Attachment Disorder in Adult- Part 1

                    Attachment Disorder in Adults- Part 1

      An attachment disorder is a type of mood or behavioral disorder affecting a person's ability to form and maintain relationships. 

   These disorders typically develop in childhood. They can result when a child is unable to have a consistent emotional connection with a parent or primary caregiver. 

  There is no formal attachment disorder diagnosis for adults, but they can experience attachment issues. These can stem from untreated or undiagnosed attachment disorders in childhood. 

The Fundamentals: Attachment theory 

Attachment theory deals with how people form emotional bonds. The way that a person learns to form and maintain relationships primarily stems from their initial interactions with a parent or primary caregiver during childhood. 

 

 Psychologists initially study and categorized different types of attachment that can develop during childhood. Researchers later developed the Adult Attachment Interview to distinguish the types in adults. The questions assess the type of easy relationship that an adult had with their primary caregiver. 

 Types of attachment in adults are similar to those observed in children. They include:

Secure: An adult with secure attachments likely had a positive emotional bond with their primary caregiver. They are comfortable in their relationship and have low relationship anxiety. 

 Avoidant or dismissing: Adults with these attachments are uncomfortable with closeness and value independence in their relationship. As a child, their caregiver may not have been attuned to their needs. 

 Anxious or preoccupied: Adults with these attachments crave intimacy and do not feel secure in their relationships. A child may develop this attachment style if their caregiver has intermittent or unpredictable availability. 

 Disorganized: Adults with this attachment style may have intense or chaotic patterns of relationships, marked by seeking closeness and then pushing people away, for example. It may develop in response to childhood trauma or abuse. 

Types of attachment disorder: 

 -Reactive attachment disorder 

 -Disinhibited social engagement disorder 

- Reactive attachment disorder:

 RAD is typically a trusted source of early childhood maltreatment or neglect. 

  American academy of child and adolescent psychiatry notes that children with RAD may:

 - Have low levels of interaction with other people

- Show little or no evidence of emotion during social interactions

- Have difficulty claiming down when stressed

- Seem unhappy, irritable, sad, or scared when engaging in everyday activities with their caregivers. 

 If the child does not receive adequate treatment, the symptoms of RAD may manifest or continue into adulthood. Possible symptoms of the disorder in adults include:

- Difficulty reading emotions

- resistance to affection

- Difficulty showing affection

- Low levels of trust

- Difficulty maintaining relationships

- A negative self-image

- Anger issues

- Impulsivity

- Detachment. 

Disinhibited social engagement disorder:

 DSED may develop in response to social neglect and lack of consistent attachment to a primary caregiver during the first 2 years of life. 

Children in care often demonstrate symptoms of DSED. These may include:

- Hyperactivity

- Minimal social boundaries 

- Extreme sociability

- Readiness to approach and engage with strangers

If a child with DSED does not receive adequate treatment, the issue can manifest continuing into adulthood. An adolescent or adult with DSED may display:

- Hyperactivity

- An extreme trust in people that they do not know well

- A lack of awareness of social boundaries

- A tendency to ask intrusive questions to people that they have just met 

- Other behaviors that show a lack of inhibition 

Signs and symptoms:

- Uncertainty about their true identity

- Discontinuity in their sense of self 

- Related changes in behavior, consciousness, and memory

- A feeling of disconnectedness from 

- Memory loss relating to personal information or everyday events

- Reduced ability to feel physical pain. 

Attachment disorder and adult relationships:

 An attachment disorder that develops in childhood may affect relationships in adulthood, and more research into this area is necessary. 

 A person with an attachment disorder may have difficulty trusting others or feeling safe and secure in a relationship. As a result, they may have difficulty forming and maintaining friendships and romantic partnerships. 

Complications:

 Untreated childhood RAD or DSED can cause the following during adulthood:

 - Low self-esteem

- Emotional impairment

- Difficulty in social situations 

- Anxiety 

- Depression

- Dissociation

- Problems with substance use trusted source 

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Narcolepsy

                                    Narcolepsy

Narcolepsy is a chronic sleep disorder characterized by overwhelming daytime drowsiness and sudden attacks of sleep. People with narcolepsy often find it challenging to stay awake for long periods of time, regardless of the circumstances. 

     A chronic sleep disorder that causes overwhelming daytime drowsiness. 

   Sometimes, narcolepsy can be accompanied by a sudden loss of muscle tone(Cataplexy), which can be triggered by strong emotions. Narcolepsy that occurs with cataplexy is called type 1 narcolepsy. Narcolepsy that occurs without cataplexy is known as type 2 narcolepsy. 

     Narcolepsy is a neurological disorder that affects your ability to wake and sleep. People with narcolepsy have excessive, uncontrollable daytime sleepiness. They may also suddenly fall asleep at any time, during any type of activity. In a typical sleep cycle, we enter the early stages of sleep, then the deeper states, and finally after about 90 minutes of rapid eye movement (REM) sleep. People with narcolepsy go into REM sleep almost immediately in the sleep cycle and sometimes while awake. 

   Type 1 narcolepsy comes with a sudden loss of muscle tone that causes weakness and makes you unable to control your muscles(cataplexy). Type 2 is narcolepsy without cataplexy. 

Causes: 

    The exact cause of narcolepsy is unknown. People with type 1 narcolepsy have low levels of the chemical hypocretin. Hypocretin is an important neurochemical in your brain that helps regulate wakefulness and REM sleep. 

  Hypocretin levels are particularly low in those who experience cataplexy. Exactly what causes the loss of hypocretin-producing cells in the brain isn't known, but experts suspect it's due to an autoimmune reaction. It's also likely that genetics play a role in the development of narcolepsy, but the risk of a parent passing this disorder to a child is very low only about 1%. 

   Research also indicates a possible association between exposure to the swine flu (H1N1 FLU) virus and a certain form of H1N1 vaccine that's currently administered in Europe, though it's not yet clear why.

                             

Symptoms of Narcolepsy:

  Those symptoms may include:

 Excessive daytime sleepiness(EDS):

 In general, EDS makes it harder to do everyday activities, even if you got enough sleep at night. You have memory lapses and feel depressed or exhausted. 

Cataplexy:

   This can cause problems ranging from slurred speech to total body collapse, depending on the muscle involved. It's often triggered by intense emotions such as surprise, laughter, or anger. 

Hallucinations:

   These delusions can happen at any time and are often vivid and frightening. They're mostly visual, but any of the other senses can be involved. If they happen as you're falling asleep, they're called hypnagogic hallucinations. If they happen when you're waking up, they're called hypnopompic hallucinations. 

Sleep Paralysis:

  You may be unable to move or speak while falling asleep or waking up. These episodes usually last a few seconds to several minutes. 

Disrupted sleep:

  You might have a hard time staying asleep at night because of things like vivid dreams, breathing, problems, or body movements.

Some people with narcolepsy also have related problems, including:

  - Periodic limb movement disorder (PLMD): 

   Your leg muscles move without your control many times during the night.  

- Sleep apnea:

   Your breathing often stops and starts while you sleep.

Automatic behavior:

  You fall asleep during a regular activity like driving, walking, or talking. You continue the activity while asleep and wake up with no memory of what you did.

Narcolepsy Diagnosis:

  Symptoms of narcolepsy can look like those of other health problems. Your diagnosis might involve:

 - Physical exam and medical history:

  Sleep records:

  Your doctor might ask you to keep track of your symptoms and when you're sleeping for a couple of weeks. 

Polysomnogram(PSG):

  This is done in a sleep disorder clinic or a sleep lab. It's an overnight test that takes constant measurements while you're asleep to record problems in your sleep cycle. A PSG can help reveal whether you go into REM sleep at unusual times in your sleep cycle. It can rule out other problems that might be causing your symptoms.

Multiple sleep latency test(MSLT): 

 This is also done at a special clinic or lab. The test takes place during the day to measure your tendency to fall asleep and find out whether certain elements of REM  sleep happen at unusual times furin the day. You'll take four or five short naps, usually 2 hours apart. 

Other Characteristics:

 People with narcolepsy may have other sleep disorders, such as obstructive sleep apnea a condition in which breathing starts and stops throughout the night, restless legs syndrome, and even insomnia. 

    Some people with narcolepsy experience automatic behavior during brief episodes of narcolepsy. For example, you may fall asleep while performing a task you normally perform, such as writing, typing, or driving, and you continue to perform that task while asleep. When you awaken, you can't remember what you did, and you probably didn't do it well.

Normal sleep pattern VS. Narcolepsy:

    The normal process of falling asleep begins with a phase of non-rapid eye movement (NREM) sleep. During this phase, your brain waves slow considerably. After an hour or so of NREM sleep. Your brain activity changes and REM sleep begins, most dreaming occurs during REM sleep.

   In narcolepsy, however, you may suddenly enter into REM sleep without first experiencing NREM sleep, both at night and during the day. Some of the characteristics of narcolepsy, such as cataplexy, sleep paralysis, and hallucinations, are similar to changes that occur in REM sleep, but occur during wakefulness or drowsiness. 

Risk Factors:

  There are only a few known risk factors for narcolepsy, including:

  - Age: Narcolepsy typically in people between 10 to 30 years old. 

 - Family history: Your risk of narcolepsy is 20 to 40 times higher if you have a family member who has narcolepsy. 

Complications:

 Public misunderstanding of the condition: 

 Narcolepsy may cause serious problems for you professionally and personally. Others might see you as lazy or lethargic. Your performance may suffer at school or work. 

Interference with intimate relationships:

  Intense feelings, such as anger or joy, can trigger signs of narcolepsy such as anger or joy, can trigger signs of narcolepsy such as cataplexy, causing affected people to withdraw from emotional interactions. 

Physical harm:

 Sleep attacks may result in physical harm to people with narcolepsy, you're at increased risk of a car accident if you have an attack while driving. Your risk of cuts or burns is greater if you fall asleep while preparing food. 

Obesity:

 People with narcolepsy are more likely to be overweight. The weight gain may be related to low metabolism. 

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Hemolacria or Bloody epiphora

               Hemolacria or Bloody epiphora

 Hemolacria or bloody epiphora is the presence of blood in the

 tear. Alternative names for the condition include bloody tears,

 blood-stained tears, dacryohemorrhea, hematodacryorrhea,  

hemolacrimia, sanguineous tears, sanguineous lacrimation,

 hematic epiphora, dacryohemorrhysis, lacrimae cruenate, and

 tears of blood. 

      Hemolacria or bloody epiphora is the presence of blood in

 tears Multiple disorders can cause Hemolacria. This activity

 reviews the evaluation and management of hemolacria and

 highlights the role of interprofessional team members in

 collaborating to provide well-coordinated care and enhance

 outcomes for affected patients. 

Etiology:

 The source of blood in tears may be: 

 Bleeding from the conjunctive- conjunctiva is a vascular tissue

 with limbal, bulbar, fornical, and palpebral parts. The

 conjunctival vessels lie at the ocular surface and may bleed

 spontaneously or after eye-rubbing, usually causing

 subconjunctival hemorrhage. 

Trauma:

  Conjunctival laceration or rupture of conjunctival vessels may

 cause hemolacria. Surgery involving incision or excision of the

 conjunctiva may also cause hemolacria. The surgeries include

 small incision cataract surgery, pterygium surgery, squint

 surgery, scleral buckling, and trabeculectomy. 

Inflammation:

 Severe conjunctivitis including hemorrhagic conjunctivitis,

 membranous or pseudomembranous conjunctivitis,

follicular conjunctivitis with congested semilunar fold and caruncle, severe viral or bacterial conjunctivitis cause blood-stained tears. 

Vascular Lesions: 

  Hemangioma, lymphangioma, inflammatory papilloma of the conjunctivitis sac, telangiectasia of conjunctival vessels, and pyogenic granuloma. 

Vicarious menstruation:

  The conjunctiva may periodically/cyclically bleed(Vicarious menstruation) during menstruation or hormonal disturbances. This phenomenon is usually seen around menarche or rarely around menopause. 

- Normal conjunctiva stimulated by hormonal or other factors. 

- Estrogenic premenstrual light blood hypertension. 

Foreign body:

  Foreign body at the upper fornix can cause chronic irritation, erosion of the conjunctiva, and hemolacria. Subconjunctival metallic splinter after trauma may cause bleeding into the tear. 

- Chemical injury- application of silver nitrate over the conjunctiva is another cause of bloody tears.

- Bleeding from the lid margin- Inflammed lid margin due to blepharitis may cause erosion of the surface of the eyelid and lead to bleeding. 

  Bleeding from the lacrimal puncta- The source of the bleeding in tears may be the puncta There is one lacrimal punctum, each at the medial side of the upper and lower lid, respectively. These are situated at the inner margin of the lid. Punctum connects medically to a lacrimal canaliculus on both the upper and lower lid. 

 - Other causes of bleeding from the lacrimal punctum include:

 - Trauma

- Infection

- Tumor- angioma, meningioma of the lacrimal sac. 

- Vascular lesions including varices and dacryolith, rupture of dilated/ distended vessels within the lacrimal sac. 

• Vascular disorders may play an important role in the pathogenesis of hemolacria. Hypertension is an important factor that has been reported to cause epistaxis and retrograde haemolacria through the leak of hemorrhage via the lacrimal puncta
• Other causes of haemolacria include
• Cranial trauma
• Post-traumatic epilepsy
• In otherwise normal individuals after stooping, or muscular effort
• In children after 'copious weeping.'
• Coughing
• Hypertensive crisis
• Acute hemorrhagic edema of infancy
• Unknown cause/idiopathic - In some cases, despite a thorough search for ocular, systemic, or psychiatric causes, no obvious etiology or source is found.

Prognosis:

 Severe bleeding through tears may even be fatal in some cases, especially in a patient with coagulopathy. Identifying hemolacria from systemic causes is of utmost importance. 

Complications:

 

 Haemolacria as such will not lead to complications, but it can be a complication of a multitude of conditions, as explained in the etiology section. Identifying the cause and targeting the treatment towards it, is the most important step in the management of hemolacria. 

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Mental Health

                          Mental Health

      Mental health includes our emotional, Psychological, and

 social well-being. It affects how we think, feel, and act. It also 

helps determine how we handle stress, relate to others, and

make healthy choices. Mental health is essential at every stage of

 life, from childhood and adolescence through adulthood. 

    Mental health encompasses emotional, psychological, and social well-being. It influences cognition, perception, and behavior. It also determines how an individual handles stress, interpersonal relationships, and decision-making. Mental health includes subjective well-being, perceived self-efficacy, autonomy, competence, intergenerational dependence, and self-actualization of one's intellectual and emotional potential, among others.  

  From the perspectives of positive psychology or holism, mental health may include an individual's ability to enjoy life and to create a balance between life activities and efforts to achieve psychological resilience. Cultural differences, subjective assessments, and competing professional theories affect how one defines "mental health". Some early sins related to mental health problems are sleep irritation, lack of energy, and thinking of harming yourself or others. 

   Mental health, as defined by the public health agency of Canada, is an individual's capacity to feel, think, and act in ways to achieve a better quality of life while respecting personal, social, and cultural boundaries. Impairment of any of these is a risk factor for mental disorders or mental illness which is a component of mental health. Mental disorders are defined as health conditions that affect and alter cognitive functioning, emotional responses, and behavior associated with distress and/or impaired functioning. The ICD-11 is the global standard used to diagnose, treat, research, and report various mental disorders. In the United States, the DSM-5 is used ad the classification system of mental disorders. 

   Mental health is associated with a number of lifestyle factors such as diet, exercise, stress, drug abuse, social connections, and interactions. Therapists, psychiatrists, psychologists, social workers, nurse practitioners, or family physicians can help manage mental illness with treatments such as therapy, counseling, or medication. 

Epidemiology:

  Mental illnesses are more common than cancer, diabetes, or heart disease. Over 26 % of all Americans over the age of 18 meet the criteria for having a mental illness. Evidence suggests that 50 million people worldwide have some mental illness. Major depression ranks 4th among the top 10 leading causes of diseases worldwide. By 2029, mental illness is predicted to become the leading cause of disease worldwide. 

  One million people commit suicide every year and 10 to 20 million attempts it. A World Health Organization (WHO) report estimates the global cost of mental illness at nearly $ 2.5 trillion in 2010, with a projected increase to over $6 Trillion by 2030. 

  Evidence from the WHO suggests that the early half of the world's population is affected by mental illness with an impact on their self-esteem, relationships, and ability to function in everyday life. An individual's emotional health can impact their physical health. Poor mental health can lead to problems such as the inability to make adequate decisions and substance use disorders. 

   Good mental health can improve life quality whereas poor mental health can worsen it. According to Richards, Campania, & Muse-Burke, there is growing evidence that is showing emotional abilities are associated with pro-social behaviors such as stress management and physical health. Their research also concluded that people who lack emotional expression are included in anti-social behaviors(e.g., substance use disorder and alcohol use disorder, physical fights, vandalism), which reflects one's mental health and suppressed emotions. Adults and children who face mental illness may experience social stigma, which can exacerbate the issues. 

A holistic model of mental health generally includes concepts based upon anthropological, educational, psychological, religious, and sociological perspectives. There are also models as theoretical perspectives from personality, social, clinical, health, and developmental psychology. 

     The tripartite model of mental well-being views mental wee-being ad encompassing three components of emotional well-being, social well-being, and psychological well-being. Emotional well-being is defined as having high levels of positive emotions, whereas social and psychological well-being defined as the presence of psychological well-being is defined as the presence of psychological and social skills and abilities that contribute to optimal functioning in daily life. The model has received empirical support across cultures. The Mental Health Continuum-short is the most widely used scale to measure the tripartite model of mental well-being. 

Early warning signs:

 Not sure if you or someone you know is living with mental health problems, experiencing one or more of the following feelings or behaviors can be an early warning sign of a problem:

- Eating or sleeping too much or too little

- Pulling away from people and usual activities

- Having low or no energy

- Feeling numb or like nothing matters

- Having unexplained aches and pains

- Feeling helpless or hopeless

- Smoking, drinking or using drugs more than usual

- feeling unusually confused, forgetful, on edge, angry, upset, worried, or scared 

- Yelling or fighting with family and friends

- Experiencing severe mood swings that cause problems in relationships

- Having persistent thoughts and memories you can't get out of your head

- Hearing voices or believing things that are not true

- Thinking of harming yourself or others

- Inability to perform daily tasks like taking care of your kids or getting to work or school

Mental Health and wellness:

Positive mental health allows people to:

 - Realize their full potential

- Cope with the stresses of life

- Work productively

- Make meaningful contributions to their communities

Ways to maintain positive mental health include:

- Getting professional help if you need it

- Connecting with others

- Staying positive

- getting physical active

- Helping others

- Getting enough sleep

- Developing coping skills. 

Well-Being Concepts:

 Well-being is a positive outcome that is meaningful for people in many sectors of society because it tells us that people perceive that their lives are going well. 

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DPNA code for Autism Spectrum children

    DNPA code for children those having Autism Spectrum at the airline traveling.   

DPNA: Disabled passenger with intellectual or developmental disability needing assistance.   

   Several situations have happened around the world where a family has been removed from An airplane because their child who is on the Autism Spectrum had a meltdown due to inconveniences that could have been prevented. Travel can be stressful for anyone let alone a child on the autism spectrum.     

 DPNA is a special service request (SSR) code. SSR codes are used in the airline industry to communicate traveler preferences or needs to airlines. 

  How to ask for special assistance from airlines? Next time book a flight ticket, add the code "DPNA" in the free-text box that appears on the booking page, in case your child needs any additional support from the airline.

  Traveling with special needs children is how parents can request support from airlines. 

  Children with intellectual disabilities like those on the autism spectrum can feel overwhelmed in unfamiliar surroundings and require special care. As a parent, how can you ensure that your child does not have to endure stress during a flight? 

   The special assistance facility offered by airlines in India to passengers with a disability or those with reduced mobility allows you to book wheelchairs prior to your scheduled flight, so when booking a flight ticket, make a request for it at the time of booking or inform the airline at least 2-48 hours prior to departure, as per the official websites. 

   We are, however, not just talking about physical disability. Children with intellectual disabilities. Children with intellectual disabilities like those on the autism spectrum or Down Syndrome can feel overwhelmed or uncomfortable in unfamiliar, crowded surroundings and therefore require special care.

 Tips for parents of special needs children:

 It is highly probable that a child with an intellectual disability might exhibit unusual behavior in a public area, and parents might feel embarrassed, stressed, or irritated, and may end up scolding the child. 

 Parents need to handle such situations with the utmost sensitivity. Barua suggested the following tips for parents to keep in mind when going out in public with special needs children. 

- The child can behave in a certain way which can seem"inappropriate" to other people. But if the parent is uncomfortable with the child's behavior, others might all the more feel that something is wrong. 

-The parent needs to be calm and comfort the child instead of criticizing or scolding them for their behavior because it is possible that the child may be dealing with something stressful in the environment and is trying to communicate it. 

- In situations of crisis, parents should avoid getting into a fight with others or it can worsen matters for the child. 

- Parents should not give in to any pressure from others but stand their ground to ensure their child is not discriminated against in any way.

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