interventions.

Categories
Health and Disease

SSRIs: Helping You or Hurting You?

By Lily Kangas

Published 11:21 PM EST, Tues June 15, 2021

Abstract

SSRIs are antidepressants that work to correct serotonin deficits for patients with various mental health problems. These drugs, however, have many downsides that are often not acknowledged including more minor side effects like headaches and nausea, to much more concerning long-term implications such as weight gain and sleep disturbances. Fortunately, alternatives do exist. 

What Are They?

Selective Serotonin Reuptake Inhibitors, more commonly called SSRIs, are the most common form of antidepressant. They work by enhancing the nerve cells that are responsible for regulating emotion and increase serotonin levels within the brain. Serotonin is a key hormone that works to stabilize mood and promote feelings of happiness and well-being. When one is in a serotonin deficit, these positive emotions and feelings are often lost or minimized, leading to psychiatric symptoms associated with anxiety, depression, and OCD. To combat this deficit, psychiatrists prescribe SSRIs in hopes that it will restore the hormone to its natural levels. What many patients are not prepared for, however, are the many harmful side effects and long term implications these drugs pose (Sharma, 1).

SSRIs Used to Treat Depression

The list of SSRIs that have been officially approved by the FDA to treat clinical depression include:

  1. Citalopram (Celexa)
  2. Escitalopram (Lexapro)
  3. Fluoxetine (Prozac)
  4. Paroxetine (Paxil, Pexeva)
  5. Sertraline (Zoloft) 

These drugs each differ in potency when it comes to blocking serotonin reuptake, and most patients metabolize (eliminate) each drug at a different rate, but they all have the same general function.  

Short-Term Effects

Most people who take SSRIs experience one or several short-term side effects. Because all SSRIs work in generally the same way, these side effects are typically similar in symptoms and severity. It is common for these side effects to fade once a patient’s body has adjusted to the drug, however if they persist, some patients may opt to try a different SSRI or discontinue antidepressants entirely (Mayo Clinic). The most commonly reported side effects include:

  • Nausea and vomiting/upset stomach
  • Fatigue
  • Headache
  • Insomnia
  • Dry mouth
  • Nervousness, restlessness, and agitation
  • Dizziness
  • Reproductive difficulties
  • Changes in appetite (resulting in weight loss or gain)

Overall, the SSRI with most commonly reported side effects is fluvoxamine, followed by paroxetine and sertraline. As a result, these three drugs have the highest discontinuation rates as well as the highest risk of complications (NCBI).

Long Term Effects

Although the short term effects listed earlier typically go away, SSRIs can also pose much more dangerous long-lasting implications. The most common of these effects include:

  • Weight gain: an uncontrolled study found that, in a period of 6-12 months, sertraline has a mean weight gain of 15 pounds, fluoxetine has a mean weight gain of 21 pounds, and paroxetine has a mean weight gain of 24 pounds (NCBI). With any form of weight gain comes increased medical risks. Patients increase their chances of a heart attack by 5-7% with each point added, so with a 24 pound weight gain on paxil, the risk of a heart attack goes up 25% (today.com). Additionally, weight gain leads to an increase in fatty acids and resistance to insulin, increasing risk of type 2 diabetes. Not only that, but people who are overweight have a 2-7% higher chance of developing end stage kidney disease than those in the healthy BMI range (World Kidney Organization). 
  • Sleep disturbances: SSRIs have been shown to disrupt the normal sleep patterns of depressed patients by delaying the onset of REM sleep and reducing the duration of REM sleep, as well as sleep efficiency, leading to an overall loss in sleep time. Over time, this loss can build up, causing “sleep debt.” The absence or lack of sleep over long periods has been found to cause issues like hormone imbalance, susceptibility to diseases such as diabetes or heart failure, and a greater risk of death.

Other long-term effects include physical and emotional dependency, increased risk of dementia (AADA), and increased likelihood of strokes. 

Alternatives 

Many alternatives to SSRIs exist and most have lessened likelihoods of adverse effects or complications. The first alternative is switching to a different form of antidepressant such as Wellbutrin, Cymbalta, or Pristiq. These drugs are not commonly associated with long-term effects such as weight gain, in fact, they are more commonly associated with slight weight loss, however, sleep hindrance may still occur. 

If SSRIs and alternative antidepressants still prove to have too many adverse effects, doctors may recommend a non-pharmaceutical approach to treatment. Non-pharmaceutical treatments encompass any activity or intervention aimed at improving one’s mental state without the use of medication, so a wide range of options exist. The most commonly recommended medication-free mental health treatments include:

  • Cognitive behavioral therapies (CBT)
  • Grounding techniques such as yoga, mindfulness, or meditation
  • Changes to diet and exercise
  • Acupuncture and aromatherapy 

Generally speaking, this naturopathic approach to psychotherapy has been proven to be just as effective at restoring serotonin levels as SSRIs. Futhermore, these treatments are free from the possible implications drugs pose, which is why much of the medical world is beginning to move away from pharmaceutical mental-health intervention (Dr. Jessica Black). 

Lily Kangas, Youth Medical Journal 2021

References

Black, Jessica. “3 Reasons Naturopathy Is Good for Emotional and Mental Health.” Jessica Black, 3 Mar. 2016, drjessicablack.com/3-reasons-naturopathy-is-good-for-emotional-and-mental-health.

Carvalho, André. “The Safety, Tolerability and Risks Associated with the Use of Newer Generation Antidepressant Drugs: A Critical Review of the Literature.” FullText – Psychotherapy and Psychosomatics 2016, Vol. 85, No. 5 – Karger Publishers, 2016, http://www.karger.com/Article/FullText/447034#:%7E:text=Some%20studies%20have%20found%20nausea,GI%20side%20effects%20%5B34%5D.

“SSRI Antidepressant Medications: Adverse Effects and Tolerability”

 NCBI, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC181155/#:%7E:text=The%20latter%202%20drugs%20are,side%20effects%20in%20clinical%20trials.&text=During%20long%2Dterm%20SSRI%20therapy%2C%20the%20most%20troubling%20adverse%20effects,weight%20gain%2C%20and%20sleep%20disturbance. Accessed 28 May 2021.

“Selective Serotonin Reuptake Inhibitors (SSRIs).” Mayo Clinic, 17 Sept. 2019, http://www.mayoclinic.org/diseases-conditions/depression/in-depth/ssris/art-20044825.

Worldkidneyday. “Obesity & Kidney Disease.” World Kidney Day, 7 June 2019, http://www.worldkidneyday.org/facts/topics/obesity-kidney-disease/#:%7E:text=People%20who%20are%20overweight%20or,to%20those%20of%20normal%20weight.

Categories
Health and Disease

Link Between Social Media and Mental Illness

By Lily Kangas

Published 9:23 PM EST, Tues April 20, 2021

Abstract 

As social media usage upsurges across the globe, our youth’s mental health is on a rapid decline. Social media has repeatedly been proven to be a direct link to a plethora of psychiatric illnesses including anxiety, depression, and various forms of disordered eating. Unfortunately, these mental ailments are only exacerbated due to widespread social-media addiction. That being said, there are ways to practice safe and healthy social media usage by training ourselves how to productively use these online platforms and limiting the use of social media throughout the day. 

Adolescents and Social Media

The technological revolution that brought us cell phones, laptops, and tablets motivated a cultural shift away from outdoor play and face-to-face contact and instead replaced these activities with social media. Today, platforms such as Instagram, Tiktok, and Twitter have transformed the lifestyles of adolescents all over the world. And while at first glance, social media seems to be an innovative and exciting way to connect with new people, these online worlds often lead children to neglect other more important aspects of their lives. In fact, the majority of today’s kids would rather spend their days scrolling down their Pinterest feed than participate in extracurricular activities or finish their schoolwork, which can cause problems in many areas of the child’s academic and social life. This claim is backed by a survey conducted by the American Academy of child and adolescent psychiatry that showed that roughly 90% of American teenagers admit to having used social media excessively and another 50% that report being online almost constantly.  

Mental Health Among Social Media Users 

The excessive immersion in social media platforms among today’s youth has lasting consequences to one’s mental health. In fact, teens who use social media more often have been found to have a higher risk for:

  1. Depression: the prioritization of online contact rather than face-to-face communication has been associated with the depletion of various mood-stabilizing hormones such as serotonin, therefore leading to conditions such as major depressive disorder. 
  2. Anxiety: Social media has been dubbed a “fuel for anxiety” as it enables individuals with anxiety-related tendencies to negatively compare themselves with others and obsessively worry about how they are perceived through these online platforms. For example, if an anxious individual only receives 20-30 likes per post while her friend racks up 90-100, irritation thoughts may lead them to feel as though they are doing something wrong or that their peers dislike them. 
  3. Eating disorders and body dysmorphic disorder: Most social media posts do not reflect reality. Famous influencers will often pose or photoshop their body to fit society’s beauty standards. Still, constantly seeing the same toned and seemingly perfect bodies often leads teenagers to feel as though they are an outlier and that their body is weird or unattractive. These thoughts are directly correlated with the development of body dysmorphia, anorexia nervosa, and bulimia. 
  4. Self-harm and suicidal tendencies: Evidently, social media plays a major role in the rising rates of depression, anxiety, and disordered eating, which inherently increases suicide rates. Studies show that social media is often an outlet for suicidal individuals to post or glorify self-inflicted injuries and other forms of triggering content. 

Supporting the above points, a meta-analytic study conducted by the American Psychological Association showed that the average teen today suffers a substantially higher rate of mental maladies than psychiatric patients in the 1950s. While there may be a plethora of distinguishing factors between modern-day society vs. society in the 50s, arguably the most prevalent is social media usage. In the past 70 years, technology has completely transformed the adolescent experience, and therefore must play a large role in our youth’s rapidly declining mental health.  

Addiction

After observing the many mental and emotional ramifications of social media, most would argue for its eradication, however, a complete nullification of such a widely used form of communication and entertainment is an inconceivable task, mainly due to its addictive nature. Studies show that a rush of dopamine, a neurotransmitter that releases feel-good chemicals, is released when teens receive positive feedback on certain posts or comments, which rewards the habit and encourages them to repeat it. After repeating the action a second time, their brain continues to crave the dopamine rush, leading to a full-fledged addiction. In addition, the use of these online platforms is occurring on such a large scale that experts estimate that about 10% of users have reached the point of severe addiction. And unfortunately, while these individuals may recognize a decline in their mental and emotional stability, their addiction will force them to continue with the detrimental behavior. 

Safe Social Media Use

So, the question is, how can we use social media in a way that is safe and effective for our mental well-being? Well, first we need to evaluate which social media apps most commonly trigger our negative psychological response. For most, these apps consist of photo or video sharing platforms, as these forms of media are far more likely to arouse unfavorable comparisons or feelings of inadequacy. We can evaluate these responses by monitoring our anxiety levels on usage across all platforms. Then, we should ensure that the time spent on each of these apps is not impeding our other responsibilities such as school, work, chores, or time with family and friends. In order to do this, individuals should set screen time or set out specific rules for when social media use is permitted vs when you should be putting time towards something more productive. You should also make it a goal to take a set amount of 5-10 minute breaks for every 30 minutes online. Doing so will allow your brain time to snap back into reality and rid oneself of any intrusive thoughts or comparisons. Finally, you should take time in your day to ground yourself. This may be through meditation, time spent in nature, or even pursuing an interest. By grounding yourself, not only will you be putting less time towards social media per day, which will enable you to fight any underlying addiction, but you will also be taken to a much more rational mental state, therefore decreasing anxiety levels by a substantial amount. 

Lily Kangas, Youth Medical Journal 2021

References 

“Anxiety, Loneliness and Fear of Missing Out: The Impact of Social Media on Young People’s Mental Health | Centre for Mental Health.” Centerformentalhealth.Org, http://www.centreformentalhealth.org.uk/blogs/anxiety-loneliness-and-fear-missing-out-impact-social-media-young-peoples-mental-health. Accessed 5 Jan. 2021.

Cherney, Kristeen. “What Is Social Media Addiction?” Healthline, 6 Aug. 2020, http://www.healthline.com/health/social-media-addiction#overview.

Intern, Nchr. “Social Media and Adolescents’ and Young Adults’ Mental Health.” National Center for Health Research, 21 Aug. 2020, http://www.center4research.org/social-media-affects-mental-health.

Psycom.net. “Social Media and Teens: How Does Social Media Affect Mental Health?” Psycom.Net – Mental Health Treatment Resource Since 1996, 17 Nov. 2020, http://www.psycom.net/social-media-teen-mental-health.

Robinson, Lawrence. “Social Media and Mental Health – HelpGuide.Org.” Helpguide.Org, http://www.helpguide.org/articles/mental-health/social-media-and-mental-health.htm. Accessed 5 Jan. 2021.

“The Social Dilemma: Social Media and Your Mental Health.” Mcleanhospital.Org, http://www.mcleanhospital.org/essential/it-or-not-social-medias-affecting-your-mental-health. Accessed 30 Dec. 2020.

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Health and Disease

Adolescent Sleep Deprivation: Effects and Solutions

By Lily Kangas

Published 6:56 PM EST, Fri March 12, 2021

Abstract

Sleep deprivation is a pressing issue among teenagers and has many adverse effects that may lead to long term consequences to various aspects of one’s life and should not be taken trivially. Sleep is essential for balance and wellbeing in one’s life, especially in adolescents. Factors such as biological tendencies and technology may hinder teenagers’ sleep, leading to a variety of issues ranging from mild fatigue and troubles in school to major health conditions such as heart disease. And while sleep deprivation is a fixable issue, it is of the utmost importance to get out of sleep debt before long term bodily damage takes effect.

Susceptibility/Causes

According to sleephealth.org, at least 11% of adults report getting an insufficient amount of sleep each night and an estimated 50-70 million Americans are sleep deprived. Although sleep deprivation is a common issue among adults, it is even more widespread among children aged 10-19. Adolescents are far more susceptible to becoming sleep deprived due to their biological make-up. During adolescence, the body’s natural clock, known as the circadian rhythm, is programmed differently than that of an adult. During puberty, the circadian rhythm undergoes a dramatic shift forward in its cycling phase. Teens are naturally inclined to stay up several hours later and sleep in longer than adults, however, early school start times and extracurricular activities do incorporate such schedules, so kids are forced to develop unnatural patterns of sleep. This unnatural shift frequently causes teenagers to recieve little amounts of sleep each night because they are unable to change their bodies’ circadian rhythm.

Not only do teenagers’ natural tendencies hinder their sleep, in many cases, technology may also be to blame. A survey conducted by common sense media shows that in the United States, 53% of children own smartphones by the time they turn 11. This technological subculture greatly contributes to the nationwide crisis of sleep deprivation due to the smart phone’s addictive nature. Like nicotine or cocaine, cell phones provide their users with a rush of dopamine. According to Web Watcher, a computer software company, “Dopamine is known as a “reward” or “feel-good” hormone. It’s the chemical that causes you to feel happy. And texts, likes, retweets, and other notifications cause that hormone to be released.” Users become hooked on the dopamine supplied by their devices, leading to the use of their phones more and more often throughout the day and even at night, even when they should be asleep.

Short Term Effects

Sleep deprivation greatly impacts an individual’s social life as the overwhelming desire to fall asleep overrides anything and everything else in a sleep deprived person’s life, including social interaction. Hence, while in social environments, a sleep deprived person may not have the energy or motivation to carry out basic interactions. A study at the University of California, Berkeley showed that sleep deprivation often presents itself in a manner similar to that of social anxiety. Socially anxious people often withdraw from society and do not take part in activities involving large groups of people. Similarly, because interaction involves alertness and engagement, those suffering from sleep deprivation tend to avoid social outings because they are too fatigued to hold even simple conversations (Healthline).

On top of one’s social life being harmed, sleep deprivation is often a cause of drops in GPA and test scores. Research shows that on average, students have a very hard time developing a healthy and consistent sleeping pattern, as their sleep varies tremendously as schoolwork increases or decreases. A study by Brigham and Women’s Hospital “measured sleep and circadian rhythms as well as the association to academic performance among college students…The research found that students who had more regular sleep patterns had better average school grades” (SI news). The study showed that the body’s natural clock’s rhythm was roughly 3 hours later than in people who have erratic sleep patterns. For example, a test may be scheduled for 10 am, which to an erratic sleeper, feels like 7 am, hence impairing the student’s abilities.

Finally, when one fails to get an adequate amount of sleep each night, mental health often takes the biggest hit. Symptoms and effects of sleep deprivation range from mild sleepiness to severe tolls on a person’s mental health, depending on the individual and severity of deprivation. Being sleep deprived can often lead individuals to feel overwhelmed because they don’t feel equipped or energized enough to do the things they need for school, work, etc., which can lead to hopelessness, excess stress, depression, or anxiety. Sleep deprivation also alters one’s mood dramatically, increasing irritability and hindering an individual’s ability to deal with even minor inconveniences. 

Long Term Effects

While sleep deprivation is often seen as a trivial issue with minor or no lasting implications, not getting enough sleep can lead to serious health conditions and in extreme cases, death. The absence or lack of sleep over long periods has been found to cause issues like hormone imbalance, susceptibility to diseases such as diabetes or heart failure, and greater risk of death. Research from Medical News Today shows that sleep deprivation can inhibit hormone production and lead to imbalances in growth hormones and testosterone as well as hormones such as leptin and ghrelin. Leptin creates the feeling of satiety and fullness so when circulating levels of leptin are high, one’s appetite will be lost. In contrast, ghrelin creates the sensation of hunger, so when an individual’s ghrelin is high, their appetite will be as well, often leading to substantial amounts of weight gain. Sleep deprivation also puts people at risk for type 2 diabetes as inadequate sleep causes the release of insulin, leading to an increase in fat storage. Additionally, sleep is needed for heart vessels to heal and rebuild, maintain blood pressure and sugar levels, and control inflammation. When one does not get enough sleep for such healing to occur, they put themselves at risk for major heart conditions such as cardiovascular disease (Medical News Today). Many people who are severely deprived of sleep may not even realize the damage they are doing to their bodies before it is too late to reverse the problems. 

Solutions

While it may seem hopeless, sleep deprivation is a fixable issue, assuming that no major health conditions occur. There are many ways one can get back into a healthy and adequate sleep cycle such as setting limits for oneself, turning off technology before bed, or even seeing a doctor. However, recovering from sleep deprivation can often bring feelings of frustration because not only is it very difficult to completely reset the body’s internal clock, “catching up on a missed night of sleep isn’t quite the same as getting the sleep you need in the first place. When you catch up, it takes extra time for your body to recover. According to a study from 2016, it takes four days to fully recover from one hour of lost sleep” (Healthline). In addition to making schedule changes, Healthline says that some of the most effective ways to catch up on missed sleep is to take power naps, go to bed earlier, and sleep in a few hours later than usual on the weekends. Additionally, while sleep deprivation is reversible, it is extremely important to get out of sleep debt before long term consequences take effect. 

Lily Kangas, Youth Medical Journal 2021

References

Mccullough, Adam David, et al. “SiOWfa15: Science in Our World: Certainty and Controversy.” 

SiOWfa15 Science in Our World Certainty and Controversy, 7 Oct. 2015, 

sites.psu.edu/siowfa15/2015/10/07/how-does-sleep-effect-grades/comment-page-1/.

Monitor on Psychology, American Psychological Association, http://www.apa.org/monitor/oct01/sleepteen.

Monroe, Jamison. “Technology and Sleep Deprivation Affect Teens.” Newport Academy

Newport Academy, 11 Jan. 2019, http://www.newportacademy.com/resources/well-being/technology-and-sleep-deprivation/.

News Center. “Among Teens, Sleep Deprivation an Epidemic.” News Center

med.stanford.edu/news/all-news/2015/10/among-teens-sleep-deprivation-an-epidemic.html.

Segaren, Sharuna. “The Impact of Sleep on Academic Performance.” Study International, 9 Oct. 

2019, 

http://www.studyinternational.com/news/the-impact-of-sleep-on-academic-performance/.

Walker, Matthew P. Why We Sleep: Unlocking the Power of Sleep and Dreams. Scribner, an 

Imprint of Simon & Schuster, Inc., 2018

 WebWatcher, Published. “Is Your Teen Addicted? How Parental Control Apps Can Treat 

Smartphone Addiction.” WebWatcher, 19 Mar. 2019, http://www.webwatcher.com/blog/is-your-teen-addicted-how-parental-control-apps-can-treat-smartphone-addiction/ 

Categories
Health and Disease

Maladaptive Daydreaming: Trapped in a Fictional Reality

By Lily Kangas

Published 7:37 PM EST, Sat February 27, 2021

Introduction

It is completely normal for people to daydream from time to time. In fact, up to 96% of adults daydream daily. However, when these daydreams interfere with daily tasks and responsibilities, it may be a sign of maladaptive daydreaming. Maladaptive daydreaming (MD) is a form of dissociative absorption and is typically seen as a coping mechanism for PTSD, serious psychiatric conditions, and loneliness. Unfortunately for MD patients, the condition is not widely recognized within the medical community, making its diagnosis excessively difficult. Still, an Israeli Professor, Eliezer Somer, created a scale based on the condition’s most commonly experienced symptoms, which may be used to make an MD diagnosis. Following this diagnosis, cognitive behavioral therapy or select SSRIs may be used as treatment. 

Causes

Maladaptive daydreaming is one facet of dissociative absorption, an absorption in and reliance on external stimuli such as television or books, to a point of limited self-awareness. Experts believe that (in most cases) MD, like dissociative absorption, is not a psychiatric condition itself, but a coping mechanism for prior trauma, abuse, serious mental illness, or even loneliness. MD sufferers seek an escape from their own harsh reality. For instance, when triggered, maladaptive daydreamers will dissociate and slip into a story-like world, playing through fiction scenarios in their minds until the underlying stress brought on by the trigger goes away. This conjecture is supported by a study conducted by Professor Eliezer Somer, which identified six maladaptive daydreamers, each one a sexual assault survivor. 

Symptoms and Diagnosis

The most common symptoms of MD include:

  • Lucid, storylike daydreams with a definitive plot, characters, and setting
  • Daydreams are triggered by or based on real-life events or circumstances
  • Daydreams interfere with daily activities and responsibilities 
  • Insomnia or difficulty falling/staying asleep 
  • Pacing or the performance of other repetitive movements/facial expressions while daydreaming
  • Talking, mumbling, or whispering during daydreams
  • Strong urge to continue daydreaming 
  • social/academic withdrawal
  • Daydreaming for extensive periods of time (1+ hours )  

Despite MD not being mentioned in any diagnostic manuals and a lack of medical recognition, MD can be diagnosed using the following list of symptoms in conjunction with Professor Somer’s, maladaptive daydreaming scale (MDS). The MDS is a 14 part scale based on the 5 main characteristics of maladaptive daydreaming. The scale rates and individual in each of the following areas:

  1. Quality/detail of daydreams
  2. The individual’s ability to control both the content and duration of their daydreams
  3. Amount of distress daydream causes the individual
  4. The individual’s perceived benefits of daydreaming
  5. Interference of daydreams with daily life 

Treatment Options and Addiction

Though there is no official treatment for MD, experts believe that cognitive-behavioral therapy, or CBT, may help alleviate the intensity and frequency of daydreams. CBT is one of many psychotherapeutic treatment options for individuals suffering from OCD, anxiety, depression, and other common mental illnesses. In the case of maladaptive daydreaming, cognitive behavioral therapy is used to change the daydreamer’s train of thought. Through mindfulness and grounding techniques, CBT shifts one’s focus from past traumas or worries about the future to the present moment, and because MD is a form of dissociation, grounding the sufferer in the present lessens the urge to slip into a false reality. 

In addition to CBT, a 2009 study found that Luvox (fluvoxamine), may be beneficial in controlling maladaptive daydreams. Luvox is a selective serotonin reuptake inhibitor frequently used for obsessive-compulsive disorder, depression, and other psychiatric conditions in which serotonin production may be lacking. Medical professionals are not yet sure how Luvox works to curve daydreams, but it likely has to do with the fact that the medication treats underlying mental disorders, which as mentioned earlier, have been known to trigger MD. 

Unfortunately, many maladaptive daydreamers never seek treatment due to the condition’s addictive nature. Because MD eliminates any emotion or psychological pain for a given period of time, many MD patients find that they would rather spend time in their fantasy worlds than in reality. Over time, these individuals will not only increase the frequency, but also the duration of their daydreams, which impedes daily responsibilities and often leads to a significant social withdrawal, which in turn poses a great risk to a sufferer’s school or work life. Still, to many MD sufferers, the pleasure provided by these daydreams outweighs any drawbacks, and this mentality stops these individuals from seeking proper treatment.  

Lily Kangas, Youth Medical Journal 2021

References 

Cirino, Erica. “Maladaptive Daydreaming.” Healthline, 13 Dec. 2018, http://www.healthline.com/health/mental-health/maladaptive-daydreaming#treatments.

“Maladaptive Daydreaming as a New Form of Behavioral Addiction.” PubMed Central (PMC), 1 Sept. 2018, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6426361.

“People with ‘Maladaptive Daydreaming’ Spend an Average of Four Hours a Day Lost in Their Imagination.” Research Digest, 3 Nov. 2020, digest.bps.org.uk/2018/06/25/people-with-maladaptive-daydreaming-spend-an-average-of-four-hours-a-day-lost-in-their-imagination.

Schupak, Cynthia. “Excessive Daydreaming: A Case History and Discussion of Mind Wandering and High Fantasy Proneness.” PubMed, pubmed.ncbi.nlm.nih.gov/19062309. Accessed 15 Jan. 2021.

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Health and Disease

P.A.N.D.A.S: When Strep Throat Turns Violent

Abstract

Pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections or P.A.N.D.A.S, is a neuroimmune disorder, most commonly affecting children between the ages of 3 and 12. The condition occurs through a process of molecular mimicry which triggers an autoimmune response. Onset is abrupt and symptoms consist of a variety of psychiatric and neurological abnormalities including: obsessive-compulsive like behaviors, tics, depression, anxiety, and more. Because P.A.N.D.A.S is a clinical diagnosis, no official lab tests can be used to solidify its presence. Still, blood tests such as the Cunningham Panel™ and strep throat cultures can aid doctors in the diagnosis. Treatment of P.A.N.D.A.S typically consists of a single course of antibiotics, however, IVIG and steroids may be used if symptoms are not alleviated by the antibiotics alone. 

Introduction

Pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections, more commonly known as P.A.N.D.A.S, is a rare neurological autoimmune disease. Autoimmune diseases occur when the body’s natural defense system (immune system) attacks the body’s healthy tissues, causing inflammation. In P.A.N.D.A.S, because the streptococcal organisms survive in their host through “molecular mimicry,” a form of disguising themselves to look almost identical to that of the child’s heart, joint, or brain tissues, the bacteria can remain undetected in its host for extensive time periods. [1]  When the body’s immune system recognizes these organisms, however, the antibodies released, known as cross-antibodies, not only attack the strep, but also the child’s healthy tissues that were mimicked through the molecular mimicry. This attack of the brain is specifically targeted at the basal ganglia, a group of subcortical nuclei found within the cerebral hemispheres, and causes inflammation to the region. [2] This inflammation results in various psychiatric and neurological symptoms.  

Symptoms

P.A.N.D.A.S is characterized by a sudden onset of psychological symptoms following a strep throat infection. The most common of these symptoms include tics, anxiety, food restriction, panic attacks, emotional/developmental regression, and OCD-like behaviors. A study done by the Human Phenotype Ontology (HPO), shows that 80-99% of P.A.N.D.A.S patients suffer from tics and another 30-79% show symptoms typically associated with ADHD and depression. [3] Because these symptoms present similarly to those of more common psychiatric disorders, misdiagnosis among affected children is extremely high. In fact, many children with P.A.N.D.A.S are given an initial diagnosis of OCD or anxiety and put on Selective Serotonin Reuptake Inhibitors (SSRIs), the most commonly prescribed form of antidepressants.  They are very effective in increasing serotonin levels for those suffering from anxiety disorders, depression, or any other illness that cause serotonin deficiencies. However, for P.A.N.D.A.S children, the issue stems not from a deficiency itself, but from the body’s immune response (which is likely to be a trigger of such deficiencies). When these drugs fail to alleviate the child’s symptoms, the validity of the initial diagnosis is called into question. Still, even after a correct diagnosis of P.A.N.D.A.S has been received and treatment has been administered, symptoms often relapse and remit over time, especially when contact with group A streptococcus (GAS) occurs. 

Diagnosis and Treatment

P.A.N.D.A.S is a clinical diagnosis, meaning that no lab tests are needed to make the diagnosis. Still, many doctors use the Cunningham Panel™ by Moleculera Labs. The Cunningham Panel™ is a blood test used to measure the levels of autoantibodies associated with psychiatric/neurological symptoms. The panel contains 5 tests (Dopamine D1 receptor, Dopamine D2L receptor, Lysoganglioside GM1, Tubulin, and CaM Kinase II). [4] If any one of these titers are high, it is an indication that P.A.N.D.A.S is present, but typically cannot provide a definitive diagnosis. 

Health care providers must also follow diagnostic criteria including: 

  1. Previous/recurring strep infection (confirmed by lab tests or throat culture)
  2. Presence of tics or obsessive compulsive symptoms
  3. Abrupt pediatric onset and episodic course of symptoms
  4. Positive throat culture for GAS or history with scarlet fever
  5. Neurological abnormalities i.e. hyperactivity, jerky movements, etc. [5]

Once the P.A.N.D.A.S has been diagnosed, the underlying strep infection must be treated. Then, Physicians take a throat culture to establish whether or not the initial infection is still present. If the culture is positive, antibiotics including azithromycin, amoxicillin, cephalosporins, and penicillin are recommended. [6] If the course of antibiotics fails to alleviate symptoms, some doctors recommend intravenous immunoglobulin (IVIG), a common treatment for many autoimmune diseases. The IVIG treatment interacts with the body’s immune cells and has proven to be effective in children with P.A.N.D.A.S. In fact, a longitudinal study from 2018 determined that 88% of IVIG patients did not experience any obsessive compulsive symptoms within a span of 4.8 years. [7]. Still, some P.A.N.D.A.S. may not experience remission with antibiotics or IVIG, in which case steroids may be considered. However, this form of treatment is controversial as many report worsening tics or other rebound effects. Additionally, steroids can only be used for a short period of time because long-term use can be detrimental to the child’s health. Fortunately for the many children who do not find relief through any of the previously mentioned treatments, tonsillectomies are currently being researched as a possible solution. A tonsillectomy is the surgical removal of the tonsils. Though it is not yet widely accepted as a viable treatment option by many medical professions, anecdotal evidence and unpublished research findings prove the operation’s success in eradicating strep infections and therefore alleviating P.A.N.D.A.S symptoms.  

Lily Kangas, Youth Medical Journal 2021

References

  1. “NIMH » PANDAS—Questions and Answers.” Nih.Gov, http://www.nimh.nih.gov/health/publications/pandas/index.shtml#:%7E:text=PANDAS%20is%20considered%20a%20pediatric,from%20age%203%20to%20puberty.
  2. “Children with PANDAS – Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infection.” Moleculera Labs, 24 Apr. 2020, http://www.moleculeralabs.com/what-is-pans-and-pandas/#:%7E:text=PANDAS%20occurs%20when%20the%20immune,disorders%2C%20neuropsychiatric%20symptoms%20and%20abnormal.
  3. “Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus Infections | Genetic and Rare Diseases Information Center (GARD) – an NCATS Program.” Nih.Gov, rarediseases.info.nih.gov/diseases/7312/pediatric-autoimmune-neuropsychiatric-disorders-associated-with-streptococcus-infections. Accessed 26 Dec. 2020.
  4. “The Cunningham Panel Overview.” Moleculera Labs, 20 Aug. 2019, www.moleculeralabs.com/cunningham-panel-pandas-pans-testing.
  5.  Nimh.Gov, NIMH, http://www.nimh.nih.gov/health/publications/pandas/index.shtml. Accessed 13 Dec. 2020.
  6. “How a Strep Throat Infection Can Cause Gradual OCD Symptoms.” Verywell Mind, http://www.verywellmind.com/first-large-scale-study-supports-pandas-4141719#:%7E:text=The%20NIMH%20stresses%20that%20if,penicillin%2C%20azithromycin%2C%20and%20cephalosporins. Accessed 26 Dec. 2020.
  7. Leon, Jill. “Longitudinal Outcomes of Children with Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections (PANDAS).” PubMed, pubmed.ncbi.nlm.nih.gov/29119300. Accessed 26 Dec. 2020.