Victims of psychological trauma

By Dr. R.A.R. Perera  - Consultant Psychologist.

Post-traumatic stress disorder is a common occurrence in people who have undergone life-threatening incidents. A life threatening condition could be a natural disaster like floods, earthquake, fire, or an incident like a bomb blast, an accident, rape, attempted murder, or witnessing a murder taking place etc.

This could be an incident, which can happen to the patient or it could be that the patient has witnessed happening to a person close to him or her. This can cause immense problems to him or her and to his normal lifestyle. Posttraumatic stress disorder does not happen to all the individuals who have undergone this life-threatening event.

Vulnerability

* A past history of psychiatric or psychological disorder
* A neurotic anxiety-prone personality
* Exposure to previous traumatic experiences - e.g. child abuse
* Perceived threat to life and personal safety at the time of a traumatic event

When a person undergoes this traumatic experience he or she shows specific psychological symptoms, which is characteristic to post traumatic stress disorder.

A life threatening event outside normal human experience

* Re-experience the trauma - intrusive memories - repeated thinking about the incident; Dreams/night mares; Flashbacks-sense of reliving the event; Distress at exposure to ‘resembling events’

* Avoidance of stimuli associated with the trauma

* Evidence of increased arousal-sleep disturbances; Irritability; Hyper vigilance; Exaggerated startle response

* Duration for more than a month

In Sri Lanka, most of the people who have this disorder presents themselves as if having a physical problem and is generally treated by physicians.

These patients do not want to label themselves as having a psychological (mental) disorder as this often leaves behind a stigma. It is very important to educate and direct these patients to a psychologist so that they can be evaluated and be treated accordingly.

Psychological therapies - establish a good therapeutic relationship with the patient

* Group therapy - particularly useful when dealing with the victims of a shared trauma e.g. Combat, disaster rescue workers

* Dynamic psychotherapy - early developmental experiences are explored in depth - Has been widely advocated particularly for victims of multiple trauma

* Cognitive techniques and exposure based behavioural techniques - e.g. Audiotape desensitization (tape the conversation as he/she describes it any play back the tape frequently in the subsequent days)

* Drug treatment - although drugs alleviate some of the symptoms of posttraumatic stress disorder, they are not, in general effective following acute posttraumatic stress disorder, and are of particular benefit in reducing ‘positive’ symptoms e.g. Nightmares, intrusive thoughts.

Depression and other psychiatric disorders are also indication for drug treatment. These drugs include antidepressant and anti-anxiety drugs.

Drugs generally need to be used in higher doses and for a long duration (One year or more, than in the treatment of normal depression).

There may be a latent period of eight weeks or more before the effect of drug treatment are seen.

A lack of controlled studies up to now, means the effectiveness of these techniques in reducing long-term post-traumatic stress disorder is unclear. Inappropriate and ill-timed interventions may accentuate symptoms of stress.

A variety of psychological interventions and drug treatments have been shown to relieve at least some of the symptoms of posttraumatic stress disorder.

The diversity of available treatments is an indication that none of these alone is particularly effective, and a comprehensive approach combining psychotherapy and social support is more likely to succeed.

The author Dr. Ranasinghe Arachchige Ranjith Perera, Consultant Psychologist has been conducting clinics for Disabled Soldiers at “Ranaviru Sevana,” Army Rehabilitation Centre, Ragama, every Friday since 7th May 1999.

Mobile menace

How safe is it to use mobile phones?

Are mobile phones dangerous? “Do mobile phones cause brain tumour? Are they harmful to health?” These questions are constantly being asked even as mobile phones revolutionise the concept of communication.

How do mobile phones work? They emit electromagnetic radiation called low intensity pulsed microwave radiation. Can this interfere with biological systems? Specific Absorption Rate (SAR) measures the rate of radio energy absorption in the body tissue.

The SAR limit recommended by the International Commission of Non-Ionising Radiation Protection is 2 Watts/kilogram (W/kg). Most mobile phones emit radio signals at SAR levels between 0.5 and 1 W/kg. Of late, third generation phones that emit higher rates of radiation are being marketed.

Initial reports said that mobile phone radiation had some minor effects on the human body and caused headaches and nausea. Later, it was said that they affected the brain and could cause memory impairment.

But the experts failed to consider the negative biological effects of exposure to long-term low intensity pulsed microwave radiation that the phones emit. Our bodies, especially our brains, are extraordinarily sensitive receptors of EMF radiation.

To find out if use of mobile phones causes tumours, researchers studied the medical records of 1,600 patients who had used mobile phones for up to 10 years before being diagnosed. They found that the more mobile phones were used and the longer they were used, the higher the risk of brain tumours.

Researchers also found that spending more than an hour a day on the mobile phone increased the risk of a type of tumour called acoustic neurinoma by 30 per cent. This tumour arises in the nerve responsible for hearing in the brain and can lead to deafness in one ear. They also found that the tumour was on that side of the head to which the user held the phone.

But this tumour has occurred earlier too, so how can we conclude that the tumour is caused by mobile phones? Researchers then found that the incidence had increased from one in 100,000 in 1980 (before the advent of mobile phones) to one in 80,000 today.

The Reflex study conducted by 12 research groups in seven European countries and coordinated by the German research group Verum looked at the effect of radiation on human and animal cells.

They found that after being exposed to radiomagnetic fields between 0.3 and 2 W/kg, cells showed a significant increase in single and double strand DNA breaks i.e. the basic gene that contains the DNA itself is damaged. The cells could not always repair this. This implied that there was damage for the future generation of cells.

The change led to a genetic mutation producing cells different from the normal existing cells. The conclusion was that radio waves from mobile phones could harm body cells and damage DNA in laboratory conditions but that did not prove that mobile phones were a risk to health.

It was also stated that more research was needed to see if effects could be found outside labs. Research groups also felt that children may be more vulnerable since, with a developing nervous system, they may have a greater absorption of energy and a longer lifetime exposure.

Where does that leave us? There is still no final answer to the million-dollar question “Do mobile phones cause brain tumour?” But we can take precautions: Use text messaging for communication and use low SARs phones for a short time. Also keep pace with the new technology and replace obsolete ones.

Acoustic neurinoma is amenable to surgical resection resulting in a complete cure if detected at an early stage and if the tumour size is small. However, even after the surgery there may be hearing impairment on that side.

The Hindu

Baby bottle chemical label call

More information should be given to parents about a controversial chemical found in most plastic baby bottles, the National Childbirth Trust has said.

American scientists last month raised concerns about Bisphenol A, or BPA, which they say could cause behavioural changes and the early onset of puberty.

Some US retailers are to stop selling the bottles, while Canada wants a ban.

The National Childbirth Trust wants all UK bottles clearly labelled, but the government says they are safe to use. In April, the National Toxicology Program, part of the US National Institutes of Health, found that, based on animal experiments, exposure to low-levels of BPA “can cause changes in behaviour and the brain, prostate gland, mammary gland and the age at which females attain puberty”.

In the US, major chain stores, including Wal-Mart - the word’s largest retailer - say they are now going to stop selling bottles made with the chemical. In the UK, Wal-Mart subsidiary Asda is producing its own BPA-free range.

BPA is widely used in reusable plastic products to prevent them from shattering.

The National Childbirth Trust wants bottles containing BPA to be clearly labelled. Belinda Phipps, the charity’s chief executive, said the lack of awareness was “concerning”.

“As a first step, it is important that bottles and other items that might reach a baby’s mouth are labelled in a standard and easy-to-understand way. This will help to remove the risk of Bisphenol A contamination.”

The charity advised parents not to pour boiling water directly into a bottle, as this could cause more of the chemical to be released. It also said scratched and damaged bottles should be discarded.

The Food Standards Agency and the manufacturers say the amount of the chemical in such products is well below levels considered harmful and the bottles are completely safe to use.

- BBC News

Insulin boost for early diabetes

A short course of intensive insulin treatment may delay disease progression in people newly diagnosed with type 2 diabetes, a Chinese study suggests. Patients who had an initial course of insulin injections did better a year later than those given a short course of oral diabetes drugs.

All 380 patients in the Lancet trial were later managed with the standard diet and exercise regime. Diabetes UK said the approach may be useful for some patients. There are 2.35m people with diabetes in the UK, the vast majority of whom have type 2 diabetes - where the body does not produce enough insulin or the insulin that is produced does not work properly.

The research shows that considering using insulin early when people are first diagnosed with type 2 diabetes might be an additional way to achieve good diabetes management Pav Pank, Diabetes UK Normal management of the condition includes making lifestyle changes, with the addition of medication as necessary.

However, previous research has suggested that initial intensive therapy to get blood sugar levels under control could change or delay the natural course of the disease. Treatment boost Patients aged 25 to 70 taking part in the trial were given an infusion of insulin, daily insulin injections or oral anti-diabetic tablets.

The treatment was only given for two weeks after normal blood glucose levels were achieved. Most of those given insulin were able to meet blood glucose targets in four to five days compared with nine days in those given oral drugs.

After a year, 51% of patients given an insulin infusion and 45% of those given insulin injections had maintained their good blood glucose levels by sticking to a diet and exercise programme. But only 27% of those who had initially been treated with oral drugs still had good blood glucose control.

The researchers reported that the early insulin treatment seemed to have restored the function of insulin-producing beta cells in the body. Tests showed the cells had a better response to insulin after treatment and the effect was sustained after a year.

Study leader, Professor Jianping Weng, said good diabetes control, especially early intensive blood sugar control, can eliminate the damage caused by high blood sugar levels and rescue injured beta-cells.

Pav Pank, care advisor at Diabetes UK, said achieving good diabetes control is key to diabetes management and also helps prevent people with the condition from developing life-threatening complications such as heart disease, stroke, kidney disease, amputation and blindness.

“The research shows that considering using insulin early when people are first diagnosed with type 2 diabetes might be an additional way to achieve good diabetes management. “Nevertheless decisions about treatment need to be made on an individual basis for each patient.”

Professor Rury Holman, head of the Diabetes Trial Unit at Oxford University, said the research was “important” but more information was needed on different measures of diabetes control before a change in practice could be advocated.

BBC NEWS