Alcohol dependence: the neuropsychiatric complications
Dr Rajeev Gupta

Alcohol is the central nervous system depressant. It alters the neurochemistry of brain cells. Regular and chronic alcohol consumption may prove toxic and eventually damage our brain. These changes can finally lead to a number of neuropsychiatric complications, which may need proper medical treatment.

Alcohol produces a number changes in our brain functioning. At a blood alcohol level of 0.05 per cent, our thought, judgement and emotions are affected. At a level of 0.05 to 0.1 per cent motor skills become clumsy. When the blood alcohol level reaches 0.2 per cent the entire area of the brain that controls motor functions is affected. At 0.3 per cent the person is confused and at 0.4 per cent the patient may go into coma. If levels exceed 0.5 per cent one may choke and stop breathing.

Epidemiological surveys and clinical studies show psychiatric disorders in alcoholics. Alcohol-dependent individuals are known to suffer from a number of neuropsychiatric problems.

Personality deterioration: A number of negative changes start appearing gradually in one’s personality. In many cases, these changes occur so gradually that even the user may not identify them. These common changes are intolerance, irritability, anger, frequent mood swings, feeling of insecurity and stubbornness.

Blackouts: Alcoholics often complain of loss of memory. One may not even remember the conversation and commitment during the period.

Intellectual deficit and dementia: Long-tern alcohol use can lead to deterioration of one’s intellect, judgement and reasoning capacity, memory, personal and social behaviour. Structural changes occurring in the brain can be detected by psychological tests and MRI brain scans. Initially, these changes are reversible if one stops taking alcohol. If alcohol consumption is continued one can have an irreversible condition called dementia.

Alcoholic hallucinosis: It is a rare complication of withdrawal in alcoholics. It develops about 12-24 hours after one stops taking alcohol. The patient hears threatening or accusatory voices. This is commonly seen in chronic alcoholics. It is commonly associated with mood disturbances.

Alcohol and depression: Alcohol consumption may be either a cause for or a consequence of depression. Alcohol induces euphoria in the initial stage but once its levels fall, it causes depression. Alcohol dependence can cause a range of problems such as family conflicts, and financial problems that themselves can cause increased anxiety and depression. Alcohol dependence is one of the important risks for suicide.

Alcohol-induced seizures (fits): Heavy alcohol consumption can induce seizures. Alcohol-induced seizures are of a different type. One is commonly called "rum fits". It can happen because of over-indulgence in taking alcohol on a given day.

Sleep disturbances: Alcohol use is commonly associated with sleep disorders. Alcohol dependence can lead to complaints of insomnia and sleep disruption that can persist for many months. Changes like daytime sluggishness, fatigue, abnormal sleep patterns, disturbing dreams and nightmares can develop. Certain problems like sleep-disordered breathing (SDB), the restless leg syndrome (RLS) and sleep-related movement disorders are more commonly associated with patients of alcohol dependence.

Are there mental health benefits of alcohol consumption?

It has been suggested that mild-to-moderate drinking can improve mood and help non-problem drinkers cope with stress or other negative emotional problems. There is, however, no concrete scientific evidence to show that alcohol consumption has any beneficial effect on the mental health of an individual.

Eat healthy meals for optimal learning

WASHINGTON: An expert has said that the child’s lunchbox not only holds secrets to better physical health but can also help a child mentally prepare for learning.

Karin Richards, Director of the Exercise Science and Wellness Management programme and Director of Health Sciences at the University of the Sciences, suggests the following tips when planning breakfast, lunch and snacks for a student:

l Incorporate at least three types of foods into each meal, making sure to include some type of protein and carbohydrates. Complex carbohydrates like whole wheat bagels and pasta or honey wheat pretzels will give your child energy while the protein will satisfy the appetite for a longer period of time.

l Have children shop with the parents to choose one fruit or vegetable each week. Encourage them to try new and interesting fruits and vegetables like kiwi, papaya and edamame.

l Be bold. Remember, breakfast doesn’t have to be what is considered "typical." Thin crust pizza, peanut butter and jelly on whole wheat, a grilled chicken sandwich, or last night’s leftovers can be nutritious, delicious and fun breaks from the norm!

l Most meals may very well be "grab and go," so plan accordingly. Prepare homemade pancakes on Sunday evening and freeze for quick access later in the week.

l Be a little sneaky. Add more veggies to everyday favourites. Try zucchini bread, healthy low-fat dips with veggies or adding shredded carrots into tomato sauce and soups.

l It is all about balance. Everything in moderation is the key. — ANI

Strong muscles prevent elbow injuries
Dr Ravinder Chadha

Elbow joint is vulnerable to injuries due to overuse or accident. Overuse injuries occur when the muscles supporting a joint are weak, incapable of absorbing the load transmitted to the joint, tendons or ligaments. Elbow injuries occur while picking up heavy objects or performing some twisting movement at the wrist joint.

Elbow pain is common but difficult to evaluate due to the complexity of the joint and its central location in the upper extremity. Correct diagnosis entails proper understanding of the anatomy of elbow, which includes three articulations, two ligament complexes, muscles and nerves.

Common injuries at the elbow joint include the following:

Tennis elbow is the result of overuse of wrist extensor muscles at the lateral epicondyle (bony part on the outer side of the elbow) where there is least elasticity. Symptoms include pain which worsens with activity and frequently radiates down the lateral forearm.

The most common cause in tennis players is a late mechanically poor back-hand stroke which places excess force on the weak muscles of the elbow.

Activities involving flexion/extension, rotation at the wrist joint like screwdriver use, lifting heavy objects with the palm down, turning a doorknob, etc.

Golfer’s elbow is an injury to the muscle and tendon on the inside of the elbow. This is commonly caused by the elbow absorbing the club’s impact onto the ground such as talking a divot. Typically, a right-handed golfer holds the club with a flexed right wrist, therefore, putting some strain on the on front/flexor muscles of the forearm. These flexor muscles are attached to the bony point on the inner side of the elbow. If the strain is excessive and muscles are weak, this attachment becomes inflamed.

Biceps tendinosis — Pain at the front side of the elbow due to activities involving repetitive elbow bending and forearm rotation.

Pronator syndrome — It occurs because of the median nerve entrapment. Symptoms are pain at the front side of the elbow with tingling sensation. This happens after participation in racquet or throwing sports.

Triceps tendinosis — It is mostly caused by repetitive/forceful elbow extension. Tenderness is present at the back side of elbow joint.

Olecranon impingement — It typically occurs in throwing activities and is characterised by clicking or locking of the elbow with extension.

Rest: Avoid the activities that aggravate the injury. Absolute rest should be avoided as it can lead to muscle atrophy, decreasing blood supply to the area which is detrimental to the healing process.

Activity modification: Elimination of the activities that are painful is the key to improvement Avoid any strenuous movements like carrying shopping bags, opening tight taps, repetitive valve opening, etc.

Ice: Apply ice packs to the affected elbow three to four times a day for 10 minutes at the early stage to decrease pain/swelling.

Physiotherapy: Ultrasound with deep friction massage helps in reducing inflammation.

Shockwave therapy —It is a revolutionary technique that effectively treats a tennis elbow. With shock-wave therapy, the body responds with increased metabolic activity around the site of pain. This stimulates and accelerates the healing process.

Stretching the affected muscles helps in breaking down any scar tissue or adhesions that occur with inflammation. Stretch by pulling your hand downward for a count of 10 several times a day.

Elbow bands are designed to minimise the muscle pull on the tendon attachment at the elbow and these should be worn during the play.

Steroid injection reduces inflammation at the site of the tendon. The tendon becomes fragile after the injection and therefore a week’s rest is required.

Manipulation, if done properly, can prove to be very effective in providing immediate relief.

Progressive resistance elbow exercises with a stretch-band for the forearm muscle are very effective in increasing strength.

The following exercises may be started when pain subsides:

Finger extension: Place a rubber band around all five finger-tips. Spread the fingers 25 times. Repeat it three times. If resistance is not enough, add a second rubber band of greater thickness, which will provide more resistance.

Ball squeeze: Place a rubber ball in the palm of your hand, squeeze it 25 times, and repeat it three times a day.

Wrist curls : Grasp a dumbbell or a Theraband in hand with the palms facing upwards. Support the forearm at the edge of a table or on your knee. Begin by curling the weight/Theraband upwards at the wrist and then slowly start lowering it.

Reverse wrist curls: Grasp a dumbbell or a band in your hands with the palms facing downwards. Begin by curling the weight/Theraband upwards at the wrist and then slowly return back.

Forearm pronation: Grasp a hammer in your hand, perpendicular to the floor with the forearm supported. Rotate the hand to the palm down position, return to the starting position and rotate to the palm up position. Repeat it 8-10 times.

Strengthening the muscles supporting the elbow joint is the best way to prevent elbow injuries.