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Anxiety: a medical condition or just the new normal? New bird flu virus infection: Threat of a pandemic Health Notes
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Anxiety: a medical condition or just the new normal? “Anxiety is a necessary emotion; we need it to perform well,” says Dr Natasha Bijlani, a consultant psychiatrist at the Priory in Roehampton, south-west London, “and life is no more dangerous than it ever was. But people’s expectations are different — we’re more achievement-oriented and we want a quick fix.” A fix such as Xanax (alprazolam)? Yes, though you can’t get it on the NHS in the UK. Hugely popular in the US (48.7 million prescriptions were written for it there last year), it’s known as the crack cocaine of benzos. It’s similar to Valium but faster-acting and with a much shorter half-life – Valium stays in the system for 20 to 100 hours, Xanax for only six to 12. This is an advantage in some ways – less of a hangover – but accounts for its more addictive qualities. You want more and you want it now. Anti-anxiety meds are nothing new. Miltown (meprobamate), the first blockbuster tranquilliser, became the toast of Hollywood in the 1950s. Lucille Ball, Tennessee Williams, Aldous Huxley, Norman Mailer and Salvador Dali’s wife, Gala, were all fervent fans. Then came the benzos: Librium, followed by the wildly successful Valium, both developed by Leo Sternbach at Roche’s plant in Nutley, New Jersey, and approved by the Food and Drug Administration in 1963. Perfect for Cold War angst, more potent than Miltown, Librium and then Valium (developed because of Librium’s bitter aftertaste) were also less toxic and sedating and set the way for the “codification of anxiety into medical pathology”, as Andrea Tone puts it in The Age of Anxiety: A History of America’s Turbulent Affair with Tranquilizers (Basic Books). Paul Gilbert, professor of clinical psychology at the University of Derby and author of The Compassionate Mind, says that “our cognitive abilities are plumbed into an ancient anxiety system”, and that in anxiety disorder, the threat/self-protection system – useful if to avoid being eaten by a lion – seems to be inflamed and easily activated, and that the amygdala, that part of the brain’s limbic system that plays a vital role in the regulations of emotions, has become oversensitive. And – no surprise there – it’s in the amygdala that the benzos concentrate their soothing, often addictive, magic. We worry, states The New York Times, which has a whole section of its Opinionator blog devoted to exploring the navigation of the worried mind. “Nearly one in five Americans suffers from anxiety. For many, it is not a disorder, but a part of the human condition.” Should this human condition be medicated? “Much better to learn how to tolerate distress,” says consultant psychiatrist Dr David Veale, who recommends compassion-focused therapy (CFT), a type of cognitive behavioural therapy particularly effective with anxiety, “though it’s much harder than benzos.” In CFT, only just gaining a foothold in the UK with Professor Paul Gilbert and Dr Chris Irons in the vanguard, you learn to build up a “soothing system” that calms and comforts. But sometimes, meds can tide you over a bad patch – not everyone gets addicted, after all. Joe, a teacher, whose anxiety achieved an “apocalyptic, political edge” around the time of the American election, when he couldn’t sleep for worrying about whether Barack Obama would get in, calls his form of anxiety the “learnt doom and gloom” – all the long, pessimistic articles he was reading sent him over the edge. He felt “immobilised by angst” but Ativan (lorazepam), a benzo that’s often prescribed for panic disorder, helped him to cope, short-term, with the daily stress of work, family and money problems and put the latest Atlantic piece in some sort of perspective. Dee, a gerontologist, became so consumed with worry about her teenage son “lying dead in a gutter when out late” that she started taking a low dose of Prozac to help her to calm down. She stopped a few years later when her son was older but found herself still so racked by amorphous regret and anxiety that she has started taking it again. “I can’t get off the track in my brain that goes over and over some bad thing – something I feel certain I should have done or something I fear could happen.” She describes her anxiety as being like “veins in my brain, iron ore or something. When I’m gripped by it I try to imagine a laser penetrating my brain and zapping the awful thought.” Meds may come and meds may go – Xanax now far outsells Valium and Roche will close its Nutley plant next year as part of a streamlining operation – but panic disorder, anxiety, worrying: they’ll go on forever. — The Independent |
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New bird flu virus infection: Threat of a pandemic We now have a new bird flu virus infection, fortunately limited to China for the present. The highly fatal strain (H7N9) was initially reported in three patients from Eastern China. Subsequently, more cases had appeared from four other provinces. The most worrisome was the case of a seven-year-old girl in Beijing, some 750 miles away from Shanghai, raising the possibility of a distant spread. Over 50 cases have been reported till date. Fortunately, there is no evidence so far to suggest the presence of human to human transmission and/or of spread to other countries. This, however, remains an area of great concern and active investigation. It is important to know for our readers that there are several strains or types of influenza virus which differ in their infectivity for humans, causing diseases of variable severity with different levels of fatality. Infection of poultry birds with influenza A, subtype H7, viruses is known worldwide. Unlike the highly pathogenic H5H1 infection, the H7N9 virus has low pathogenicity for birds. Therefore, the disease in the birds is mild, may remain undetected. This, however, is not true for humans. All the three patients cited in the first ever report had died of severe pneumonia, respiratory failure and septic shock. In humans, the infection with H7N9 virus had never been earlier reported before the first report in The New England Journal of Medicine this month. The Chinese scientists have identified the H7N9 virus and mapped its genome with a great speed, for which they had earned worldwide appreciation. The human H7N9 virus is believed to occur due to genomic re-assortment of three other viruses of avian-origin — H7N3 from ducks, H7N9 from wild birds and H9N2 from bramblings. The novel genome has proved to be highly fatal with a mortality of about 50 per cent in humans. The absence of a sustained human-to-human transmission should result in self-containment and disease arrest in the local community. This, however, cannot be guaranteed as yet. The global experience with the 2009 H1N1 pandemic had shown a rapid spread to unexpected locations through air travel. One cannot totally ignore the possibility of spread as had happened with some other influenza viruses. Limited human-to-human transmission was reported in an earlier H7N7 outbreak in 2003 in the Netherlands. That, however, was not an H7N9 epidemic which is detected now for the first time. The H7N7 episode had followed an outbreak of fowl-plague that involved 89 patients; the illness was rather mild with only one death attributed to the acute respiratory distress syndrome. The World Health Organization has already taken note of the problem and cautioned the neighbouring countries where poultry smuggling is common from China. Several hundred people in direct contact with the infected individuals are being watched and the poultry birds have been slaughtered. Quite likely, the disease will not spread. The disease presents like any other lower respiratory tract infection with fever, cough, breathlessness, generalised aches and pains, fatigue and malaise, etc. Severe pneumonia, developing in some cases is responsible for respiratory failure and death. The incubation period of 15 days is rather long making it difficult for an early diagnosis. It has been reported in all age groups. The presence of co-morbidities — the underlying systemic illnesses, old age, malnutrition and other conditions — is reportedly common. There is no good anti-viral drug available at present. The virus is reported to show resistance to the traditional drugs making the treatment even more difficult. Similarly, the commonly used vaccines against bird flu are not effective against this novel strain. Efforts are, however, on to develop potential H7N9 vaccines as quickly as possible. Similarly there are attempts to develop a rapid molecular assay for identification and sub-typing of H7N9 virus for diagnosis and assessment of the viral load. It is largely for the health administrators and international organizations to keep a close guard avoiding panic at all costs. Vaccination of poultry birds is another important consideration. The writer is Professor and Head, Department of Pulmonary Medicine, PGI, Chandigarh. |
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Simple op could replace daily drugs for blood pressure patients
London: A simple operation which could effectively cure high blood pressure is being tested on patients in Britain. The breakthrough treatment could save thousands of lives each year after the trials showed a substantial and permanent reduction in blood pressure and a decrease in drugs needed, the Daily Express reported. It is hoped the technique will end the need for powerful drugs and help many patients come off daily medication completely. Cardiologists in London and Eastbourne carried out the first half-hour operations using the keyhole process last month and hailed the results as “exciting” after patients experienced an immediate reduction in extremely high blood pressure. Dr Neil Sulke, a cardiologist at Eastbourne General Hospital, said, “This operation holds the promise of a meaningful long-term reduction of high blood pressure in patients whose blood pressure isn’t controlled by their medication.” — ANI Eating tree nuts can boost health and cut heart disease risk
Washington: Three new studies have explored the health benefits of consumption of tree nuts (almonds, Brazil nuts, cashews, hazelnuts, macadamias, pecans, pine nuts, pistachios and walnuts). Researchers found that tree nut consumption was associated with a better nutrient profile and diet quality; lower body weight and lower prevalence of metabolic syndrome; and a decrease in several cardiovascular risk factors compared to those seen among non-consumers. First, researchers at Loma Linda University studied 803 adults using a validated food frequency questionnaire and assessed both tree nut and peanut intake together and separately. “Our results showed that one serving (28g or 1 ounce) of tree nuts per week was significantly associated with 7 per cent less MetS,” stated lead researcher Karen Jaceldo-Siegl, DrPH. “Interestingly, while overall nut consumption was associated with lower prevalence of MetS, tree nuts specifically appear to provide beneficial effects on MetS, independent of demographic, lifestyle and other dietary factors,” the researcher noted.
— ANI
Why sleep loss leads to heart disease and obesity
Washington: Cutting back on sleep could harm blood vessel function and breathing control, a new study has found. A bevy of research has shown a link between sleep deprivation and cardiovascular disease, metabolic disorders, and obesity. However, it’s been unclear why sleep loss might lead to these effects. Several studies have tested the effects of total sleep deprivation, but this model isn’t a good fit for the way most people lose sleep, with a few hours here and there. In a new study by Keith Pugh, Shahrad Taheri, and George Balanos, all of the University of Birmingham in the United Kingdom, researchers test the effects of partial sleep deprivation on blood vessels and breathing control.
— ANI |
This is the age of anxiety, the era of the benzodiazepine Xanax – “all jumpy and edgy and short of breath,” as New York magazine puts it. Climate change, terrorism, recession – there’s something for everyone to worry about, and a medication or a book to go with it. But is anxiety a medical condition or just the new — even not so new — normal?