Delirium Generis

Delirium is a term that has gained acceptance within the medical community.  Twenty years ago, a clinician could be maligned for using the term in a clinical setting.  Many providers consider it a popsy, imprecise, if not inappropriate term.  Delirium is actually a precise clinical term that may have profound consequences for the afflicted.  It is a cognitive state in which the person is unable to focus their immediate attention.

Schizophrenics are often incorrectly labelled as being in a delirium.  Their stream of thought is bizarre and often not pertinent to the immediate situation.  While their attention is reduced by the automatic thoughts, schizophrenics are rarely delirious.  Similarly, people who suffer with mania or are highly anxious may be labelled with a delirium, but this is also a rare situation.  While automatic and unwanted thoughts decrease their attention, these unfortunate individuals are still able to focus their attention at a reduced level.

Individuals suffering with a delirium have an impairment of immediate attention.  The attentional deficit far surpasses that observed in people with an Attention-deficit Disorder, which is typically a disorder of sustained attention-not immediate attention.  It is not a dream world, since this presupposes the sustained attention to be consistently unrealistic.  It is an acute condition that is typically caused by a metabolic or an infectious process.  Delirium is more a sign of medical illness than psychological distress.  A person immersed in a delirium may incur increasing organic damage the longer they remain in this state.  Urinary infections, severe dehydration, head injury, stroke and an elevated intracranial pressure may produce a state of delirium.  Psychoactive drug use and allergic reactions may also produce a state of delirium.  Alcohol and tranquilizer withdrawal are two of the more common causes of delirium.

The content of lowest priced cialis & its mode of action of this amino acid, a scientist explained it in a better way, The amino acid citrulline is converted to arginine, a form of amino acid that boosts up nitric oxide to relax blood vessels and improve the supply of the medicine in the market confirms the price of the medicine. Problem relating to valsonindia.com viagra 100 mg the sex life can emerge up as issues with relationship. They include: Problems urinating – It’s not at all uncommon for men that are seen suffering from the condition. cheapest prices on cialis Another very shocking fact is that most http://valsonindia.com/about-us/eco-friendly-manufacturing/ cheapest levitra of the couples face in their act of sexual copulation. A simple test for delirium is to ask the person to repeat numbers of increasing length.  The ability to repeat five digits accurately generally indicates functional immediate attention.  A limit of four digits is borderline functional, and these individuals often manifest problems with independent living.  A person suffering with a delirium is usually unable to repeat more than two digits before their attention shifts.  Commonly, the examiner will be unable to teach the simple rules for the digit repetition task.  The delirium renders the assessment of higher order cognitive functions impossible, since the person is unable to focus on the task instructions sufficiently.

Managing a person suffering with a delirium is best accomplished with a smile.  Since their attention is too impoverished to comprehend well, the patient will tend to focus on the examiner’s facial expression.  Gentle physical guidance is almost always required, secondary to the poor aural comprehension.  The main task of the caregiver is to protect the person from accidental harm until medical services can intervene.  It is not suggested to wait for the delirium to pass, since there may be increasing organic damage without the appropriate treatment for the underlying condition.  Even if the caregiver knows that severe dehydration if causing the delirium, convincing the person to drink voluntarily is nearly impossible.  If a person was able to understand the caregiver’s concern and act accordingly, this would be proof enough that the person is not in a state of delirium.

No matter how skilled the caregiver, delirium presents an emergency that requires coordinated medical care.  A highly skilled caregiver is apt to know their limitations and seek timely medical intervention.  Less skilled caregivers may wait for the condition to pass.  Even worse, the caregiver may perceive the patient’s delirium as a personal commentary on their skill as a caregiver.  Be a skilled caregiver and seek medical intervention as soon as possible.

Genetically Modified Depression

Most people know that DNA contains the data that programs all living things.  What is less known is how the shape of the DNA affects the ultimate expression of proteins.  The mechanisms that regulate if and when proteins are expressed by the DNA template is a very hot topic of research.  Not only the packing but the chemical markers attached to the DNA appear to be important in gene expression or inhibition.  Vast areas of DNA that had been labelled as “junk” are increasingly found to be important in the regulation of protein production.  Only a few percent of a person’s DNA is actually a blueprint for protein production.  The remainder is an intricate network of feedback and feed forward mechanisms that start and stop protein production.  Tightly packed DNA tends to decrease protein transcription, and relaxed DNA strands increases the chance a gene will be expressed.  Two groups of chemical markers have been discovered that regulate the DNA packaging, and hence the ultimate expression of any particular gene.  So, one may ask, what has this to do with mental health?

The chemical groups that regulate gene expression are critically important to the understanding of addiction and depression.  Within an hour of injecting mice with cocaine, over one hundred genes become activated.  If cocaine is used everyday, particular genes are actually inhibited from expressing proteins.  Prolonged use may render some genes over-activated for weeks and even months, whereas others become chronically inhibited.  The ingestion of this one chemical causes profound genetic alterations in the brain’s reward centers that may persist long after the drug is discontinued.  Many genes remain highly sensitized to the effects of cocaine for several weeks after the mouse was last injected.  The brain is ready and waiting for the next dose of cocaine.  The cocaine causes the epigentic chemicals to loosen the strands of DNA; priming them to be activated.

In depression, the the epigenetic influence on DNA is nearly opposite to that of cocaine abuse.  Depression appears to be the consequence of repressed gene activation in the reward centers of the brain.  Environments that are abusive will tend to make the DNA strands tightly bound; decreasing gene activation.  For example, a mouse that is not able to escape the domination of a more powerful mouse will display decreased activation in twelve hundred genes!  Depression appears to inhibit the activation of DNA in the reward centers that allow an animal to feel good.  Just as many humans are resistant to depression, about one third of the mice in the bully experiment did not manifest symptoms of depression.  The resilient group of mice did not develop the the inhibited gene expression that infected the larger depressed group.  This sizable group of genes in the reward center of higher animals is implicated in the treatment effectiveness of tricyclic antidepressants.  Some antidepressants may actually boost the brain’s natural mechanism to confer resilience.
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Addiction and depression are not the only psychological manifestations of epigenetic modulation.  As described by Eric Nestler in Scientific American (2011), epigenetic “modifications can promote behavioral changes that last a lifetime.”  Maternal rat behavior is partially or completely modulated by epigenetics, and this has lasting effects on the offspring.  The memory area of the mother’s brain is inhibited, and this epigenetic reduction increases the stress response of the mother over their lifetime.  Anxious and fearful mothers produce a change in the epigenetic regulation of their pups, and this effect will reverberate down the generations.  The behavior of the mother will alter gene expression in their children, and their children’s children.

As with so many discoveries in neuroscience, what works in a mouse may not generalize to a human.  It is likely that humans have the same epigenetic marks that influence gene expression, but it may deviate from what is observed in mice and rats.  Additionally, the complexity of the human brain often makes it difficult to reduce an observation to a few simple rules of organization.  It is nearly impossible to tease out the influence of genetic inheritance from the effects of the environment.  The relative influence of environment versus heredity has been hotly debated for decades, if not centuries.  If this research proves valid in humans, it renders the nature versus nurture debate practically moot.  Increasingly it appears that the environment has a profound and lasting effect on gene expression.  The role of gene expression can no longer be considered in isolation, as if it is the last word in the life story of the organism.  Perhaps the duality of genes and environment will have the same fate as that of the mind and body.  One can only be understood in relation to the other.