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Tuesday, May 28, 2019

Electroconvulsive Therapy

Electroconvulsive Therapy (ECT)


What is ECT? Electroconvulsive Therapy or ECT is a medical procedure used to treat symptoms of some mental illnesses such as severe depression, Bipolar Disorder and psychosis. ECT can also help people who have thoughts of hurting themselves or others. Your doctor may ask you to try ECT if other treatments have not worked in the past. During ECT, a small controlled electric current is passed through the brain.

How does ECT work? It is believed that ECT helps the part of the brain that controls emotions and thoughts to return to a more stable condition.

  • ECT treatments are usually done twice a week.
  • ECT may be used with other types of treatments, such as medications and psychotherapy.
  • After you feel better ECT may be continued to help keep you feeling better.

How do you prepare for ECT?

  • Your doctor will explain the procedure and answer your questions. You will need to agree in writing to have ECT.
  • You will have blood tests and a cardiogram (a test of your heartbeats) to make sure you do not have any physical problems that prevent ECT.
  • The day before treatment your doctor may make changes to your medication. You will need to stop eating and drinking after midnight.
  • In the morning, your nurse will help you get ready and will accompany you to the treatment room.
  • When you arrive in the treatment room, a nurse will put an intravenous line (TV) into your arm. Medication will be given to you to help relax your muscles and put you to sleep for the treatment.

What happens during the treatment?

  • Your heartbeat, blood pressure, oxygen levels and your brain waves will be monitored.
  • A blood pressure cuff is placed on one of your arms to measure your blood pressure. A small monitor is put on one of your fingers to measure the oxygen level in your blood.
  • When you are asleep, one or two electrodes (small metal discs) are placed on the side of your head. These electrodes carry the electrical current through your brain. The current lasts from 1 to 4 seconds. You will have a short seizure (your muscles contract and then relax). This lasts 20 to 60 seconds.
  • You will not feel pain.
  • You will not remember this part of the treatment because you are asleep.

What can you expect after treatment?

  • Your nurse will continue to check you’re your blood pressure, oxygen level, heartbeat and breathing.
  • After resting, you may eat and return to your regular activities.

What are the side effects of the treatment?

  • You may feel muscle aches, headache or jaw pain. The pain goes away after a few hours.
  • You may feel confused and forget what happened just before and after the treatment. Your memory usually returns after a few hours.

What are the risks?

Electroconvulsive Therapy is a safe treatment with the same type of risks as any other treatment that uses general anesthesia. Your doctor will discuss possible risks with you.

Do you have other question about ECT?

If you have any question, it is very important to discuss them your doctor or nurse before you have ECT.

ECT. Illustration by Elena.

Bipolar Disorder

Bipolar Disorder


Bipolar disorder is a mood disorder. A person with Bipolar Disorder has extreme “high” and “lows” in mood. It is different from the normal “ups” and “downs” that everybody goes through. Severe types of this illness can cause problems at home, work, school and social life… it may even result in suicide.

What causes Bipolar Disorder? – There is no one reason why someone develops Bipolar Disorder. Family history and brain chemistry play a big role in producing the illness. One`s personality and stress can bring on the illness.

Signs and Symptoms – A person with bipolar disorder has extreme changes in mood, such as overly “high” (Mania) and overly “low” (Depression). Some people have periods of normal mood in between. Periods of Mania may last several days to mouths. Periods of Depression may last several weeks to months.  These symptoms are a change from a person`s normal behaviour.

Symptoms of Mania may include:

  • Very good mood
  • Increased energy and restlessness
  • Too many ideas too fast
  • Talking more than usual or very quickly
  • Less need for sleep without being tired
  • Poor judgement and acting without thinking. For example, spending a lot of money, careless driving, increased use of alcohol or drugs, getting into fights, foolish financial decisions
  • Unable to focus
  • Exaggerated believes in one's abilities.  For example, believing he or she id God or has special powers (such as being able to fly), thinking he or she is smarter than others, etc.
  • Feeling “on top of the world”.

Symptoms of Depression may include:

  • Feeling sad, crying for no obvious reason
  • Feeling hopeless and empty
  • Feelings of guilty or worthless
  • Loss of interest or pleasure in activities once enjoyed
  • Low energy or feeling tired
  • Difficulty thinking or remembering things
  • Sleeping too much or too little
  • Eating less or more than usual
  • Thoughts of suicide

What are the treatments?: Bipolar disorder responds well to treatment once the illness has been diagnosed. Since the symptoms of Bipolar Disorder will keep coming back, ongoing treatment is needed. A combination of medication and psychosocial treatment (such as stress management) is best for managing the illness over time.

Sometimes changes to the treatment plan may be needed to manage the illness effectively. For example, the psychiatrist may change the type of dose of medication. Support from family, friends and self-help groups can also be very helpful.

A person with Bipolar Disorder has extreme “high” and “lows” in mood. It is different from the normal “ups” and “downs” that everybody goes through. Illustration: © Megan Jorgensen.

Strategies for Getting Motivated

Ten Strategies for Getting Motivated


  1. Make a commitment: Commit yourself by making a plan, writing it on the calendar sharing your plan with another person.
  2. Calendar or day book: Write tasks and activities down on a wall calendar or small day book. Carry your day book with you, and look at it frequently. Check things off when completed.
  3. Think of all the resources available to you: Who and what might be able to help you to follow through with your plan or commitment? What creative ideas can you think of to get around obstacles? Ask for help if you need it.
  4. Be open minded to new ideas: Recognize that trying to do things the same old way may not be working for you. Listen to how others are getting things done. Try the suggestions of others.
  5. Visualize the positive benefits: Think about all the positives you will get from following through with the task of activity. Imagine the sense of accomplishment you will feel later.
  6. One step at a time: Break activities down into manageable steps, to avoid feeling overwhelmed. It is easiest to get started if you remind yourself it is OK to just do the first step.
  7. Action before interest: Remember that the feeling of being interested in an activity often sets in after starting an activity, not before. Get started on something no matter how you feel, and the interest will come. Try activity even if initially you feel tired, bored, nervous or uninterested.
  8. The buddy system: It is often easier to get moving when you have the support of a friend with whom to face a challenge. Go to a new activity with a friend or supportive family member.
  9. Keep your expectations realistic: What are your expectations for yourself when trying something new? Keep them realistic. Do not aim for perfection. Expect to feel nervous. Expect to make mistakes. Expect it to be difficult.
  10. Do the five times test: When joining a new activity, club or class do not make a decision quitting until you have attended at least five times. It is not fair to judge the merits of something until you have given it a fair chance. That’s five times!
Getting motivated... Illustration by Elena.

What motivates you (survey)


Different things motivate different people. Your motivation may be low right now, but by identifying what tends to motivate you, you may find some ways to move yourself forward.  Have a look at the list below and check off items that apply to you. It is not a complete list, so add your own ideas.

  • Doing my best
  • Others depending on me
  • Being encouraged or complimented by others
  • Seeing the positive result of my actions
  • Being around positive people
  • Proving something to myself
  • Proving something to others
  • Feeling of accomplishment
  • Last minute pressure
  • Wanting independence
  • Seeing my children happy
  • Conflict
  • Money
  • Enjoying a sense of pride in my actions
  • Having to meet a deadline
  • Learning new things
  • Enjoying the challenge
  • To avoid the pressures caused by procrastination
  • To avoid criticism from others
  • To avoid feeling guilty
  • Getting encouragement from others
  • Reward motivation
  • Internal focus of control and personal mastery

Select one of your motivators that were checked from the list above… Now develop a plan for using this to enhance your low motivation. For instance, “getting encouragement from others” is one of your motivators, consider asking a friend or family member for this type of support in a particular area where you need a push.

See if you can make a plan for any of the other motivators that you checked.

Getting motivated: It is easier when you have a support… Illustration: Megan Jorgensen.

Cognition and Sleep

Cognition


Psychology, the scientific study of the mind, like most disciplines contains many branches. An undergraduate student in psychology, while perhaps wishing to specialize in health psychology, must go through a panoply of introductory level courses: neuroscience, perception, child psychology, social psychology, abnormal psychology, learning and memory, cognition and so on.

Cognition relates to thought processes and mental schemas. Further, social cognition refers to how humans see, and think about, the social world. Social psychologists define social competence as the ability to positively interact with others, a crucial skill in teamwork, a quality many employers look for in potential candidates today.

But what about social cognition? How do humans perceive others' intentions, emotions and states of mind? One such process is called Theory of Mind (ToM) and has been widely documented as deficient in autistic individuals (Sally's hidden object test is often used to measure subjects' ability to "read others' minds"). Body language, facial expressions, tone of voice, vocabulary alongside content, and other social cues are likewise used in face-to-face interactions to detect deception and aid interpersonal communication in general.

Sleep


In the long run, humans need sleep in order to survive. Even a single night out partying without sleeping can cause significant impairment to one's cognitive function. Sleep is divided into non-rapid eye movement (NREM) and rapid eye movement (REM). NREM consists of N1, N2 and N3 stages. Circadian rhythms vary from person to person, but typically span the usual daylight schedule.

Sleep deprivation weakens memory, a function associated with the hyppocampus. Conversely, the amygdala represents responses to real and imagined threats, fear and anxiety, respectively; while the frontal lobe is the seat of executive function (impulse control, decision-making, inhibition, planning). Executive dysfunction is diagnosed using the Wisconsin Card Sorting Test.

The woods are lovely, dark and deep. But I have promises to keep, and miles to go before I sleep. (Robert Frost). Illustration : Megan Jorgensen.

Beast

Beast

By Peter Benchley


By the time Darling rounded the point into Mangrove Bay, the blue of the sky was fast turning violet, and the departed sun had tinted the western clouds the color of salmon.

A single light bulb burned on the dock, and beneath it, moored to a piling, was a white twenty-five-foot outboard motorboat with the word Police stenciled on the side in foot-high blue letters.

“Christ,” Mike said, “he's reported us already.”

“I doubt it,” said Dorothy, “he's a fool, but he's not crazy.”

Two young policemen stood on the dock, one white, one black, both wearing uniform shirts, shorts and knee socks. They watched as Darling eased the boat against the dock, and they passed Mike the bow and stern lines.

Darling knew the policemen, had no problem with them – no more than he had with the marine police in general, whom he regarded as ill-trained, underequipped and overburdened. These two he had taken to sea with him on their days off, had helped them learn to read the reefs, had shown them shortcuts to the few deep-water channels in and out of Bermuda.

Still, he chose to remain on the flying bridge, sensing instinctively that altitude reinforced his authority.

He leaned on the railing and raised a finger and said, “Colin... Barnett...”

“Hey, Whip...” Colin, the white cop, said.

Barnett said, “Come aboard?”

“Come ahead,” said Darling. “What brings you fellas out of the night?”

“Hear you found a raft,” Barnett said.

“True enough.”

Bernett stepped aboard and pointed to the raft lying athwart the cockpit, “That it?”

“That's the one.”

Barnett shone a flashlight on the raft and leaned down to it. “Lord, it stinks!”

Colin stayed where he was and said hesitantly, “Whip... we gotta take it.”

Darling paused: “Why's that?” Somebody claim to have lost it?”

“No... not exactly.”

“Them it's mine, isn't it?... First law of salvage: finders keepers.:

“Well...” Colin seemed uneasy. He looked at his feet. “Not this time.”

“Dr. St. John,” Colin said. “He wants it.”

“Dr. St.John.” Now Darling knew he was bound to lose, and his temper was bound to win. “I see.”

Liam St.John was one of the few men in Bermuda whom Darling took the trouble to loathe. A second-generation Irish immigrant, he had gone away to school in Montana and graduated from some diploma mill that awarded him a doctorate. Exactly what the doctorate was in, nobody knew and he never said. All anybody knew for certain was that little Liam had left Bermuda pronouncing his name “Saint-John” and had returned pronouncing it (and insisting everyone else do, too) “SINjin.”

Armed with an alphabet appended to his name, St.John had rallied a few powerful friend of his parents and besieged the government, arguing that certain disciplines, such as maritime history and wildlife management, were being grossly mishandled by amateurs and should be turned over to certified, qualified experts – which meant him, since he was the only status-Bermudian with a doctorate in anything other than medicine. Never mind that his degree was in an unknown field, probably some thing utterly useless like Druid combs.

An island. Pic by Elena.