Affective disorder

Also known as maniac depressive disorder, bipolar affective disorder or maniac depression, bipolar disorder is a lifelong condition that can be managed with appropriate treatment. People with bipolar disorder experience a change in their energy levels and activities along with severe mood swings. This disorder is aptly named bipolar disorder because the mood of a person varies between two opposite poles of euphoria and depression. The highly elevated mood episodes are known as mania or extremely sad moods are called depression. A patient suffering from bipolar disorder might experience mania, depression or a mixed feeling of both. A mild episode of elevated mood is known as hypomania. Normal mood persists in between episodes of mania and depression.

Bipolar I disorder: In this type of disorder, the patient has at least one episode of mania or mixed mood and often gets depressed. In between mood swings, the patient might appear to have normal mood. Mood swings can come about with changing seasons.

Bipolar II disorder: In this type of disorder, the patient has at least one episode of depression and at least one episode of hypomania. Hypomania is not a severe form of mania.

Cyclothymic Disorder: This is the mildest form of bipolar disorder. The patient experiences mild gloominess and somewhat elevated feelings. Mood swings are less severe and prevail for a short period of time. People with cyclothymic disorder might develop severe bipolar disorder with time.

Causes for affective disorder

Hereditary factor: Any relative from the patient's family might have been a victim of this disorder thus passing on the disorder.

Hormone level fluctuation: It is understood that varying hormonal levels in the body could lead to bipolar disorder. For e.g. people with altering thyroid hormone levels are prone to this disorder.

Brain part: Varying size and shape of parts in the brain can also lead to bipolar disorder.

Chemical imbalance in the brain: If the chemical levels in the brain are not at the optimum levels, it can result in bipolar disorder.

Treating Bipolar disorder

Bipolar disorder varies from person to person and so the treatment offered is also based on the current condition of the patient. Medications can help control extreme mood swings. Psychotherapy or talk therapy enables the patient to talk about his/her condition to the health professional.

Dementia

According to statistics, dementia affects about 36 million people globally and about 10% of people develop the disease at some point in their lives. It becomes more common with age. As more people are living longer, dementia is becoming more common in the population as a whole. Also known as Senility, dementia is a broad category of brain diseases that causes gradual decrease in the ability to think and remember. It is a collective term that is used to describe various underlying brain disorders or damage that can lead to memory loss, language and thinking.

While the likelihood of dementia increases with age, it is not to be misunderstood with normal part of aging. Light cognitive impairments and poorer short-term memory can happen as normal part of aging and this is known as age related cognitive decline and not dementia.
Alzheimer's disease is the best known and most common form of dementia, although there are others types including Vascular Dementia, Lewy Body Dementia and Frontotemporal dementia.

Causes

The loss or damage of nerve cells or neurons in the brain can cause dementia. Alzheimer's disease is the leading cause. Dementia can also be caused by head injury, a stroke or brain tumor. Brain cell death caused by conditions such as cerebrovascular disease like stroke can cause vascular dementia. This prevents adequate blood flow, depriving brain cells of oxygen.

Post traumatic dementia is directly related to brain cell death caused by injury. Some repetitive injuries suffered by sports players are linked to certain form of dementias appearing later in life. Dementia can also be caused by diseases such as Prion disease, from certain types of proteins, HIV infection, medication interactions, depression and vitamin deficiencies. A small proportion of dementia cases run in families.

Signs and symptoms

Other than the decrease in the ability to think and remember even daily functions, some common symptoms of dementia are:

• Emotional problems
  
• Problems with language, communication and forgetting simple words or using wrong ones
  
• Reduced motivation
  
• Recent memory loss – asking the same questions repeatedly
  
• Difficulty in completing familiar tasks – like making a drink or cooking a meal
  
• Disorientation with time and place, getting lost on a previously familiar street and not knowing to get home again
  
• Poor judgment and total distraction
  
• Problems with abstract thinking such as dealing with money
  
• Misplacing things and forgetting about doing this
  
• Mood swings and changes quickly through set of moods
  
• Personality changes and becoming irritable, suspicious and fearful
  
• Loss of initiative.

Diagnosis

The first thing is to assess memory performance and cognitive health. A healthcare professional would ask a set of questions to test knowledge of facts that should be known to any adult to get an indication whether there is dementia or not. The patient is asked to complete the standard tests, and answers are recorded to form a diagnostic indication. Tests to assess a person's mental ability are conducted and test scores are ascertained. Questions such as 'What is your age', 'What is the time', 'What is the year', Counting 20 backward etc are asked. One task for the patient is to write the hours of a clock face around a blank circle on a piece of paper and with accurate relative spacing. These cognitive tests measure dementia symptoms and other tests help to narrow down, if for example, it is Alzheimer's disease.

Treatment

As brain cell death cannot be reversed, there is no known treatment to cure a degenerative cause of dementia symptoms or fully halt its progress. The aim is to provide care and treat symptoms rather than their underlying cause and manage the disorder. If dementia symptoms are due to reversible, non-degenerative cause, treatment is possible to prevent or halt further brain tissue damage.

Symptoms of Alzheimer's can be reduced by drugs to improve the person's quality of life. Educating and providing emotional support is imperative. Exercise programs are beneficial. Treatment of behavioral problems of psychosis with antipsychotics is not usually recommended due to increased risk of death.

Prevention

Other than age which is the biggest predictor of dementia, certain risk factors are modifiable. These risk factors include:

• Smoking and alcohol usage
  
• Atherosclerosis
  
• High levels of bad cholesterol
  
• Above average blood levels of homocysteine, a type of amino acid
  
• Diabetes
  
• Mild cognitive impairment which can sometimes, if not always, lead to dementia.

Pick's Complex

This is a less common form of dementia, more prominent in those under the age 65. Frequently misdiagnosed as Alzheimer's disease, Pick's patients initially exhibit marked personality and behavioral changes. And gradually the ability to speak coherently declines.

Although there is no cure for Pick's complex presently, it can however be managed well and the quality of life improved. According to Arnold Pick, who first described the disease in 1892, Pick's disease causes an irreversible decline in a person's functioning for several years. Pick's affects adults between the ages of 40 and 60 and is more common in women than men.

Causes

The frontal and temporal lobes of the brain control a person's speech and personality. Excess protein build-up in these parts causes slow atrophy in these regions. The cause for this build-up of protein is unknown. Other than causing speech and behavioral changes, Pick's disease can also cause memory loss quite like those with Alzheimer's as well as socially inappropriate behavior, poor decision making, progressing to severe impairment in intellect, speech and memory. Some opine that Pick's disease may have a genetic or heredity component although not all family members are affected.

Symptoms of Pick's disease

The first sign of Pick's complex is personality changes and decline of basic functioning. Pick's can occur in an age earlier than Alzheimer's and memory loss need not be a predominant early sign of Pick's disease. Although there could be reports of Pick's occurring as young as 20 years of age, the progression is slower in Pick's disease. However, there are cases where symptoms could worsen over time and brain cells degenerate. More severe symptoms appear at later stages of Pick's. Some noticeable behavioral symptoms of Pick's disease are poor judgment, extreme restlessness especially in the early stages, overeating or drinking, lack of personal hygiene, sexual exhibitionism, decreased interest in daily activities and obsessive behavior.

Mood swings, lack of empathy, apathy, rudeness, impatience and aggression, easy distraction and being unaware of strange behavior and memory loss are some of the prominent emotional symptoms of Pick's disease. Loss of vocabulary, difficulty in speaking and understanding, uncoordinated speech and decrease in the ability to speak and write are some serious signs of Pick's.

Diagnosis of Pick's Complex

Other than careful symptomatic evaluation, brain scans and EEG, three of the following five characteristics are found to be present in the early stages. They include:

Onset before age 65
Personality changes
Lack of normal behavior / Loss of control
Lack of inhibition
Roaming behavior
When compared to Alzheimer's, memory loss and mental impairment occur later in Pick's.

Diet and activity

There should be a restriction on foods with high sugar content. There could be carbohydrate cravings in some. While in Alzheimer's and Parkinsons, a diet relatively high in fat and protein and low in carbohydrates is necessary, it is unclear if the same is recommended for Pick's complex. It is better to get a doctor's opinion on an appropriate heart-healthy diet. A regimen of therapeutic exercises such as brisk walking can help to regulate the patient's mood and benefit on cognitive function.

Treatment

Pick's disease, like any other dementia progresses rapidly and life gets shortened about six to eight years, although some do live for as long as twenty years. As currently there is no cure for Pick's like Alzheimer's, the aim is to maximize quality of life by way of medications to manage particular symptoms, regular supervision, and assistance.

Emotional and substantive support is an important aspect of the treatment. The family of the affected may help with the following control symptoms:

• Eyeglasses and hearing aids to bolster the failing senses.
  
• Positive behavior when symptoms set in by creating a calm and soothing atmosphere so that the patient feels safe and less anxious.
  
• Speech therapy or any other physical therapy that can improve communication and movement.
  
• Selective antidepressants that can provide some relief from apathy and depression and help reduce food cravings, impulse control and compulsive activity.
  
• Treatment for other disorders such as anemia, thyroid disorders and kidney or liver diseases.
  
• Stopping medications like paracetamol, NSAIDS, anti-cholergenics or changing them under medical guidance.

Tips for coping with Pick's complex

Being diagnosed with Pick's complex can be overwhelming especially when it involves any form of dementia. It is good to learn more about Pick's disease and frontotemporal dementia. In this way, more control can be exhibited and they will be better prepared to manage symptoms.

• Music therapy, meditation, deep breathing exercises can help control stress and anxiety.
  
• Pet therapy and visits from specially trained animals can help relieve stress and improve mood.
  
• Treating depression can make it easier to handle other challenges of the disease.
  
• Reaching out to family and friends for emotional support can help avoid isolation. A support group of similar patients can help overcome feelings of depression and isolation and provide a wealth of coping tips. Staying socially active will lighten the load and increase patient comfort.
  
• Playing cards and word games such as scrabble, crossword and Sudoku puzzles can exercise the brain and help slow cognitive decline.
  
• It would be wise for a Pick's patient to avoid medical, financial and legal confusion and instead create a design plan and discuss and document end-of-life preferences with doctors and family members.