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Health and Disease

A Brief History of Organ Transplantation: The Past, Present, and Future

By Sophie Farr

Published 6:46 PM EST, Thurs June 10, 2021

History

Transplantation began with the basic principle of the Carrel Patch which proved that a vein could be reattached and still support a functioning blood flow. This technique was employed by the Ukranian surgeon Voronoy Kiev and allowed him to accomplish the feat of being the first person to successfully transplant a kidney in a cadaver. 

After this promising start to transplantation, medical advancements were catalysed during the Second World War of 1939-1945 and transplantation especially had major breakthroughs. The war meant that severe injuries were more common and novel treatments could be tested as a last resort. Skin grafts were first used to heal airmen’s burns and this prompted the realisation that the immune system may reject transplants, a problem which has continued throughout the surgery’s development. 

David Hume, an American doctor, was the first to attempt a kidney transplant in a living patient, albeit in the arm instead of in the normal position in the thorax. The implanted kidney was removed After two days and natural function then resumed and the patient miraculously survived. This is still seen in the NHS today with the “Bridge to Transplant System” which uses ventricular assist devices for prospective heart surgery patients that are then removed and if the relief has assisted function, full transplantation may not be necessary. 

In 1951, a doctor in Paris performed the first ever renal transplant, using the kidney of an executed criminal, into a patient in renal failure. Although the surgery failed, the kidney was transplanted into the groin and bladder which forms the basis of the modern technique. Still in Paris, the first ever successful live kidney donor, Mrs Renard, gave her organ to her son Marius in 1952. Mrs Renard’s kidney functioned in Marius for 21 days but then it ceased but this was most likely due to rejection.

Finally, the first successful transplantation was achieved in Boston in 1954, having been done on a set of identical twins. One twin was experiencing kidney failure and the other donated a kidney which was transplanted without rejection because of their identicalness. After renal transplants had been accomplished, liver transplants followed in the 1960s and the first successful heart transplant happened in 1967. This heart transplant was undertaken by Christian Barnard in Cape Town on a female car crash victim and marked the greatest achievement in transplantation, now allowing full heart and lung transplants. 

Present

Since the amazing triumph of successful transplants, the world has been focused on decreasing the likelihood of complications. Immunosuppressants have been widely used to reduce the chance of rejection and 6MP and azathioprine are the most commonly used after the immunosuppressive effect was demonstrated in a rabbit by Schwarz and Dameshek and on a dog in 1959 by Roy Calne, who later performed the first European liver graft in 1968 in Cambridge. 

Preservation has also been a pressing issue as chance of function is reduced with poor preservation. In the past, kidneys were simply stored in ice, preservation fluid and a plastic ice to remain sterile but this arrangement was less successful with livers so the University of Westconsin Preservation fluid was developed by Jamieson for normal liver function. This fluid, combined with improved anaesthetic and the ability to keep patients warm during surgery to prevent clotting, increased transplantation success rates by the 1980s and further advancements are still improving chances of success today.

The opt-out system of organ donation that the NHS moved to in March of 2020, where all adults are assumed to be donors unless they actively specify against, has mitigated against the issue of how few organ donations the NHS had. This, combined with the risk of reduced function due to storage, means that transplantations have long waiting lists and it is contentious as to who receives them. Currently, storing organs for more than 12 hours in ice means that efficacy decreases by 25% every 6 hours. 

Future

In the future, the main developments are likely to surround storage and preservation. Cold storage can cause tissue injury and immediate graft function is roughly 65% effective, compared to the delayed function that is only 35% effective. In order to combat these worrying statistics, ex vivo normothermic machine perfusion, a new technique that restores kidney function out of the body before it is transplanted to remove the issue of cold storage, is being tested as a way to repair kidneys and allow more organs to be successfully transplanted.

Write up based on “Horrible History of Organ Transplantation and its Future” at the Cambridge Festival 

Sophie Farr, Youth Medical Journal 2021

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Health and Disease

ADHD, ASD, and Schizophrenia

By Neha Menon

Published 1:00 AM EST, Sun May 30, 2021

Introduction – Psychological Disorders

Psychological disorders or mental illnesses are explained by the DSM-5: “…as a syndrome characterized by​ a clinically significant disturbance in an individual’s cognitive, emotion regulation, or behaviour that reflects a dysfunction in the psychological, biological, or developmental process underlying mental functioning.”[1]

This definition by the American Psychiatric Association’s diagnostic manual, broadly classifies certain disorders or abnormalities under a vast topic: psychological disorders. There are several psychological disorders and if we begin to study them one by one, we will observe distinct characteristics in each one. The scope of this article is to discuss 3 common psychological disorders: ASD, ADHD, and schizophrenia.

ASD: Autism Spectrum Disorder

ASD is most commonly diagnosed by the age of 2-3 with obvious symptoms. It is a complex developmental condition that challenges verbal & non-verbal communication, social interactions and repetitive or restricted behaviours. Autism is regarded as a “spectrum” disorder because of the range and severity of symptoms that can differ across patients. Some people with this disorder may also have intellectual delays. What’s more interesting about people with ASD is that the person’s cognitive functioning may either be delayed/challenged or very gifted. Some signs or symptoms amongst others that may indicate the existence of the disorder are as follows[2][3]:

  • have trouble relating to others or not have an interest in other people at all
  • avoid eye contact and want to be alone
  • have trouble understanding other people’s feelings or talking about their feelings
  • prefer not to be held or cuddled, or might cuddle only when they want to
  • appear to be unaware when people talk to them, but respond to other sounds
  • Getting upset by slight changes in a routine

Why is Autism called Autism Spectrum Disorder? (2020, July 13). Retrieved from https://carmenbpingree.com/blog/what-is-autism-spectrum-disorder/

ADHD: Attention Deficit Hyperactivity Disorder

Attention Deficit Hyperactivity Disorder is the most commonly diagnosed mental disorder in children. It can continue into adulthood as well and is commonly spotted and recognised during the early years of learning when a child is seen to have issues paying attention—this is the most common and obvious symptom. These symptoms are grouped into three types: inattentive, hyperactive-impulsive and combined. You may have heard the term ADD to describe a condition similar to ADHD. The difference is simply that ADD, Attention Deficit Disorder, is an outdated term. ADHD is the current overarching name of the condition. The term ADHD became official in May 2013, when the APA released the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

Despite the infamous and predominant nature of the disorder, doctors and researchers do not know exactly what causes it, however, reduced dopamine is said to be a factor in it. Some signs or symptoms amongst others that may indicate the existence of the disorder are as follows:

  • Seem to not listen when spoken to directly
  • Fail to not follow through on instructions, fail to finish schoolwork, chores, or duties in the workplace, or start tasks but quickly lose focus and get easily sidetracked
  • Have problems organizing tasks and activities, such as doing tasks in sequence, keeping materials and belongings in order, keeping work organized, managing time, and meeting deadlines
  • Avoid or dislike tasks that require sustained mental effort, such as schoolwork or homework, or for teens and older adults, preparing reports, completing forms, or reviewing lengthy papers
  • Lose things necessary for tasks or activities, such as school supplies, pencils, books, tools, wallets, keys, paperwork, eyeglasses, and cell phones
  • Become easily distracted by unrelated thoughts or stimuli
  • Forgetful in daily activities, such as chores, errands, returning calls, and keeping appointments

Schizophrenia

Schizophrenia is a serious mental disorder that causes patients to interpret reality abnormally. This can range from delusions to hallucinations. Keeping symptoms under control requires lifelong treatment. It usually appears in late adolescence or early adulthood. Schizophrenia can be divided into negative and positive, wherein negative indicates lack of psychosis and positive indicates its presence. Some signs or symptoms amongst others that may indicate the existence of the disorder are as follows[4]:

  • confused speech that is hard for others to understand
  • lack of facial expression
  • lack of emotional expression
  • lack of motivation
  • difficulty concentrating
  • psychosis, such as delusions and hallucinations

According to NIMH, the cause for the disorder is when environmental factors combine with genetic factors. 

Schizophrenia Treatment in Ludhiana, Punjab. (n.d.). Retrieved from https://manashospitals.com/schizophrenia/

Conclusion

Psychological disorders–including but not limited to the ones discussed above–are widely present in a large number of people. They require treatment and care, but above all, understanding. Everyone’s brain is wired uniquely. Certain abnormalities in the wiring that leads to mental disorders are no fault of the person and this is the most important thing to keep in mind while dealing with people who have mental disorders. However, it is important to note that improving mental health opportunities is still an area we need to improve on globally.

Neha Menon, Youth Medical Journal 2021

References

Diagnostic and Statistical Manual of Mental Disorders (DSM–5). (n.d.). Retrieved from https://www.psychiatry.org/psychiatrists/practice/dsm [1]

Autism Spectrum Disorder. (n.d.). Retrieved from https://www.nimh.nih.gov/health/topics/autism-spectrum-disorders-asd/index.shtml[2]

What is Autism Spectrum Disorder? (2020, March 25). Retrieved from https://www.cdc.gov/ncbddd/autism/facts.html[3]

ADHD: Symptoms, Types, Testing, and Treatment. (n.d.). Retrieved from https://www.webmd.com/add-adhd/childhood-adhd/attention-deficit-hyperactivity-disorder-adhd

Schizophrenia: Symptoms, causes, and treatments. (n.d.). Retrieved from https://www.medicalnewstoday.com/articles/36942[4]

Schizophrenia. (2020, January 07). Retrieved from https://www.mayoclinic.org/diseases-conditions/schizophrenia[5]

Categories
Health and Disease

What OCD Really Entails

By Nara Ito

Published 4:50 PM EST, Sat May 22, 2021

Introduction

The DSM system recognizes OCD, or Obsessive-compulsive disorder, and a range of related disorders as characterized by either obsessions (recurring thoughts and images), or compulsions (repetitive actions). Most with a diagnosis of OCD have both obsessions and compulsions.

Compulsions

A behavioural characteristic of OCD is compulsive behaviour.

Compulsions are repetitive

Sufferers of OCD feel compelled to repeat a certain behaviour. For example, excessive hand washing; what seems like a simple action that particularly amidst the current COVID-19 pandemic we’ve encouraged to do more, can affect sufferers of OCD by which they wash their hands to the extent it causes damage. Other common compulsive repetitions include counting, praying and tidying/ordering groups of objects.

Compulsions reduce anxiety

Around 10% of sufferers of OCD show compulsive behaviour alone – they have no obsessions, just a general sense of irrational anxiety. For the vast majority, however, compulsions are used to manage the anxiety produced by obsessions. For example, linking to the previous example compulsive hand washing is carried out as a response to an obsessive fear of germs.

Avoidance 

Another behavioural aspect of OCD is that sufferers of OCD tend to try to manage their OCD by avoiding situations that trigger anxiety. For example, sufferers who wash compulsively may avoid coming into contact with germs. However, this avoidance can lead people to avoid very ordinary situations, such as emptying their rubbish bins. These actions end up interfering with their lives and prevent them from leading a normal life. 

Obsessions

For around 90% of OCD sufferers, the major cognitive feature of their condition is obsessive thoughts. Though heavily varying between individuals, obsessive thoughts are intrusive and unpleasant. Some sufferers may respond by adopting cognitive coping strategies. For example, a religious person tormented by obsessive guilt may respond by praying or meditating.

Insight into excessive anxiety  

Sufferers of OCD are aware that their obsessions and compulsions are not rational. In fact this is necessary for a diagnosis of OCD. OCD sufferers experience catastrophic and intrusive thoughts about the worst scenarios and also tend to be hypervigilant, focusing on potential hazards. 

Anxiety

OCD causes severe emotional arousal swell as distress due to the anxiety that accompanies both obsessions and compulsions.  It is also often accompanied by depression, so anxiety can be accompanied by low mood and lack of enjoyment in activities and irrational guilt over minor issues

Genetic explanation of OCD

OCD is an example of a condition that is presently largely understood as biological in nature.

OCD has been found to be polygenic, whereby multiple genes are involved in vulnerability to OCD; Taylor (2013) suggested ~230 different genes can be linked to the onset of OCD. Lewis (1936) observed that of his OCD patients 37% had parents with OCD and 21% had siblings with OCD, suggesting that OCD can run in families, but rather provides genetic vulnerability to OCD rather than causality. The diathesis-stress model suggests that the presence of certain genes make people more likely and vulnerable to suffer a mental disorder. However, environmental stress is also necessary to trigger the condition. 

Certain genes, which create vulnerability for OCD, called candidate genes have been identified, including the gene 5HT1-D beta. This gene has been found to affect the efficiency of transport of serotonin across synapses. 

Neural explanation of OCD

The genes associated with OCD are likely to affect the levels of key neurotransmitters as well as structures of the brain are called neural explanations. 

Serotonin:

The neurotransmitter serotonin is known to regulate mood. Neurotransmitters are chemicals responsible for relaying information from one neuron to another. Some cases of OCD may be explained by a reduction in the functioning of the serotonin system in the brain, and some other  cases of OCD, and in particular hoarding disorder, seem to be associated with impaired decision making. 

Treating OCD with Drug Therapy

Selective serotonin reuptake inhibitors (SSRI) are the standard class of drugs used to treat OCD. They work on the serotonin system in the brain, by preventing the re-absorption and breakdown of serotonin, increasing its levels in the synapse and continuing to stimulate the postsynaptic neuron.

It takes three to four months of daily use for SSRIs to have much impact on symptoms. 

Drugs are often used alongside cognitive behaviour therapy (CBT) to treat OCD. The drugs reduce a patient’s emotional symptoms, such as feeling anxious or depressed. This means that patients can engage more effectively with the CBT. 

In practice some people respond best to CBT alone whilst others benefit more from drugs like Fluoxetine. Occasionally other drugs are prescribed alongside SSRIs. 

Whereby patients do not respond to SSRIs, a second line of defence can be other drugs such as:

  • Tricyclics (an older version of antidepressant) have the same effect on the serotonin system as SSRIs. Tricyclics like clomipramine have more severe side effects than SSRIs thus are generally kept in reserve.
  • SNRIs (serotonin-noradrenaline reuptake inhibitors) increase levels of serotonin as well as another different neurotransmitter – noradrenaline.

Nara Ito, Youth Medical Journal 2021

References

Tolin, D. F., Worhunsky, P., & Maltby, N. (2006). Are “obsessive” beliefs specific to OCD?: A comparison across anxiety disorders. Behaviour Research and Therapy, 44(4), 469-480.

Pertusa, A., Fullana, M. A., Singh, S., Alonso, P., Menchón, J. M., & Mataix-Cols, D. (2008). Compulsive hoarding: OCD symptom, distinct clinical syndrome, or both?. American Journal of Psychiatry, 165(10), 1289-1298.

Team, P. O. T. S. P. (2004). Cognitive-behavior therapy, sertraline, and their combination for children and adolescents with obsessive-compulsive disorder: the Pediatric OCD Treatment Study (POTS) randomized controlled trial. Jama, 292(16), 1969-1976.

Masellis, M., Rector, N. A., & Richter, M. A. (2003). Quality of life in OCD: differential impact of obsessions, compulsions, and depression comorbidity. The Canadian Journal of Psychiatry, 48(2), 72-77.

Ivarsson, T., Melin, K., & Wallin, L. (2008). Categorical and dimensional aspects of co-morbidity in obsessive-compulsive disorder (OCD). European Child & Adolescent Psychiatry, 17(1), 20-31.

Renshaw, K. D., Steketee, G., & Chambless, D. L. (2005). Involving family members in the treatment of OCD. Cognitive Behaviour Therapy, 34(3), 164-175.

Billett, E. A., Richter, M. A., Sam, F., Swinson, R. P., Dai, X. Y., King, N., … & Kennedy, J. L. (1998). Investigation of dopamine system genes in obsessive–compulsive disorder. Psychiatric genetics.

Denys, D., Van Nieuwerburgh, F., Deforce, D., & Westenberg, H. G. (2006). Association between serotonergic candidate genes and specific phenotypes of obsessive compulsive disorder. Journal of affective disorders, 91(1), 39-44.

Sinopoli, V. M., Burton, C. L., Kronenberg, S., & Arnold, P. D. (2017). A review of the role of serotonin system genes in obsessive-compulsive disorder. Neuroscience & Biobehavioral Reviews, 80, 372-381.

Frisch, A., Michaelovsky, E., Rockah, R., Amir, I., Hermesh, H., Laor, N., … & Weizman, R. (2000). Association between obsessive-compulsive disorder and polymorphisms of genes encoding components of the serotonergic and dopaminergic pathways. European Neuropsychopharmacology, 10(3), 205-209.

Stewart, S. E., & Pauls, D. L. (2010). The genetics of obsessive-compulsive disorder. Focus, 8(3), 350-357.

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Health and Disease

Understanding the Opioid Crisis in the United States

By Rhoda Kasin

Published 3:09 PM EST, Wed May 12, 2021

What are Opioids? 

The term ‘opioids’ is used to describe a large group of psychoactive chemicals. There are 3 major forms of opioids; Natural Opiates, Semi-Synthetic Opioids, and Fully Synthetic Opioids. 

Opiates are natural because they are created by the opium Poppy Plant. Opiates include morphine, thebaine, and codeine. Semi-Synthetic Opioids such as hydromorphone, hydrocodone, oxycodone, and heroin are made in laboratories from the natural opiates. Fully Synthetic Opioids like fentanyl, pethidine, levorphanol, methadone, tramadol, and dextropropoxyphene are completely man-made in the lab.

How do they work? 

When taken, opioids flow through your blood and attach themselves to opioid receptors located on nerve cells in the brain, spinal cord, and other neural body parts. Once secured, they block pain transmissions sent from the body into the brain. When the receptors are activated however, they also produce hormones such as dopamine which decrease pain and increase pleasure feelings. 

The regular use of opioids over a long period of time increases the body’s tolerance and dependence, equating to higher and frequent doses. Generally they are safe pain relievers when taken for a short period of time, but since they reduce pain and generate feelings of euphoria, they are easily misused. These euphoric feelings cause a drive build up to constantly chase the pleasure which causes addiction. 

History of Opioids in the US

According to the CDC, opioid overdoses have been grouped into 3 waves. First wave being the Prescription Opioid Wave, followed by the second Heroin Wave, then the third Synthetic Opioid Wave. 

The first wave started in the late 1990s, with reassurance by pharmaceuticals to the medical community, claiming that opioids were not addictive. Of course this led to an increase in its prescription and therefore a rise in misuse and abuse of prescribed and non-prescribed opioids. Making it clear that they were in fact, extremely addictive. The second wave began in 2010, where there was an abrupt increase in overdose deaths involving the opioid drug Heroin, which is made from morphine, an opiate. Significant increases in deaths that involved synthetic opioids in 2013 marked the start of the third wave. This was also the start of illicit manufactured fentanyl (IMF), one of the main causes of the wave’s deaths. 

Drug overdose death count still remains high today in the United States. The year 2019 alone, saw close to 71,000 drug overdose deaths which involved an opioid. Meaning that more than 70% of all drug overdoses in the country, a majority, involved the use of an opioid. Of these 70% overdose deaths, close to 73% included Synthetic Opioid use. 

Side Effects of Opioids 

As stated before, opioids are types of drugs which help to reduce pain. However, they are easily misused when prescribed to a patient for treatment. The patient may take the drug in an unprescribed way such as a higher dosage. Another person may take the patient’s prescription medication. The drug may also be taken for the purpose of attaining a ‘high’. Feelings of drowsiness, nausea, constipation, confusion and slow breathing are among the negative effects opioids have on the body. Slowed breathing could cause Hypoxia; where only a small amount of oxygen gets to the brain. This could lead to permanent brain damage, coma or death. 

Withdrawal symptoms that are experienced by those addicted to opioids include cold flashes and goosebumps, severe cravings, muscle pain, bone pain, etc. Since these are uncomfortable symptoms to go through, it makes the process of trying to stop opioid use difficult. 

Pregnant women taking prescription opioids may cause their babies to develop Neonatal Abstinence Syndrome. The syndrome occurs when the baby is exposed to a specific drug during pregnancy. When they are born, they experience withdrawal symptoms such as tremors, seizures, breathing problems, blotchy skin, diarrhea, vomiting, stuffy nose and others. Babies born with NAS are also at risk for other complications such as Jaundice, low birthweight or SIDS (sudden infant death syndrome). Long-term problems such as developmental delays, behavior and learning difficulties, sleep problems, vision problems, ear infections, and more are also possible due to NAS. 

Types of Addiction Treatment 

Naloxone, a type of medicine that when given right away can treat an opioid overdose. Other medications such as Methadone and Buprenorphine help reduce cravings and withdrawal symptoms. Naltrexone, another medication, helps to prevent the opioid drug from achieving an effect . Behavioral therapies such as Cognitive Behavioral Therapy alters drug use expectations and behaviors of the patient as well as managing their stress and triggers. Proven effective when used with medicines is Multidimensional Family Therapy. It was developed for adolescents and helps address personal and family influences on the patient’s drug use patterns, thus allowing an improvement in their overall functioning.

Rhoda Kasin, Youth Medical Journal 2021

References

American Society of Anesthesiologists. “What are Opioids.” American Society of Anesthesiologists, https://www.asahq.org/madeforthismoment/pain-management/opioid-treatment/what-are-opioids/. Accessed 27 April 2021.

CDC. “Opioid Overdose : Opioid Basics.” Center for Disease Control and Prevention, 16 March 2021, https://www.cdc.gov/drugoverdose/opioids/index.html. Accessed 28 April 2021.

CDC. “Opioid Overdose : Understanding the Epidemic.” Center for Disease Control and Prevention, 17 March 2021, https://www.cdc.gov/drugoverdose/epidemic/index.html. Accessed 28 April 2021.

HHS. “What is the US Opioid Epidemic.” US Department of Health and Human Services, US Department of Health and Human Services, 19 February 2021, https://www.hhs.gov/opioids/about-the-epidemic/index.html. Accessed 27 April 2021.

Johns Hopkins Medicine. “Opioid Addiction.” Johns Hopkins Medicine, https://www.hopkinsmedicine.org/opioids/what-are-opioids.html. Accessed 27 April 2021.

March of Dimes. “Neonatal Abstinence Syndrome (NAS).” March of Dimes, 2019, https://www.marchofdimes.org/complications/neonatal-abstinence-syndrome-(nas).aspx. Accessed 30th April 2021.

Mayo Clinic, and Carrie Krieger. “What are opioids and why are they dangerous?” Mayo Clinic, 21 March 2018, https://www.mayoclinic.org/diseases-conditions/prescription-drug-abuse/expert-answers/what-are-opioids/faq-20381270. Accessed 27th April 2021.

NIH. “Opioids.” National Institutes on Drug Abuse, https://www.drugabuse.gov/drug-topics/opioids. Accessed 28 April 2021.

NIH. “Prescription Opioids DrugFacts.” National Institute on Drug Abuse, May 2020, https://www.drugabuse.gov/publications/drugfacts/prescription-opioids. Accessed 28 April 2021.

NIH, and Sara Bellum. “Real Teens Ask : What are the Different Types of Opioids?” NIH : National Institutes on Drug Abuse, 16 July 2014, https://archives.drugabuse.gov/blog/post/real-teens-ask-what-are-different-types-opioids-0. Accessed 27 April 2021.

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Health and Disease

Dyslexia: The Reading Disability

By Michelle Li

Published 1:57 PM EST, Fri May 7, 2021

Introduction

Dyslexia is a learning disability that is characterized by difficulty in reading, writing, spelling, and other language skills. It was first discovered in 1887 when German physician Rudolf Berlin published a case study on a young boy who had normal intelligence but faced difficulties in reading and writing (Nelson). A few years later in 1896, the first English-language case study of dyslexia was published by the British doctor W. Pringle Morgan. Similarly to the 1887 case study, Morgan also detailed a 14 year-old boy who had normal intellectual capabilities but had not learned to read. Before the term “dyslexia” was put into widespread use, the condition was referred to by Morgan and others as “word-blindness”. It is still retained the key characteristic of difficulty reading (Nelson). 

It is believed to have a hereditary component and is most commonly identified in the early years through symptoms related to hardships in reading or other language skills. Following a diagnosis, options to treat dyslexia through special education also exist.

Causes

Dyslexia is believed to be a hereditary condition, as 40% of boys and 20% of girls with a dyslexic parent also develop the disorder. Four genes have been found to be connected to dyslexia, but no specific cause has been identified for the disorder (Nelson). Some studies involving positron emission tomography or functional magnetic resonance imaging have shown that there is lower activity in the left inferior parietal cortex, left inferior frontal gyrus, the left inferior parietal lobule, and the left middle temporal gyrus of the brain in dyslexic children when they are given reading or word tasks to complete, highlighting the connection between dyslexia and certain areas of the brain (Nelson). 

Symptoms and Diagnoses

The symptoms of dyslexia appear through the affected reading, writing, listening, and speaking abilities of individuals. Some symptoms include slow reading speed, difficulty reading and spelling words, omission of words while reading, poor reading comprehension, reversal of words or letters, confusion between similar letters, delayed speech, and transferrence of information across modes—such as reading out loud or writing thoughts or speech (Nelson; Frey). 

When these symptoms create problems in school or work settings, individuals are referred to testing for dyslexia. As instruction on reading begins in kindergarten or first grade in the U.S., it is rare for dyslexia to be diagnosed before the age of five or six (Frey). Children are generally diagnosed with dyslexia when they demonstrate that their reading level is greater than two levels below the expected average for their age or education (Nelson). Other visual, hearing, speech, intelligence, and word or letter recognition tests are also conducted to rule out disorders that could impair vision or hearing and measure a child’s capabilities; they are also evaluated psychologically to rule out depression or anxiety as a cause for the learning impairment (Nelson, Frey). Generally, reading problems must substantially interfere with school or daily life, as outlined by the APA’s diagnostic criteria for dyslexia (Frey).

Treatment

Appropriate and early intervention through special education has been proven effective in treating dyslexia. Under the Individuals with Disabilities Education Act, children with dyslexia are entitled to individualized education plans (IEP) that address the learning disability (Nelson; Frey). The IEP defines specific problems and the associated learning objectives. This is usually done through a cross-disciplinary approach. The three core principles of the successful approach developed by Samuel Torrey Orton in the 1920s have a sound/symbol based component, where words are broken down into letters and associated sounds; a multisensory component, where visual, auditory, and kinesthetic connections are strengthened; and a highly structure component, which involves working up from letters to words to sentences with repetitive practice (Nelson). There are also a number of techniques that reading specialists may test out to see which are most effective. Generally, dyslexia can be treated with appropriate intervention; the earlier the diagnosis and intervention, the greater the likelihood of improved reading abilities and less interference in education.

Conclusion

As the most common learning disability in the United States, dyslexia interferes in the education and lives of many individuals each year. While a clear cause has not been identified, a hereditary component and low activity in certain areas of the brain have been linked to the condition. Symptoms are related to impairments in reading, writing, spelling, and speech; evaluations of these impairments are used to diagnose dyslexia. Early treatment through specialized education plans have been proven successful in improving reading and related abilities, providing hope for dyslexic individuals.

Michelle Li, Youth Medical Journal 2021

References

Frey, Rebecca J., and Jack Lasky. “Developmental Reading Disorder.” The Gale Encyclopedia of Children’s Health: Infancy through Adolescence, edited by Jacqueline L. Longe, 4th ed., vol. 2, Gale, 2021, pp. 846-50. Gale Health and Wellness, link.gale.com/apps/doc/CX8067400255/HWRC?u=mlin_m_newtnsh&sid=HWRC&xid=fee6c3a7. Accessed 19 Apr. 2021.

Nelson, Katy, and Jack Lasky. “Dyslexia.” The Gale Encyclopedia of Children’s Health: Infancy through Adolescence, edited by Jacqueline L. Longe, 4th ed., vol. 2, Gale, 2021, pp. 901-04. Gale Health and Wellness, link.gale.com/apps/doc/CX8067400273/HWRC?u=mlin_m_newtnsh&sid=HWRC&xid=d2d05de7. Accessed 19 Apr. 2021.

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Health and Disease

Insomnia

By Bharathi Arivazhagan

Published 1:10 AM EST, Thurs May 6, 2021

What Is Insomnia?

Insomnia can be caused by numerous reasons in an individual’s life. Two types of insomnia can be experienced in someone’s life. There is acute insomnia and chronic insomnia. Acute insomnia is short-term and can be caused by a multitude of various causes. Immense pain in itself can cause acute insomnia due to its disruption to a person’s ability to sleep. Jet lag when traveling to another country is another prominent example of acute insomnia. Acute insomnia is caused when someone is getting used to a new environment and any stress that may be widely significant during that certain time for that person. Chronic insomnia has to last for three months at least to be considered as so as chronic insomnia. It can be distinguished between as either primary or secondary. Primary is when there is no known or aware cause to be able to be identified for that specific condition of insomnia. Secondary insomnia can be caused by underlying conditions in terms of psychology. This includes psychological conditions for anxiety and depression. Diabetes is another example of something that can promote insomnia in the lives of individuals. Medical conditions can also promote the prominence of insomnia in the lives of many individuals. Furthermore, acute insomnia can be caused by stress which can emphasize insomnia in that certain person’s life. This can be also emphasized by a trauma the person witnessed, which could have deeply upset them in order to trigger an instance of insomnia in their life. If someone changes their environment, such as staying in a new place, or a new country, due to unfamiliarity, the person can undergo acute insomnia due to this unfamiliar situation. There is also the instance of certain intakes of certain medicines that can promote acute insomnia in the individual who is ingesting the specific medication. In regards to chronic insomnia, substance use is an example that would emphasize this is in regards to substance use. Medical conditions vary for insomnia including cancer and sleep apnea. Additionally, there are also some instances that it could occur in regards to insomnia, in regards to food intake. When you eat too late in the day, the uncomfortable sense of your full stomach will cause discomfort in terms of sleep.

What Is Transient Insomnia

Transient insomnia is another type of insomnia that a person can gain. Transient insomnia is when it lasts for less than a week for the individual affected. This differs from someone possessing chronic or acute insomnia. Going into detail of the symptoms that may arise due to insomnia are all in regards to difficulty in terms of sleep in the affected individual’s life. It is related to waking up, leading to either waking up at insufficient times. It could lead to waking up too early or waking up in the night. It can cause difficulty in starting to sleep at night, causing one to stay awake amidst vast hours. This will cause overall stress in terms of one’s performance on an ongoing day afterward. This will affect one’s attention span, as it’s difficult to manage focus due to the lack of sleep. There will be trouble remembering and managing focus in regards to remembering certain things they needed to do. This will cause a decrease in accuracy in terms of the person’s performance in daily activities as the lack of sleep has a major prominent effect on their life overall.

Treatment For Insomnia

Treatment can be taken in regards to insomnia. Above all, a doctor must be contacted in regards to what action can be taken to combat insomnia for that specific person. Some doctors prescribe melatonin supplements for people who have insomnia. When there are higher melatonin levels present in one’s body, they tend to become sleepier. The dosage is highly influential for how well it will perform for a person’s body, as higher dosages can cause some detrimental alterations to a person’s sleep. Dosages can be discussed with their doctor. Other sleep medications can also be prescribed to the patient by the doctor to help with sleep. Cognitive-behavioral therapy is also recommended by some doctors to aid with sleep overall in the individual. Insomnia affects many individuals on a day-to-day basis, and more research is being dedicated to learning more about it today. 

Bharathi Arivazhagan, Youth Medical Journal 2021

References

“Insomnia.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 15 Oct. 2016, www.mayoclinic.org/diseases-conditions/insomnia/symptoms-causes/syc-20355167.

“Effects of insomnia on the body.” Healthline https://www.healthline.com/health/insomnia-concerns#see-a-doctor

“Everything You Need to Know About Insomnia.” Healthline https://www.healthline.com/health/insomnia

Categories
Health and Disease

Alice In Wonderland Syndrome : A Very Rare Neurological Disorder

By Mary Mai

Published 1:08 AM EST, Sat May 1, 2021

Introduction

Alice in Wonderland syndrome, also known as dysmetropsia or Todd’s syndrome, is a neurological condition that affects the brain and causes distortions of visual perception. The term Alice In Wonderland Syndrome came from a book known as, “Alice’s Adventures In Wonderland,” and was based on one of the main characters named Alice who also suffers from similar symptoms of Todd’s syndrome. AWS (Alice In Wonderland Syndrome) can cause a person to feel as though they are smaller and bigger than they actually are. This syndrome is not actually caused by hallucinations, but the ways in the brain perceives the environment around it. This syndrome highly affects how the brain understands certain things and multiple senses. As an extremely rar disorder, there is much to be learned about Alice In Wonderland Syndrome, specifically the symptoms, causes, and possible treatment. 

Symptoms Of Alice in Wonderland Syndrome

Alice in Wonderland Syndrome can affect the way a person perceives their environment and can affect most senses. This includes sight, hearing, time, sensation, and touch. However, the most common symptom is visual distortions. Micropsia, a sensation that affects the body or objects within the environment, causes size distortion. Due to Micropsia, those who suffer from AWS often see objects growing bigger and smaller when in actuality, they are not. Furthermore, they are three main categories that divide up what type of perceptual disorder ASW patients could possibly have. These categories split up into type A, type B, and type C. Type A is when the disorder is somesthetic and sensory, somesthetic referring to sensation that can occur anywhere in the body.  Type B on the other hand, affects the visual senses a lot more. For example, those who suffer from Type B Alice in Wonderland Syndrome will view certain objects as too big or too small. It can also affect how shapes appear and how far objects may appear. Finally, type C is a mixture between both types A and B which means a patient who suffers from AWS will experience both sensory disorders and visual distortions. A few common symptoms also include distorted body image, distorted perception of size, and many migraine episodes. Researchers believe that AWS is an aura, meaning it acts as a warning sensation before a migraine or epilepsy attack. Therefore, those who suffer from AWS are more likely to experience migraines and epilepsy. 

Causes Of Alice in Wonderland Syndrome

Researchers and scientists believe that the main causes of AWS include migraines or Epstein barr virus infections. There have been research studies that prove that some infectious diseases that cause Alice in Wonderland Syndrome are typhoid encephalopathy, mycoplasma, and Influenza A virus. AWS are definitely not caused by sight issues, hallucinations, or any sort of mental illness. There was one study that showed that 33% people who suffered from AWS have had infections and also 6% had head trauma. Other causes may include, stress, brain lesions, epilepsy, brain tumors, cough medicine, psychiatric conditions, and the use of hallucinogenic drugs. There are many risk factors that come with Alice in Wonderland Syndrome. Experiencing AWS can lead to migraines, infections, and genetics, meaning that someone with family history of AWS is likely to experience it as well. 

Treatment For Alice in Wonderland Syndrome

Currently, there are no treatments for AWS.  If a patient suffers from symptoms like migraines, then doctors will usually suggest patients to manage by altering their daily diet and provide medication to help patients cope. However, there is no treatment or cure specifically for the Alice In Wonderland Syndrome. Medical health professionals suggest that if a child suffers from symptoms of AWS, the best course of action is lots of rest and letting it pass. It is also important to note that the symptoms of AWS are not harmful and migraines can be treatable. Doctors do not prescribe antipsychotics for Todd’s syndrome because there is no psychosis in AWS. There is also an increased risk for antipsychotics that can make a patient’s conditions even worse.

Conclusion

Those who suffer from Alice In Wonderland Syndrome have to go through various symptoms that can affect one’s lifestyle. The symptoms of Alice In Wonderland can include migraines, perceptual distortion, and size distortion. There are three types of AWS and each of them are different in their own ways. Some people with AWS suffer from visual sensing disorders while others don’t and some even have a mixture of both symptoms. Causes of this rare syndrome can include migraines and virus infections. There are also different aspects like brain tumors and cough medicine that can possibly cause Todd’s syndrome. Although there is currently no treatment or cure for Alice in Wonderland Syndrome, there are various ways to cope with it. Those with symptoms of a migraine can alter diets while those who have perceptual distortions do not have treatment. There is still much left to discover about this syndrome and still many undiscovered facts about this syndrome. 

Mary Mai, Youth Medical Journal 2021

References

“Alice in Wonderland Syndrome: Definition, Symptoms, and Treatment.” Medical News Today, MediLexicon International, http://www.medicalnewstoday.com/articles/alice-in-wonderland-syndrome#treatment.

Blom, Jan Dirk. “Alice in Wonderland Syndrome: A Systematic Review.” Neurology. Clinical Practice, Lippincott Williams & Wilkins, June 2016, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4909520/.

Holland, Kimberly. “What Is Alice in Wonderland Syndrome? (AWS).” HealthLine, 17 Apr. 2019, http://www.healthline.com/health/alice-in-wonderland-syndrome#symptoms. 

Categories
Biomedical Research Health and Disease

How Have Viruses Contributed to Human Evolution?

By Adaora Belonwu

Published 11:57 PM EST, Wed April 28, 2021

Introduction

Evolution can be defined as the biological process by which the physical characteristics of creatures change over time, new types of creatures develop, and others disappear. Even before the recent coronavirus outbreak, the World Health Organisation revealed that three infectious diseases ranked among the top 10 leading causes of death worldwide in 2016. For such reasons, among many others, it has become almost second nature to regard viruses as the enemy of evolution, an arm’s race between a host and a pathogen*. Others may consider viruses as a potential catalyst in evolution, creating a selection pressure within a population where only the fittest survive. However, the process of evolution by natural selection also relies on extensive genetic diversity within a population, caused by mutation, in the hope that one of these mutations will allow the organism to survive despite the change in environment. This article will explore the role of viruses in creating genetic diversity and provoking the emergence of adaptations that allowed Homo Sapiens to evolve as a species. In particular, this article will discuss the importance of endogenous retroviruses (ERV) in the development of the placenta in mammals, the increased sophistication of the human brain, and the significance of ERV within an embryo’s fledgling immune system.

We’re All Part Virus. How?

After having successfully evaded our first line of physical defenses, retroviruses such as HIV infect our cells and create a DNA copy of their RNA genome and insert it into the host cell chromosome. Subsequently, upon the reproduction of the infected cell by mitosis, the viral DNA is copied also. If that happens in a gamete, it creates the potential for this viral DNA to be passed on from generation to generation. The host’s offspring inherits viral DNA in all of their cells and will pass this viral DNA to all of their descendants. Thus, an exogenous retrovirus (XRV) becomes endogenous (ERV). Whilst scientists do not believe this has happened with HIV, it has cast a new light on our understanding on the development and origins of certain features that characterise us Homo Sapiens as a species today. In fact, this has happened on many other occasions of evolution since our DNA is believed to be composed of at least 8% ERV DNA.  Furthermore, ERVs are a subset of a larger class of mobile genetic elements, transposons (they move around DNA). It can be assumed that the outcome of transposons was the creation of genetic diversity that secured the survival of our ancestors.

Viruses And The Placenta During The Evolution Of Mammals

The survival of our population is dependent on the successful development of a fetus within its mother’s womb and its subsequent birth. This is enabled by the placenta, an organ that evolved during the emergence of mammals, without which we would have never been born. The placenta is a transient organ that mediates the transfer of nutrients and hormones between fetus and mother during intrauterine life whilst keeping their blood supplies. Its formation begins after the embryo implants into the womb, where finger-like projections burrow into the maternal tissue and alter its blood vessels so that they become bathed in a constant supply of the mother’s blood. This interface is what allows mother and fetus to exchange nutrients and waste yet such close contact means that the mother’s immune system could attack the developing embryo, which it sees as a foreign invader. As the first line of defense, the fetal cells along this boundary fuse together using a protein called syncytin. This removes any gaps where maternal white blood cells could squeeze through and launch an attack. Such an innovative mechanism can be attributed to endogenous retroviruses. 

Syncitin was originally a viral protein that facilitated the infection of host cells by allowing viruses to fuse with cells. Sometime in the past, the gene encoding the syncytin protein was inserted into the host genome laying dormant for years until eventually becoming repurposed by evolution to fuse cells together in the placenta. It is estimated that this happened several times, leading to the development of the placenta on at least 6 different occasions. Moreover, it is interesting to consider that fetuses behave quite similarly to a virus, in which it develops inside a host organism trying to avoid detection from its immune system. So perhaps it is fitting that syncytin, which helps the fetus ‘invade’ the womb, once helped a virus invade a host. However other studies have been inconclusive in proving the existence of syncytin in other mammals such as pigs and horses, suggesting that the protein might not be an integral factor in the intrauterine development of fetuses. Nonetheless, recent experiments have not only corroborated the role of syncytin in the development of the placenta in most mammals but also link it to gestational immunosuppression in mice. Therefore, if the ancestors of pigs and horses were not infected with an ERV then they may at least use retroviral proteins to prevent the mother’s cells from attacking the fetus during pregnancy. Thus, viruses played a significant role in evolution by increasing the likelihood of a successful pregnancy so that our ancestors with the adaptations most suited to their surroundings could pass on their genes.

Could The Immune System Be A Relic Of A Viral Infection?

If ERVs play a role in gestational immunosuppression that begs the question of whether they play a role in the somatic immune system. This was proven to be the case for embryos. A human ERV known as HERV-K codes for a protein which aids it in making viral copies and proteins so that it can infect other cells. These trigger embryonic cells to make their own anti-viral proteins that build one of its first defences against other viruses. Whilst being far from a fully-fledged immune system this may make the difference between a successful pregnancy or not. Therefore, viruses help embryos develop a primitive immune-like-system that protects them prior to the development of antibodies to pathogens in the external environment. Furthermore, while ironic, it is feasible to extend this idea to the rest of our lifespan: our immune system may exist as a consequence of an infection of a retrovirus millions of years ago. So, in response to a selection pressure created by viruses, our immune systems now serve to protect us from things that may have very well lead to its creation.

Are Viral Relics Controlling Our Brains?

Linking to the notion of viruses equipping us to become the fittest and survive, researchers have proven that ERVs also played a role in the increased sophistication of the human brain. The brain is an important aspect to consider in human evolution because they would have been helpful some 60,000 years ago when homo sapiens coexisted with other larger, more aggressive hominid species. A more sophisticated cerebrum would have made early homo sapiens more flexible to environmental changes, allowing them to adapt their behaviour and food sources using information stored in their long term memory, ultimately increasing their likelihood of survival to reproductive age and produce fertile offspring. A gene, which scientists have named Arc, the mRNA and proteins it is subsequently transcribed and translated into have been proven to accumulate in dendrites. The protein was later shown to self-assemble into virus-like capsids that encapsulate RNA and were capable of trafficking across synapses in a similar fashion to neurotransmitters. This indicates that the Arc gene is a remnant of an ERV, potentially used first to protect the virus from a host’s attack but later repurposed by the human body. Further evidence of the human body potentially repurposing viral genes was proven in another study where the inhibition of the expression of the Arc gene in the rat hippocampus impaired the long-term memory and potentiation in the rat hippocampus. Moreover, evolutionary analysis indicates that Arc is derived from ancestors to retroviruses. This may indicate an initial dependence on the presence of functional ERV RNA for the development of long-term memory. Furthermore, a correlation between excess Arc and cases of brain disorders (such as Alzheimer’s and schizophrenia) has been observed. This, as well as the fact that the aforementioned experiments studies are relatively new and their result is yet to be repeated, leads to some doubt on the theory that viruses are solely responsible for the increased sophistication of the human brain. Nonetheless, considering the evidence of our reliance on microbes elsewhere in the body (such as the placenta and microbiome) the hypothesis that an ERV played a significant role in our ability to retain information for extended periods of time remains valid.

Conclusion

To conclude, viruses have and will continue to play a considerably large yet elusive and understated role in the evolution of humans, as well as many other animals. Their nature to inject themselves into the genome of their hosts on the off chance that they might cross paths with a germline cell allows their genes to be passed down through generations, essentially preserving their genome ad finitum. Despite the minuscule sounding 8%, endogenous retroviruses have managed to influence important adaptations such as the placenta, embryonic immunity, and memory. Viruses have influenced all aspects of evolution, whether it be the selection pressure prerequisite for natural selection or mutations that allowed us to adapt to those selection pressures. So perhaps in lieu of considering the most physically menacing creatures as winners of evolution perhaps it’s time to scale down our gaze and consider these tiny, often deadly biological particles as the ‘fittest’ in a Darwinian competition for survival.

Adaora Belonwu, Youth Medical Journal 2021

References

Alberts, B., 2002. Molecular Biology Of The Cell. New York: Garland Science, p.Introduction to Pathogens: 

*pathogen meant as an infectious biological agent that causes disease, such as the prion responsible for BSE, otherwise known as ‘mad cow’, disease

DARWIN, C., 2019. ON THE ORIGIN OF SPECIES. [S.l.]: NATURAL HISTORY MUSEUM.

Denner, J., 2016. Expression and function of endogenous retroviruses in the placenta. APMIS, [online] 124(1-2), pp.31-43. Available at: <https://onlinelibrary.wiley.com/doi/full/10.1111/apm.12474>  

Guzowski, J., Lyford, G., Stevenson, G., Houston, F., McGaugh, J., Worley, P. and Barnes, C., 2000. Inhibition of Activity-Dependent Arc Protein Expression in the Rat Hippocampus Impairs the Maintenance of Long-Term Potentiation and the Consolidation of Long-Term Memory. The Journal of Neuroscience, [online] 20(11), pp.3993-4001. Available at: <https://www.jneurosci.org/content/20/11/3993.short> .

Henzy, J., 2014. Retroviruses, The Placenta, And The Genomic Junk Drawer. [online] Small Things Considered. Available at: <https://schaechter.asmblog.org/schaechter/2014/06/retroviruses-the-placenta-and-the-genomic-junk-drawer.html>  

Heron, M., 2020. Deaths : Leading Causes For 2016. [online] Stacks.cdc.gov. Available at: <https://stacks.cdc.gov/view/cdc/57988>

Kerrigan, T. and Randall, A., 2013. A New Player in the “Synaptopathy” of Alzheimer’s Disease – Arc/Arg 3.1. Frontiers in Neurology, [online] 4. Available at: <https://www.frontiersin.org/articles/10.3389/fneur.2013.00009/full>.

Kochiyama, T., Ogihara, N., Tanabe, H., Kondo, O., Amano, H., Hasegawa, K., Suzuki, H., Ponce de León, M., Zollikofer, C., Bastir, M., Stringer, C., Sadato, N. and Akazawa, T., 2018. Reconstructing the Neanderthal brain using computational anatomy. Scientific Reports, [online] 8(1). Available at: <https://www.nature.com/articles/s41598-018-24331-0>.

Mi, S., Lee, X., Li, X., Veldman, G., Finnerty, H., Racie, L., LaVallie, E., Tang, X., Edouard, P., Howes, S., Keith, J. and McCoy, J., 2000. Syncytin is a captive retroviral envelope protein involved in human placental morphogenesis. Nature, [online] 403(6771), pp.785-789. Available at: <https://www.nature.com/articles/35001608>.

NELSON, P., HOOLEY, P., RODEN, D., DAVARI EJTEHADI, H., RYLANCE, P., WARREN, P., MARTIN, J. and MURRAY, P., 2004. Human endogenous retroviruses: transposable elements with potential?. Clinical and Experimental Immunology, [online] 138(1), pp.1-9. Available at: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1809191/>.

Pastuzyn, E., Day, C., Kearns, R., Kyrke-Smith, M., Taibi, A., McCormick, J., Yoder, N., Belnap, D., Erlendsson, S., Morado, D., Briggs, J., Feschotte, C. and Shepherd, J., 2018. The Neuronal Gene Arc Encodes a Repurposed Retrotransposon Gag Protein that Mediates Intercellular RNA Transfer. Cell, [online] 173(1), p.275. Available at: <https://www.cell.com/cell/fulltext/S0092-8674(17)31504-0>.

Ashley, James, et al. “Retrovirus-like Gag Protein Arc1 Binds RNA and Traffics across Synaptic Boutons.” Cell, vol. 172, no. 1-2, 2018, doi:10.1016/j.cell.2017.12.022.

Bramham, Clive R, et al. “The Arc of Synaptic Memory.” Experimental Brain Research, Springer-Verlag, Jan. 2010, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2803749/.

Cornelis, Guillaume, et al. “An Endogenous Retroviral Envelope Syncytin and Its Cognate Receptor Identified in the Viviparous Placental Mabuya Lizard.” PNAS, National Academy of Sciences, 19 Dec. 2017, http://www.pnas.org/content/114/51/E10991.

DF;, Noronha LE;Antczak. “Maternal Immune Responses to Trophoblast: the Contribution of the Horse to Pregnancy Immunology.” American Journal of Reproductive Immunology (New York, N.Y. : 1989), U.S. National Library of Medicine, pubmed.ncbi.nlm.nih.gov/20618178/.

Categories
Health and Disease

Phobias and How We Can Treat Them

By Nara Ito

Published 11:58 PM EST, Tues April 27, 2021

Introduction

All phobias are characterized by excessive fear and anxiety, initiated by a phobic stimulus. The extent of the fear is most typically blown out of proportion in contrast to the real threat the phobic stimulus actually poses.

The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders), published by the American Psychiatric Association, is a system that many researchers and clinicians use to identify and diagnose mental health problems. It recognizes the following categories of phobia and related anxiety disorder: 

  • Specific phobia: phobia of a particular object, such as an animal or body part, or a certain situation. 
  • Social anxiety (social phobia): phobia of a social situation such as public speaking. 
  • Agoraphobia: phobia of being outside or being in a public place.

Phobias can be diagnosed as clinical phobias and be disabling by causing tremendous suffering and the inability for a person to function adequately. In fact, a clinical phobia is only diagnosed if anxiety is considerable and it impacts the sufferer’s life. But regardless if the phobia is clinically mild or not, individuals exhibit certain characteristics when they have a phobia falling under three categories of behavioral, cognitive, and emotional.

Behavioral characteristics of phobias 

Evolutionarily, we have a fight or flight response when we feel like we are in the presence of a threat. We respond to things or situations we fear by behaving in particular ways. Phobias cause the individual to feel high levels of anxiety and try to escape, even if the level of fear is irrational, out of all proportion to the phobic stimulus. 

Panic: Someone with a phobia may panic in response to the phobic stimulus. This may be recognized by a range of behaviors including screaming, running away, or crying heavily. Amongst children, some may express panic by freezing, clinging to an object or person, or having a tantrum. 

Avoidance: Unless the phobic person requires to or makes a conscious effort to face their fear, most of the time they attempt to avoid coming into contact with the phobic stimulus. For many with phobias of specific objects that stay in particular areas and spaces, this may be easy to avoid, however, avoidance can easily affect the individual’s daily life. For example, someone with a fear of pigeons would have to heavily limit the time spent outside, as a pigeon can fly over or appear at any moment as they are a very common bird to see around.

Endurance: The alternative to avoidance is endurance, in which the individual remains in the presence of the phobic stimulus and somewhat tolerates it but only with very high levels of anxiety. In some situations, this may be unavoidable, for example for a person who has an extreme fear of flying having to sit through a flight.

Emotional characteristics of phobias 

Anxiety: In the DSM-5 phobias are classed as anxiety disorders. Anxiety being an unpleasant state of high arousal, phobias prevent the individual from relaxing and make it very difficult to experience any positive emotion as they are continually tense.

Emotional responses are unreasonable: Being heavily irrational fears, emotional responses we experience in relation to a phobic stimulus often exceed what is considered reasonable to most others.

Cognitive characteristics of phobias 

Cognitive characteristics affect the ways people process information and think. 

Selective attention to the phobic stimulus: When phobic people can see the phobic stimulus their attention remains constantly on it as they see the stimulus as a threat. When in actual danger, this ability to have selective attention is crucial so that we can react quickly to a threat,  however, this isn’t useful when the fear is irrational.

Irrational beliefs:Someone with a phobia may hold irrational beliefs in relation to phobic stimuli. This is particularly prevalent when it comes to social phobias as the individual starts to create irrational beliefs about the self that can foster toxic mindsets and increase the pressure on the sufferer to perform well in social situations. 

So how are phobias treated?

The two main methods of treatment when it comes to phobias are systematic desensitization and flooding.

Systematic desensitization (SD) is a behavioral therapy designed to reduce unwanted responses to the phobic stimulus, this may include emotional characteristics such as anxiety. SD involves drawing up a hierarchy of anxiety-provoking situations related to the phobic stimulus, teaching the patient to relax, and then slowly exposing them to phobic situations, working their way through the hierarchy whilst maintaining relaxation. As the patient gets more accustomed to the stimulus, a new response to the phobic stimulus is learned by which the phobic stimulus is paired with relaxation instead of anxiety. This learning of a different response is called counterconditioning. 

Flooding on the other hand is a behavioral therapy in which a phobic patient is exposed to an extreme form of high concentrations of the phobic stimulus in one go in order to reduce anxiety triggered by that stimulus. This takes place across a small number of long therapy sessions, but sometimes only one long session is needed to cure a phobia, making it quick and efficient.

Flooding stops phobic responses very quickly because without the option of avoidance behavior or escaping, the patient has to tolerate and withstand the stimulus, thus quickly learning that the phobic stimulus is harmless. In classical conditioning terms, this process is called extinction. In some cases, the patient may achieve relaxation in the presence of the phobic stimulus simply because they become exhausted by their own natural fight or flight response.

Nara Ito, Youth Medical Journal 2021

References

Regier, D. A., Kuhl, E. A., & Kupfer, D. J. (2013). The DSM‐5: Classification and criteria changes. World psychiatry, 12(2), 92-98.

Kilpatrick, D. G., Resnick, H. S., Milanak, M. E., Miller, M. W., Keyes, K. M., & Friedman, M. J. (2013). National estimates of exposure to traumatic events and PTSD prevalence using DSM‐IV and DSM‐5 criteria. Journal of traumatic stress, 26(5), 537-547.

Heimberg, R. G., Hofmann, S. G., Liebowitz, M. R., Schneier, F. R., Smits, J. A., Stein, M. B., … & Craske, M. G. (2014). Social anxiety disorder in DSM‐5. Depression and anxiety, 31(6), 472-479.

Marks, I. M. (2013). Fears and phobias. Academic Press.

Seligman, M. E. (1971). Phobias and preparedness. Behavior therapy, 2(3), 307-320.

Merckelbach, H., de Jong, P. J., Muris, P., & van Den Hout, M. A. (1996). The etiology of specific phobias: A review. Clinical Psychology Review, 16(4), 337-361.

Öst, L. G. (1989). One-session treatment for specific phobias. Behaviour research and Therapy, 27(1), 1-7.

Burstein, M., He, J. P., Kattan, G., Albano, A. M., Avenevoli, S., & Merikangas, K. R. (2011). Social phobia and subtypes in the National Comorbidity Survey–Adolescent Supplement: prevalence, correlates, and comorbidity. Journal of the American Academy of Child & Adolescent Psychiatry, 50(9), 870-880.

Emmelkamp, P. M., & Wittchen, H. U. (2009). Specific phobias.

Straube, T., Glauer, M., Dilger, S., Mentzel, H. J., & Miltner, W. H. (2006). Effects of cognitive-behavioral therapy on brain activation in specific phobia. Neuroimage, 29(1), 125-135.

Davis, T. E., & Ollendick, T. H. (2011). Specific phobias. In Handbook of child and adolescent anxiety disorders (pp. 231-244). Springer, New York, NY.

Categories
Health and Disease

Management for Heart Attacks: Angioplasty and Bypasses

By Sophie Farr

Published 7:21 PM EST, Wed April 21, 2021

What Is A Heart Attack?

Throughout our lives, deposits of saturated fats called plaques can build up in the arteries of our hearts because of high cholesterol levels. Over time, this can lead to the restriction of blood flow due to vessel narrowing. These fatty deposits can lead to a complete blockage of an artery because of formed blood clots. If this occurs in the coronary artery, oxygenated blood may be prevented from reaching the heart muscle tissue. Without this vital oxygen, which is needed for aerobic respiration and normal cell function, the heart muscle can begin to die. The longer the blockage continues, the more damage can be done to the heart;this effect is known as a heart attack. In the worst case scenario, if the clot is dislodged and becomes mobile, it may travel to different areas of the body and, when it reaches the brain, could cause a stroke. 

What Are The Risk Factors For Heart Attacks?

Your risk of having a heart attack is increased by both hereditary and lifestyle factors. Firstly, a diet full of saturated fats, such as butter, cakes and bacon, increases the LDL (low-density lipoprotein) cholesterol in your blood, leading to more fat deposits. Furthermore, a sedentary lifestyle means that deposits build up more readily; smoking can also cause this effect. Another key risk factor is genetics. Men are more likely to suffer from a heart attack than women. Stress hormones, such as cortisol, can increase your heart rate which, in turn, causes more fat deposits in arteries. 

What Are The Symptoms Of A Heart Attack?

The main symptom of a heart attack is severe chest pain which may radiate across the left arm, shoulder or even abdomen. Sufferers describe this pain to be “crushing” and “vice-like”, which can cause patients to collapse and be unable to perform daily activities. Despite some cases having extreme and visible symptoms, women and the elderly are more likely to experience lesser symptoms such as mild discomfort, agitation, lethargy and weakness. 

What Is The Immediate Response In Case Of A Heart Attack?

Treating heart attacks is a key part of most first aid qualifications. If you encounter a suspected heart attack, the crucial thing is to call emergency services as soon as possible to ensure the patient receives required treatment quickly. While you wait for further assistance, the pain of a heart attack can be partially relieved by sitting the patient in the “W” position. This refers to sitting on the floor, against a wall, and bringing your knees upwards to create a “W” shape. If there is access to medication, the patient should chew a 325mg aspirin, which works to thin their blood. This would allow potential blood flow through a blockage. 

Coronary Angioplasty

Coronary angioplasty is a medical technique that attempts to relieve the blockage by expanding the artery. Not all hospitals have access to the resources required to undertake this complicated procedure. Therefore, ambulances always attempt to take patients with suspected heart attacks to advanced cardiology units such as the Royal Papworth. Coronary angioplasties are usually done through a large vessel in the groin (the femoral artery) or the arm. A catheter, with a deflated balloon attached, is threaded through to the potential site of the blockage. Once the afflicted area is reached, the balloon can be inflated which expands the artery and relieves the blockage, allowing oxygenated blood to reach the heart. Commonly, a stent is also placed in the affected artery to hold it open to prevent further damage from deposits. These are typically made of a flexible metal and aid disease management into the future. 

Coronary Bypass

A coronary bypass involves taking a blood vessel from either the arms (radial arteries), chest (internal mammary arteries), or legs (greater saphenous veins) and reattaching it to the heart. This redirects blood flow to ensure oxygenated blood reaches the heart. The blood vessel created is referred to as a graft, and the whole procedure is done in 3-6 hours under general anesthetic. If there is a risk of a patient experiencing further damage to the heart in the same area, or another heart attack, this graft can help to lower the risk.

Sophie Farr, Youth Medical Journal 2021

References

NHS England, “Treatments for Heart Attacks”, Accessed March 2021 from: https://www.nhs.uk/conditions/heart-attack/treatment/#:~:text=Primary%20percutaneous%20coronary%20intervention%20(PCI),-Primary%20percutaneous%20coronary&text=It’s%20a%20procedure%20to%20widen,such%20as%20low%2Ddose%20aspirin.

NHS England, “Coronary Artery Bypass”, Accessed March 2021 from:

https://www.nhs.uk/conditions/coronary-artery-bypass-graft-cabg/

Mayo Clinic, “Cardiac Catheterization” Accessed March 2021 from: 

https://www.mayoclinic.org/tests-procedures/cardiac-catheterization/about/pac-20384695