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| Posted: 13 Aug 2011 08:35 PM PDT Bipolar disorder is characterised by extreme fluctuations in mood, between elation and depression. ALL humans experience mood changes in daily life, and these are usually transient. However, bipolar disorder (BD) is different in that it is a mental condition in which the mood of the affected person changes from one extreme to another, ie from mania to depression. The person feels very happy in the former; it is called hypomania if it is not so extreme. During the depression phase, there are feelings of uselessness with suicidal thoughts in many. During the manic phase, there are feelings that everything is possible, with feelings of joy, creativity, and unrealistic ambitions or plans. There may also be psychotic symptoms, ie seeing or hearing things that are not there. BD can be so severe that it affects daily life, eg school, work, relationships, etc. Each phase of the condition can last for weeks or months. The condition is common and is a major cause of morbidity and even mortality. Although its actual prevalence is unknown, it is estimated that slightly more than one in 100 persons are affected. It occurs at all ages although it is more common in young adults. Males and females from all socio-economic groups are affected. The frequency of the extreme mood swings is variable. Some may have few episodes during their life time, while others have many repeat episodes. BD is often unrecognised and managed inappropriately or inadequately. As depression often occurs initially, the prescription of antidepressants alone does not address the whole problem. What causes BD? The precise cause of BD is not well elucidated. It is believed to be due to a combination of physical, environmental and social factors. Imbalances of brain neurotransmitters, ie noradrenaline, dopamine and serotonin, are considered causative. There is also a belief that it is due to genetic factors as BD is more common in families. A single gene has yet to be identified. It is believed that genetic and environmental factors interact to precipitate BD. The latter includes stressful situations, eg abuse, death, troubled relationships or physical ill health. BD can also be triggered by problems of daily living in work, finance or relationships. The factors that increase the risk of BD are history of attempted suicide, family history of suicidal behaviour, severity and/or number of depressive episodes, alcohol and/or substance abuse, level of pessimism, level of aggression and/or impulsivity and younger age of onset. What happens in BD? The criteria for the diagnosis of BD are characterised by extreme mood swings. The diagnostic features are psychiatric and physical. The psychiatric features of bipolar depression include sadness, apathy, irritability, anxiety, hopelessness, poor self-esteem, poor concentration, indecisiveness, self blame and suicidal thoughts. The physical features include altered sleep patterns, altered appetite and/or weight, decreased activity, low energy, slow thought and speech, as well as sleep and endocrine alterations. The psychiatric features of mania include elevated mood, euphoric or irritable mood, grandiosity, impulsiveness, racing thoughts, distractibility, poor insight, disorganisation, impaired attention, impaired comprehension, delusions, and hallucinations. Delusions are irrational beliefs and hallucinations are abnormal sensations, eg seeing, hearing or smelling things that are not there. Delusions and hallucinations are features of psychosis. The physical features include rapid or pressured speech, decreased sleep requirements, overly active, social, or hostile behaviour, increased libido, recklessness, bizarre behaviour, and even destructive activity. The mania phase usually follows a few depression phases. There are occasional phases between mania and depression in which the mood is normal. The change from mania to depression can be very rapid. A complication of BD is suicide, the risk of which is 15 to 20 times more than the general population. Studies report that about 25% to 50% of BD sufferers attempt suicide at least once in their lifetime and long term treatment reduces suicide rates. BD is often suspected by the family doctor who usually makes a referral to a psychiatrist. The psychiatrist will make an assessment, through a series of questions, before a diagnosis is made, and a treatment plan formulated. There may be a need for the psychiatrist to meet family member(s) with BD. Laboratory tests may be needed to exclude physical conditions, eg thyroid disorders. Management The majority of BD sufferers can be treated with a combination of medicines and psychosocial interventions. The former are prescribed for acute attacks and to prevent episodes of mania and depression. The latter include cognitive behavioural therapy (CBT), behavioural family therapy (BFT), interpersonal and social rhythm therapy (IPSRT), and group psychoeducation (GSE). With effective treatment, there is usually improvement in about three months. If untreated, the episodes of BD may last six to twelve months. The medicines include lithium carbonate, anti-convulsant medicines and anti-psychotic medicines, which are prescribed singly or in combination. Lithium carbonate is used often to treat both phases of BD and is prescribed for at least six months. It is important to adhere to the dose prescribed and not to cease taking it unless asked by the doctor. Blood lithium levels have to be maintained at a specific level that is not too high or too low. This requires regular blood measurements; at least once every three months. The dose may be increased if the symptoms are not controlled or if there is a relapse. Monitoring of thyroid and kidney function is also done every two to three months if there is an adjustment of the dose of lithium, and every year in all other cases. It is advisable to avoid non-steroidal anti-inflammatory drugs (NSAIDs), unless specifically prescribed by the doctor. The side effects include diarrhoea and vomiting. The doctor should be informed if side effects occur. Sometimes. anticonvulsant medicines are effective in treating mania. They include valproate, carbamazepine, and lamotrigine. A single medicine may be used. In cases where there is no response to lithium or to a single anticonvulsant, they are used in combination with lithium. Valproate should not be taken in women in the reproductive age because it poses risks to the foetus. If there is a need to take valproate, reliable contraception must be used. Blood tests are necessary at the commencement of treatment and six months later. Carbamazepine is usually prescribed with a low initial dose, which is increased gradually. Blood tests, which include those that monitor kidney and liver function, are necessary at the commencement of treatment, and six months later. Lamotrigine is usually prescribed at a low dose, and then increased gradually. An annual medical check-up is necessary, but other tests are not usually needed. Women taking anticonvulsants and who are on the contraceptive pill will be advised to consider alternative contraception. Occasionally, antipsychotic medicines are prescribed in the treatment of mania and hypomania. They include clozapine and risperidone. Antipsychotics are useful when there are severe symptoms or behavioural disturbances. Because of side effects which include dry mouth, blurred vision and constipation, the dosages are kept low. Regular medical check-ups, at least every three months or more frequent, are necessary for diabetics. The treatment for the depressive phase of BD is the same as that for patients suffering from depression. The antidepressants include tricyclic anti-depressants (TCAs), selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs). Antidepressant medicines are effective in about 70% of patients with BD. However, it takes about two to four weeks for its effects to be noticeable. Patients who change from the manic to depression phases of BD rapidly with an intervening normal phase are usually prescribed lithium and valproate. If this does not work, the doctor will prescribe lithium on its own or add lamotrigine. Antidepressants are not usually prescribed unless the doctor considers it necessary. Cessation of medicines should be under medical supervision. The dose is usually reduced gradually over a minimum of four weeks or up to a minimum of three months if lithium and or antipsychotics have been taken. Electroconvulsive therapy (ECT) is considered if there is severe mania, uncontrolled mania symptoms, high risk of suicide and psychosis. Most patients can be managed as outpatients. Hospitalisation may be needed if there are severe symptoms or there is danger that the patient will harm himself, herself or others. Cognitive behavioural therapy (CBT) assumes that thinking, mood and behaviour affect each other. Patients are taught how to monitor, examine and alter the thinking and behaviour that are associated with undesirable mood states. CBT has been found to be useful for prevention of relapse and improved social functioning. Behavioural family therapy (BFT) comprises psychoeducation, communication enhancement training, and problem-solving skills. It improves family functioning and mood, reduces the likelihood of relapse, and reduces hospitalisation rates. Interpersonal and social rhythm therapy (IPSRT) teaches patients the regularisation of sleep-wake patterns, work, exercise, meal times, and other daily activities, as well as therapy for interpersonal problem areas. Group psychoeducation seeks to improve awareness of illness, treatment compliance, early detection of symptoms and recurrences, and lifestyle regularity. The interventions enhance care and reduce the likelihood of relapse. Recognition of the warning signs of mania or depression or its triggers do not prevent its occurrence, but it enables the sufferer to seek medical assistance in time. BD can have repeated and occasionally severe impact on patients' well-being. There can be significant morbidity and mortality. Medicines are available for its treatment, but regular monitoring is necessary. However, compliance to treatment is a major challenge. ■ Dr Milton Lum is a member of the board of Medical Defence Malaysia. This article is not intended to replace, dictate or define evaluation by a qualified doctor. The views expressed do not represent that of any organisation the writer is associated with. For further information, e-mail starhealth@thestar.com.my. The views expressed are those of the writer and readers are advised to always consult expert advice before undertaking any changes to their lifestyles. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information. Full Feed Generated by Get Full RSS, sponsored by Used Car Search. |
| Posted: 13 Aug 2011 08:34 PM PDT Nutritionists in the region must be poised to face the challenges of a rapidly developing Asia. THE 11th Asian Congress of Nutrition (ACN) was held in Singapore in mid July, organised by the Singapore Nutrition and Dietetics Association. The scientific programme covered the whole range of topics that are relevant to nutrition in the region. Some 60 Malaysians participated in the congress. This write up provides some highlights from the 11th ACN, particularly those sessions that I participated in and made presentations. The Asian Congress of Nutrition (ACN) is held every four years under the auspices of the Federation of Asian Nutrition Societies (FANS). The first congress in this series was organised 40 years ago, in 1971 by the Nutrition Society of India. The congress provides an opportunity for nutrition scientists, experts and activists to share information on nutrition advances in research and technical expertise. Malaysia joined FANS soon after the formation of the Nutrition Society of Malaysia (NSM) in 1985. NSM organised the 6th Congress in 1991, in Kuala Lumpur. Facing nutritional challenges in Asia There has been rapid socioeconomic development in Asia for over four decades. As a result, nutrition issues have changed dramatically. There has been a decline in nutrient deficiencies in many population groups, whilst many communities are now afflicted with huge problems of overweight and obesity and associated chronic diseases. Asia is burdened with the largest number of undernourished people and the most number of overnourished individuals, at the same time. Asia will continue to develop and progress rapidly in the years to come. The theme of the 11 ACN, "Nutritional Well-Being for a Progressive Asia – Challenges and Opportunities", is indeed appropriate. It is a reminder that as Asia progresses further into developed and industrialised nations, it is imperative that the nutritional well-being of the population must not be neglected. It is a reminder that the nutrition community must be ready to face the challenges ahead. It is a reminder that opportunities abound for networking and sharing of expertise and experiences among Asian nutrition scientists. Malaysia has its own share of the nutrition problems. Every effort must be made in pushing ahead with the nutrition agenda of the country as contained in the National Plan of Action for Nutrition. Progress of dietary guidelines in Asia A pre-congress seminar on dietary guidelines in Asia was organised by Danone Institutes in Indonesia, Japan and China. Nutrition experts from eight Asian countries updated participants regarding the development and promotion of dietary/nutritional guidelines, namely China, Indonesia, Japan, Malaysia, Philippines, Singapore, Thailand and Vietnam. Faced with the double burden of malnutrition and overnutrition, countries in Asia need to regularly review their dietary/nutrition guidelines so that they remain relevant and beneficial to the population at large. The seminar is most timely and provided an excellent opportunity for nutritionists to share experiences in the development and promotion of dietary guidelines. I presented on the development and promotion of dietary guidelines in Malaysia. The first official Malaysian Dietary Guidelines (MDG) was published in 1999 and was thoroughly reviewed and launched in 2010. The new MDG has 14 key messages and 55 recommendations, covering the whole range of food and nutrition issues, from importance of consuming a variety of foods to guidance on specific food groups, messages to encourage physical activities, consuming safe food and beverages, and making effective use of nutrition information on food labels. In collaboration with other professional bodies and the private sector, the Nutrition Society of Malaysia has been promoting the dissemination and usage of the MDG to the public through a variety of formats and channels. Speaking as president of the Nutrition Society of Malaysia (NSM), I shared with participants numerous examples of strategic partnerships in nutrition promotion programmes in Malaysia. Many of these examples are partnerships between NSM and other professional bodies and the private sector, targeted towards promoting healthy eating and active living amongst various population groups. On-going collaborative programmes with major food companies include the Health Kids Programme, the Healthy Meal Time Magic, and the nationwide nutrition promotion programme of Nutrition Month Malaysia. Several other programmes are being planned for implementation in the next months. The Singapore Health Promotion Board shared its experiences in public-private-people partnerships to promote a conducive ecosystem for healthy eating in the island republic. These include the Healthier Choice Symbol Labelling Programme, the Healthier Hawkers Programme and Health Promotion Malls. The Food Industry Asia discussed various considerations for successful public-private partnership opportunities to improve health. A successful example of metabolic syndrome prevention in Taiwan was presented by Taiwan Millennium Health Foundation. Since 2006, the foundation has alerted people to self-monitor waist circumference regularly and to practise healthy eating and active lifestyle. A variety of campaigns and community programmes have been conducted every year. Lastly, the Hong Kong Nutrition Association (HKNA) described its activities, aimed at promoting healthy eating among the local community. HKNA has formed strong partnership with its stakeholders, including mass media, other healthcare associations and commercial firms to disseminate knowledge on proper nutrition. Functional foods and health It is now recognised that bioactive or functional components in foods, other than nutrients, are able to serve physiological roles beyond provisions of basic nutrient requirements. Foods containing such components have been termed "functional foods". This symposium on functional foods had five presentations, to share the latest findings on selected Asian functional foods and ingredients and their health benefits and to discuss scientific substantiation of nutrition and health claims for these foods. As the first speaker in this symposium, I provided an overview of the "Development and Status of Functional Foods in Asia". International Life Sciences Institute SEA Region has been in the forefront of scientific activities to promote a harmonised development of functional foods in the region. Over the years, a number of documents have been published resulting from these scientific activities, including a monograph on functional foods and a suggested framework and guidelines for the scientific substantiation and safety evaluation of functional foods. There have been major regulatory developments in health claims in Asia, specifically on functional claims and disease risk reduction claims. These claims focus on the role of food bioactive or functional components in improving or modifying a physiological function or promoting health. I presented a review of the health claim status in several South East Asian countries (Brunei, Indonesia, Malaysia, Philippines, Singapore, Thailand and Vietnam) as well as China and Japan. There are significant differences in the health claims permitted in these countries. All regulatory authorities require proper scientific substantiation of health claims. The objectives of these regulations are to achieve a high degree of consumer protection, to ensure confidence in claims on foods, to promote fair trade, to stimulate academic research, and to encourage product innovation. The second presentation in the symposium was on "Scientific Substantiation for Functional Foods – How Much Evidence Is Enough?" The health benefits of foods are communicated to consumers in many ways through nutrition communications. In each case a review of the scientific literature lies behind the summaries that are communicated. Two presentations were focused on specific functional foods. A presentation discussed "Evidence on Polyphenol-Rich Functional Foods for Cardiovascular Health". Theother was focused on the "Effects of Functional Foods and Components on Microbiota and Gut Health". Food and nutrient database in Asia Almost all countries in Asia have established nutrient composition databases. This dedicated symposium on food and nutrient database, organised by NEASIAFOODS, SAARCFOODS and Chinese Nutrition Society, provides an update on activities, particularly in Asia. The first of the four presentations was on the FAO/INFOODS "Advances in Food Composition and Database Management System". International Food Data Systems (INFOODS) was established in 1984 to increase the availability and quality of food composition data. Its secretariat is at FAO since 1999. Over the years, INFOODS has developed several standards (nomenclature of foods, component identifiers and interchange formats), provided guidelines (on compilation, dissemination and use) and was involved in over 25 international training courses. In recent years, the dimension of food biodiversity was introduced to food composition. I provided an overview of the current regulations on nutrition labeling and health claims in several Asian countries and implications for developing capabilities in food analysis. There are various implications and challenges in implementing these regulations. One area relevant to this conference is developing capability in food analysis. For truthful nutrition labeling, food manufacturers have to ensure that there is accurate data on the composition of the nutrients contained in the food. Similarly, for nutrition and health claims, accurate data on the amounts of the nutrients or bioactive components are needed. For scientific substantiation of health effects, accurate quantitation of the amounts of these nutrients or components is essential. For regulatory agencies, well-equipped laboratories and well-trained personnel are required for surveillance and enforcement purposes. Nutrient profiling (NP) is a tool for classifying foods based on their nutritional composition. A review was first carried out to evaluate 34 NP models in the world. A simple score model of NP was established and can be used to filter foods bearing nutrition and health claims. Nutrient content differences among cultivars of the same species are more significant than has generally been recognised. The last presentation in this symposium described nutrient biodiversity in major food crops and its health implications. The findings of the study on 300 rice cultivars and 125 landraces, 43 potato varieties, 32 carrot, 130 mango, 20 pearl millet, 24 sorghum and 40 minor millets which are commonly consumed in India was presented. ■ Dr Tee E Siong is a nutritionist with over 30 years of experience in the research and public health arena. For more information, email starhealth@thestar.com.my. Full Feed Generated by Get Full RSS, sponsored by Used Car Search. |
| Posted: 13 Aug 2011 08:33 PM PDT Billie Jean King on new knees and boomer fitness. BILLIE Jean King is back playing tennis in Central Park with gusto after double-knee replacement surgery. At age 67, she is encouraging all ages, especially baby boomers, to exercise and stay fit. She also says it is OK to forgive yourself if you cannot match the workouts you did when you were young. King, who inspired a generation of women and men to pick up a racket in the 1970s, did not play tennis for nearly two years before getting new knees. She needed about a year of rehabilitation, working out for two hours, five days a week to regain the strength and range of motion to get back on the court. When the pain was intense, she imagined "a bright, sunny day in my head. And I pictured hitting the first tennis ball again." King realised that goal last year at Wimbledon, four months after surgery. She sneaked onto Court 16 and hit a few shots with friend Roz Fairbank while her partner Ilana Kloss snapped pictures. This year, King celebrates the 50th anniversary of her first Wimbledon doubles victory. She went on to win a record 20 Wimbledon titles in singles, doubles and mixed, and recently, she was photographed at Wimbledon sitting in the Royal Box behind Prince William and his wife, Kate. To stay in shape these days, the 39-time Grand Slam winner heads to the neighbourhood gym and public tennis courts. She does not use a personal trainer because she travels so much, hitting the hotel gym instead. She recently traveled in a two-week span to Philadelphia, Pennsylvania, back to New York, then to Washington, D.C., while promoting her World Team Tennis league, which features Serena and Venus Williams, 52-year-old John McEnroe and other stars in nine cities. Here King shares her insights on working out, the proper mental approach and diet. Her advice for boomers? Increase the frequency, lower the intensity and listen to your body. What is your exercise routine? King: "My age group should do a half-hour, five days a week. What that means is I'm walking, doing the bike, lifting weights or playing tennis. I love it when Ilana and I go to Central Park and play tennis. It's fantastic. I go to Equinox to do lower and upper body stuff. Do a lot for my back; I need to be doing a lot for my core. I do the leg presses, the leg curls, abductor and adductor. I have a bike at home, so, worse comes to worst, that's my backup. I'll turn on the TV and pedal." This was your eighth knee surgery. What was life like before the double-knee replacement? King: "I got to the point I couldn't even walk two blocks. I had my first operation at 23 when I was No 1 in the world, and it's been downhill ever since in terms of function. I used to take a taxi (two blocks) to get to my workout. My life was closing in on me. It kept getting less and less, and then it was really getting disheartening. Now I'm pain-free, if I want to play tennis or take a walk in the park. I'm going through this mindset change now. It's amazing. My first knee-jerk reaction is, 'Oh, I can't – oh, yes I can do that.' I can go up and down stairs. I wouldn't be able to do that a year ago." How has your thinking and approach to fitness and exercise changed over the years? King: "The most important thing is frequency. You don't have to do as much as you think. Like walking 30 minutes, five times a week is good. I would never increase more than 10% at a time. People will do 20 minutes on the bike and the next day they'll do 40. Nah-uh. If you're out of shape, don't do that. Figure out ways to keep your motivation. "On days I'm not motivated, I will say, 'OK, just get on the bike or walk for five minutes, and if you want to stop, fine.' I give myself permission. I've only once in my whole lifetime stopped, when I realised I was sick. Every other time I end up doing at least 25-30 minutes. So then it's done for the day, it's great. I would go without exercising if I wasn't careful." What are your eating habits like these days? King: "I try to cut down on carbs. I'm older, my metabolic rate probably is not as fast. I figure I'm burning three calories a minute on the bike. I'm not as intense as I used to be, so that makes a difference. It suppresses your appetite to go slowly on the bike or walk and go longer. "I was playing senior tennis (after retirement) for a while but then I gained a huge amount of weight. Then I went on Nutrisystem; that really helped me lose. I lost 16kg. Then I got too thin with the knee stuff, and now I'm a little overweight. So it's hard for me to get to where I want to all the time. I struggle." You were a bit of a perfectionist on the court. Do you forgive yourself for the limitations of age or stress about it? King: "It's a blessing for me to walk on the court. Then I go, 'OK, I just want to hit one ball that feels like it used to.' You just make smaller goals, you make different goals. "Coming back from this knee replacement, I had to really think in degrees, literally (in terms of knee bend). It's important to play more tennis, but play half an hour to 45 minutes instead of trying to play an hour and half. Instead of doing marathons, do a 10K. Listen to your body, what's going on with your joints, your muscles. "I know boomers are into fitness, and taking good care of themselves. And now they're at the age they still want to be active. (They say) 'I want to still play tennis and do this and keep running.' They're pretty demanding. Which is good, because that's why we're living as long as we are." What's your role as a member of the President's Council on Fitness, Sports & Nutrition? King: "It's amazing being on this council. There's Michelle Kwan, Grant Hill, Chris Paul and doctors. Our job is to get the word out. You can't believe the findings with exercise and taking tests at school or reading or math tests. They go way up. If they're going to take an SAT, they have the kids work out for 20 minutes and they take it immediately because the circulation is going, the brain's got more oxygen. They do much better on tests. "Now we have the scientific stuff behind it. I knew it before, because I knew how I felt. But now we have the scientific stuff to back it up." – AP Full Feed Generated by Get Full RSS, sponsored by Used Car Search. |
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