Multiple sclerosis

Multiple sclerosis is an autoimmune disease that affects the brain and spinal cord (central nervous system).

Causes, incidence, and risk factors

Multiple sclerosis (MS) affects women more than men. The disorder is most commonly diagnosed between ages 20 and 40, but can be seen at any age. MS is caused by damage to the myelin sheath, the protective covering that surrounds nerve cells. When this nerve covering is damaged, nerve signals slow down or stop. The nerve damage is caused by inflammation. Inflammation occurs when the body's own immune cells attack the nervous system. This can occur along any area of the brain, optic nerve, and spinal cord. It is unknown what exactly causes this to happen. The most common thought is that a virus or gene defect, or both, are to blame. Environmental factors may play a role. You are slightly more likely to get this condition if you have a family history of MS or live in an part of the world where MS is more common.

Symptoms
Symptoms vary, because the location and severity of each attack can be different. Episodes can last for days, weeks, or months. These episodes alternate with periods of reduced or no symptoms (remissions). Fever, hot baths, sun exposure, and stress can trigger or worsen attacks. It is common for the disease to return (relapse). However, the disease may continue to get worse without periods of remission. Because nerves in any part of the brain or spinal cord may be damaged, patients with multiple sclerosis can have symptoms in many parts of the body. Muscle symptoms:

Loss of balance Muscle spasms Numbness or abnormal sensation in any area Problems moving arms or legs Problems walking Problems with coordination and making small movements

Tremor in one or more arms or legs Weakness in one or more arms or legs

Bowel and bladder symptoms:

Constipation and stool leakage Difficulty beginning to urinate Frequent need to urinate Strong urge to urinate Urine leakage (incontinence)

Eye symptoms:

Double vision Eye discomfort Uncontrollable rapid eye movements Vision loss (usually affects one eye at a time)

Numbness, tingling, or pain

Facial pain Painful muscle spasms Tingling, crawling, or burning feeling in the arms and legs

Other brain and nerve symptoms:

Decreased attention span, poor judgment, and memory loss Difficulty reasoning and solving problems Depression or feelings of sadness Dizziness and balance problems Hearing loss

Sexual symptoms:

Problems with erections Problems with vaginal lubrication

Speech and swallowing symptoms:

Slurred or difficult-to-understand speech Trouble chewing and swallowing

Fatigue is a common and bothersome symptoms as MS progresses. It is often worse in the late afternoon.

Signs and tests

Symptoms of MS may mimic those of many other nervous system disorders. The disease is diagnosed by ruling out other conditions. People who have a form of MS called relapsing-remitting may have a history of at least two attacks, separated by a period of reduced or no symptoms. The health care provider may suspect MS if there are decreases in the function of two different parts of the central nervous system (such as abnormal reflexes) at two different times. A neurological exam may show reduced nerve function in one area of the body, or spread over many parts of the body. This may include:

Abnormal nerve reflexes Decreased ability to move a part of the body Decreased or abnormal sensation Other loss of nervous system functions

An eye examination may show:

Abnormal pupil responses Changes in the visual fields or eye movements Decreased visual acuity Problems with the inside parts of the eye Rapid eye movements triggered when the eye moves

Tests to diagnose multiple sclerosis include:

Lumbar puncture (spinal tap) for cerebrospinal fluid tests, including CSF oligoclonal banding MRI scan of the brain and MRI scan of the spine are important to help diagnose and follow MS Nerve function study (evoked potential test)

Treatment
There is no known cure for multiple sclerosis at this time. However, there are therapies that may slow the disease. The goal of treatment is to control symptoms and help you maintain a normal quality of life. Medications used to slow the progression of multiple sclerosis are taken on a long-term basis, they include:

Interferons (Avonex, Betaseron, or Rebif), glatiramer acetate (Copaxone), mitoxantrone (Novantrone), and natalizumab (Tysabri) Fingolimod (Gilenya ) Methotrexate, azathioprine (Imuran), intravenous immunoglobulin (IVIg) and cyclophosphamide (Cytoxan) may also be used if the above drugs are not working well

Steroids may be used to decrease the severity of attacks. Medications to control symptoms may include:

Medicines to reduce muscle spasms such as Lioresal (Baclofen), tizanidine (Zanaflex), or a benzodiazepine Cholinergic medications to reduce urinary problems Antidepressants for mood or behavior symptoms Amantadine for fatigue

For more information see:

Neurogenic bladder Bowel retraining

The following may also be helpful for people with MS:

Physical therapy, speech therapy, occupational therapy, and support groups Assistive devices, such as wheelchairs, bed lifts, shower chairs, walkers, and wall bars A planned exercise program early in the course of the disorder A healthy lifestyle, with good nutrition and enough rest and relaxation Avoiding fatigue, stress, temperature extremes, and illness Changes in what you eat or drink if there are swallowing problems Making changes around the home to prevent falls Social workers or other counseling services to help you cope with the disorder and get assistance (such as Meals-on-Wheels)

For more information about living with MS, see: Multiple sclerosis - at home Household changes to ensure safety and ease in moving around the home are often needed.

Support Groups
For additional information, see multiple sclerosis resources.

Expectations (prognosis)
The outcome varies, and is hard to predict. Although the disorder is chronic and incurable, life expectancy can be normal or almost normal. Most people with MS continue to walk and function at work with minimal disability for 20 or more years. The following typically have the best outlook:

Females People who were young (less than 30 years) when the disease started People with infrequent attacks People with a relapsing-remitting pattern People who have limited disease on imaging studies

The amount of disability and discomfort depends on:

How often you have attacks How severe they are The part of the central nervous system that is affected by each attack

Most people return to normal or near-normal function between attacks. Slowly, there is greater loss of function with less improvement between attacks. Over time, many require a wheelchair to get around and have a more difficult time transferring out of the wheelchair. Those with a support system are often able to remain in their home.

Complications

Depression Difficulty swallowing Difficulty thinking Less and less ability to care for self Need for indwelling catheter Osteoporosis or thinning of the bones Pressure sores Side effects of medications used to treat the disorder Urinary tract infections

Calling your health care provider

Call your health care provider if:

You develop any symptoms of MS Symptoms get worse, even with treatment The condition deteriorates to the point where home care is no longer possible

Dementia
Chronic brain syndrome; Lewy body dementia; DLB; Vascular dementia; Mild cognitive impairment; MCI dementia is a loss of brain function that occurs with certain diseases. It affects memory, thinking, language, judgment, and behavior

Causes, incidence, and risk factors

Most types of dementia are nonreversible (degenerative). Nonreversible means the changes in the brain that are causing the dementia cannot be stopped or turned back. Alzheimer's disease is the most common type of dementia. Lewy body disease is a leading cause of dementia in elderly adults. People with this condition have abnormal protein structures in certain areas of the brain. Dementia also can be due to many small strokes. This is called vascular dementia. The following medical conditions also can lead to dementia:

Huntington's disease Multiple sclerosis Infections that can affect the brain, such as HIV /AIDS and Lyme disease Parkinson's disease Pick's disease Progressive supranuclear palsy

Some causes of dementia may be stopped or reversed if they are found soon enough, including:

Brain injury Brain tumors Chronic alcohol abuse Changes in blood sugar, sodium, and calcium levels (see: Dementia due to metabolic causes) Low vitamin B12 levels Normal pressure hydrocephalus Use of certain medications, including cimetadine and some cholesterol-lowering medications

Dementia usually occurs in older age. It is rare in people under age 60. The risk for dementia increases as a person gets older.

Symptoms
Dementia symptoms include difficulty with many areas of mental function, including:

Language Memory Perception Emotional behavior or personality Cognitive skills (such as calculation, abstract thinking, or judgment)

Dementia usually first appears as forgetfulness. Mild cognitive impairment is the stage between normal forgetfulness due to aging and the development of dementia. People with MCI have mild problems with thinking and memory that do not interfere with everyday activities. They are often aware of the forgetfulness. Not everyone with MCI develops dementia. Symptoms of MCI include:

Difficulty performing more than one task at a time Difficulty solving problems or making decisions Forgetting recent events or conversations Taking longer to perform more difficult mental activities

The early symptoms of dementia can include:

Difficulty performing tasks that take some thought, but that used to come easily, such as balancing a checkbook, playing games (such as bridge), and learning new information or routines Getting lost on familiar routes Language problems, such as trouble finding the name of familiar objects Losing interest in things you previously enjoyed, flat mood Misplacing items Personality changes and loss of social skills, which can lead to inappropriate behaviors

As the dementia becomes worse, symptoms are more obvious and interfere with the ability to take care of yourself. The symptoms may include:

Change in sleep patterns, often waking up at night Difficulty doing basic tasks, such as preparing meals, choosing proper clothing, or driving Forgetting details about current events Forgetting events in your own life history, losing awareness of who you are Having hallucinations, arguments, striking out, and violent behavior Having delusions, depression, agitation

More difficulty reading or writing Poor judgment and loss of ability to recognize danger Using the wrong word, not pronouncing words correctly, speaking in confusing sentences Withdrawing from social contact

People with severe dementia can no longer:

Perform basic activities of daily living, such as eating, dressing, and bathing Recognize family members Understand language

Other symptoms that may occur with dementia:

Incontinence Swallowing problems

Signs and tests

A skilled health care provider can often diagnose dementia by performing a physical exam and asking questions about the person's medical history. The physical exam will include a neurological exam. Tests to check mental function will be done. This is called a mental status examination. Other tests may be ordered to determine whether other problems could be causing dementia or making it worse. These conditions include:

Anemia Brain tumor Chronic infection Intoxication from medications Severe depression Thyroid disease Vitamin deficiency

The following tests and procedures may be done:

B12 level Blood ammonia levels Blood chemistry (chem-20) Blood gas analysis Cerebrospinal fluid (CSF) analysis Drug or alcohol levels (toxicology screen) Electroencephalograph (EEG) Head CT

Mental status test MRI of head Thyroid function tests Thyroid stimulating hormone level Urinalysis

Treatment
Treatment depends on the condition causing the dementia. Some people may need to stay in the hospital for a short time. Stopping or changing medications that make confusion worse may improve brain function. There is growing evidence that some kinds of mental exercises can help dementia. Treating conditions that can lead to confusion often greatly improve mental functioning. Such conditions include:

Anemia Congestive heart failure Decreased blood oxygen (hypoxia) Depression Heart failure Infections Nutritional disorders Thyroid disorders

Medications may be needed to control behavior problems caused by a loss of judgment, increased impulsivity, and confusion. Possible medications include:

Antipsychotics (haloperidol, risperidone, olanzapine) Mood stabilizers (fluoxetine, imipramine, citalopram) Stimulants (methylphenidate)

Certain drugs may be used to slow the rate at which symptoms worsen. The benefit from these drugs is often small, and patients and their families may not always notice much of a change.

Donepezil (Aricept), rivastigmine (Exelon), galantamine (Razadyne, formerly called Reminyl) Memantine (Namenda)

A person's eyes and ears should be checked regularly. Hearing aids, glasses, or cataract surgery may be needed.

Psychotherapy or group therapy usually does not help because it may cause more confusion. For information on how to take care of a loved one with dementia, see: Dementia - home care

Expectations (prognosis)
People with mild cognitive impairment do not always develop dementia. However, when dementia does occur, it usually gets worse and often decreases quality of life and lifespan.

Complications
Complications depend on the cause of the dementia, but may include the following:

Abuse by an overstressed caregiver Increased infections anywhere in the body Loss of ability to function or care for self Loss of ability to interact Reduced lifespan Side effects of medications used to treat the disorder

Calling your health care provider

Call your health care provider if:

Dementia develops or a sudden change in mental status occurs The condition of a person with dementia gets worse You are unable to care for a person with dementia at home

Prevention
Most causes of dementia are not preventable. Quitting smoking and controlling high blood pressure and diabetes can help you reduce your risk of vascular dementia. This is dementia caused by a series of small strokes. Eating a low-fat diet and exercising regularly may also reduce the risk of vascular dementia.

Migraine
Headache - migraine A migraine is a common type of headache that may occur with symptoms such as nausea, vomiting, or sensitivity to light. In many people, a throbbing pain is felt only on one side of the head.

Some people who get migraines have warning symptoms, called an aura, before the actual headache begins. An aura is a group of symptoms, including vision disturbances, that are a warning sign that a bad headache is coming.

Causes, incidence, and risk factors

Migraine headaches tend to first appear between the ages of 10 and 45. Sometimes they may begin later in life.

Migraines occur more often in women than men Migraines may run in families Some women, but not all, may have fewer migraines when they are pregnant

A migraine is caused by abnormal brain activity, which can be triggered by a number of factors. However, the exact chain of events remains unclear. Today, most medical experts believe the attack begins in the brain, and involves nerve pathways and chemicals. The changes affect blood flow in the brain and surrounding tissues. Alcohol, stress and anxiety, certain odors or perfumes, loud noises or bright lights, and smoking may trigger a migraine. Migraine attacks may also be triggered by:

Caffeine withdrawal Changes in hormone levels during a woman's menstrual cycle or with the use of birth control pills Changes in sleep patterns Exercise or other physical stress Missed meals Smoking or exposure to smoke

Migraine headaches can be triggered by certain foods. The most common are:

Any processed, fermented, pickled, or marinated foods, as well as foods that contain monosodium glutamate (MSG) Baked goods, chocolate, nuts, peanut butter, and dairy products Foods containing tyramine, which includes red wine, aged cheese, smoked fish, chicken livers, figs, and certain beans Fruits (avocado, banana, citrus fruit) Meats containing nitrates (bacon, hot dogs, salami, cured meats) Onions

This list may not include all triggers. True migraine headaches are not a result of a brain tumor or other serious medical problem. However, only an experienced health care provider can determine whether your symptoms are due to a migraine or another condition.

Symptoms
Vision disturbances, or aura, are considered a "warning sign" that a migraine is coming. The aura occurs in both eyes and may involve any or all of the following:

A temporary blind spot Blurred vision Eye pain Seeing stars or zigzag lines Tunnel vision

Other warning signs include yawning, difficulty concentrating, nausea, and trouble finding the right words. Not every person with migraines has an aura. Those who do usually develop one about 10 15 minutes before the headache. However, an aura may occur just a few minutes to 24 hours beforehand. A headache may not always follow an aura. Migraine headaches can be dull or severe. The pain may be felt behind the eye or in the back of the head and neck. For many patients, the headaches start on the same side each time. The headaches usually:

Feel throbbing, pounding, or pulsating Are worse on one side of the head Start as a dull ache and get worse within minutes to hours Last 6 to 48 hours

Other symptoms that may occur with the headache include:

Chills Increased urination Fatigue Loss of appetite Nausea and vomiting Numbness, tingling, or weakness Problems concentrating, trouble finding words Sensitivity to light or sound Sweating

Symptoms may linger even after the migraine has gone away. Patients with migraine sometimes call this a migraine "hangover." Symptoms can include:

Feeling mentally dull, like your thinking is not clear or sharp Increased need for sleep Neck pain

Signs and tests

Your doctor can diagnose this type of headache by asking questions about your symptoms and family history of migraines. A complete physical exam will be done to determine if your headaches are due to muscle tension, sinus problems, or a serious brain disorder. There is no specific test to prove that your headache is actually a migraine. However, your doctor may order a brain MRI or CT scan if you have never had one before or if you have unusual symptoms with your migraine, including weakness, memory problems, or loss of alertness. An EEG may be needed to rule out seizures. A lumbar puncture (spinal tap) might be done.

Treatment
There is no specific cure for migraine headaches. The goal is to treat your migraine symptoms right away, and to prevent symptoms by avoiding or changing your triggers. A key step involves learning how to manage your migraines at home. A headache diary can help you identify your headache triggers. Then you and your doctor can plan how to avoid these triggers. If you have frequent migraines, your doctor may prescribe medicine to reduce the number of attacks. You need to take the medicine every day for it to be effective. Medications may include:

Antidepressants such as amitriptyline or venlafaxine Blood pressure medicines such as beta blockers (propanolol) or calcium channel blockers (verapamil) Seizure medicines such as valproic acid, gabapentin, and topiramate

Botulinum toxin (Botox) injections may also help reduce migraine attacks. TREATING AN ATTACK Other medicines are taken at the first sign of a migraine attack. Over-the-counter pain medications such as acetaminophen, ibuprofen, or aspirin are often helpful when your migraine is mild. Be aware, however, that:

Taking medicines more than 3 days a week may lead to rebound headaches -headaches that keep coming back. Taking too much acetaminophen can damage your liver. Too much ibuprofen or aspirin can irritate your stomach.

If these treatments don't help, ask your doctor about prescription medicines. These include nasal sprays, suppositories, or injections. Your doctor can select from several different types of medications, including:

Triptans -- prescribed most often for stopping migraine attacks Ergots -- contain different forms of ergotamine Isometheptene (Midrin)

Some migraine medicines narrow your blood vessels. If you are at risk for heart attacks or have heart disease, talk with your health care provider before using these medicines. Do not take ergots if you are pregnant or planning to become pregnant. Other medications are given to treat the symptoms of migraine. They may be used alone or along with other drugs. Medications in this group include:

Nausea medicines Sedatives such as butalbital Narcotic pain relievers

Feverfew is a popular herb for migraines. Several studies, but not all, support using feverfew for treating migraines. If you are interested in trying feverfew, make sure your doctor approves. Also, know that herbal remedies sold in drugstores and health food stores are not regulated. Work with a trained herbalist when selecting herbs.

Support Groups
American Council for Headache Education - www.achenet.org The National Migraine Association - www.migraines.org National Headache Foundation - www.headaches.org

Expectations (prognosis)
Every person responds differently to treatment. Some people have rare headaches that need little to no treatment. Others need to take several medications or even go to the hospital sometimes. Migraine headache is a risk factor for stroke in both men and women. The risk is higher in people who have migraines that occur with aura. People with migraines should avoid other risk factors for stroke, include smoking, taking birth control pills, and eating an unhealthy diet. Also, call your doctor if:

Your headache patterns or pain change

Treatments that once worked are no longer helpful You have side effects from medication, including irregular heartbeat, pale or blue skin, extreme sleepiness, persistent cough, depression, fatigue, nausea, vomiting, diarrhea, constipation, stomach pain, cramps, dry mouth, or extreme thirst You are pregnant or could become pregnant -- some medications should not be taken when pregnant

See the general article on headaches for more information on emergency symptoms

Depression
Depression may be described as feeling sad, blue, unhappy, miserable, or down in the dumps. Most of us feel this way at one time or another for short periods. True clinical depression is a mood disorder in which feelings of sadness, loss, anger, or frustration interfere with everyday life for weeks or longer.

Causes, incidence, and risk factors

The exact cause of depression is not known. Many researchers believe it is caused by chemical changes in the brain. This may be due to a problem with your genes, or triggered by certain stressful events. More likely, it's a combination of both. Some types of depression run in families. But depression can also occur if you have no family history of the illness. Anyone can develop depression, even kids. The following may play a role in depression:

Alcohol or drug abuse Certain medical conditions, including underactive thyroid, cancer, or long-term pain Certain medications such as steroids Sleeping problems Stressful life events, such as: o Breaking up with a boyfriend or girlfriend o Failing a class o Death or illness of someone close to you o Divorce o Childhood abuse or neglect o Job loss o Social isolation (common in the elderly)

See also: Adolescent depression

Symptoms
Depression can change or distort the way you see yourself, your life, and those around you. People who have depression usually see everything with a more negative attitude, unable to imagine that any problem or situation can be solved in a positive way. Symptoms of depression can include:

Agitation, restlessness, and irritability Dramatic change in appetite, often with weight gain or loss Very difficult to concentrate Fatigue and lack of energy Feelings of hopelessness and helplessness Feelings of worthlessness, self-hate, and guilt Becoming withdrawn or isolated Loss of interest or pleasure in activities that were once enjoyed Thoughts of death or suicide Trouble sleeping or excessive sleeping

Depression can appear as anger and discouragement, rather than feelings of sadness. If depression is very severe, there may also be psychotic symptoms, such as hallucinations and delusions.

Signs and tests

Your health care provider will ask questions about your medical history and symptoms. Your answers and certain questionairres can help your doctor make a diagnosis of depression and determine how severe it may be. Blood and urine tests may be done to rule out other medical conditions with symptoms similiar to depression.

Treatment
In general, treatments for depression include:

Medications called antidepressants Talk therapy, called psychotherapy

If you have mild depression, you may only need one of these treatments. People with more severe depression usually need combination of both treatments. It takes time to feel better, but there are usually day-to-day improvements.

If you are suicidal or extremely depressed and cannot function you may need to be treated in a psychiatric hospital. MEDICATIONS FOR DEPRESSION Drugs used to treat depression are called antidepressants. Common types of antidepressants include:

Selective serotonin re-uptake inhibitors (SSRIs), including fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), fluvoxamine (Luvox), citalopram (Celexa), and escitalopram (Lexapro). Serotonin norepinephrine reuptake inhibitors (SNRIs), including desvenlafaxine (Pristiq), venlafaxine (Effexor), and duloxetine (Cymbalta).

Other medicines used to treat depression include:

Tricyclic antidepressants Bupropion (Wellbutrin) Monoamine oxidase inhibitors

If you have delusions or hallucinations, your doctor may prescribe additional medications. WARNING: Children, adolescents, and young adults should be watched more closely for suicidal behavior, especially during the first few months after starting medications. If you do not feel better with antidepressants and talk therapy, you may have treatmentresistant depression. Your doctor will often prescribe higher (but still safe) doses of an antidepressant, or a combination of medications. Lithium and thyroid hormone supplements also may be added to help the antidepressants work better. St. John's wort is an herb sold without a prescription. It may help some people with mild depression. However, it can change the way other medicines work in your body, including antidepressants and birth control pills. Talk to your doctor before trying this herb. CHANGES IN MEDICATIONS Sometimes, medications that you take for another health problem can cause or worsen depression. Talk to your doctor about all the medicines you take. Your doctor may recommend changing your dose or switching to an alternative drug. Never stop taking your medications without first talkingt o your doctor. Women being treated for depression who are pregnant or thinking about becoming pregnant should not stop taking antidepressants without first talking to their doctors. TALK THERAPY

Talk therapy is counseling to talk about your feelings and thoughts, and help you learn how to deal with them. Types of talk therapy include:

Cognitive behavioral therapy teaches you how to fight off negative thoughts. You will learn how to become more aware of your symptoms and how to spot things that make your depression worse. You'll also be taught problem-solving skills. Psychotherapy can help you understand the issues that may be behind your thoughts and feelings. Joining a support group of people who are sharing problems like yours can also help. Ask your therapist or doctor for a recommendation.

OTHER TREATMENTS FOR DEPRESSION

Electroconvulsive therapy (ECT) is the single most effective treatment for severe depression and it is generally safe. ECT may improve mood in those with severe depression or suicidal thoughts who don't get better with other treatments. It may also help treat depression in those who have psychotic symptoms. Transcranial magnetic stimulation (TMS) uses pulses of energy to stimulate nerve cells in the brain that are believe to affect mood. There is some research to suggest that it can help relieve depression. Light therapy may relieve depression symptoms in the winter time. However, it is usually not considered a first-line treatment.

Support Groups
You can often ease the stress of illness by joining a support group whose members share common experiences and problems. See: Depression support group

Expectations (prognosis)
Some people with major depression may feel better after taking antidepressants for a few weeks. However, many people need to take the medicine for 4 - 9 months to fully feel better and prevent the depression from returning. For people who have repeated episodes of depression, quick and ongoing treatment may be needed to prevent more severe, long-term depression. Sometimes people will need to stay on medications for long periods of time.

Complications
People who are depressed are more likely to use alcohol or illegal substances.

Complications of depression also include:

Increased risk of physical health problems Suicide

Prevention
Do not drink alcohol or use illegal drugs. These substances can make depression worse and might lead to thoughts of suicide. Take your medication exactly as your doctor instructed. Ask your doctor about the possible side effects and what you should do if you have any. Learn to recognize the early signs that your depression is getting worse. The following tips might help you feel better:

Get more exercise Maintain good sleep habits Seek out activities that bring you pleasure Volunteer or get involved in group activities Talk to someone you trust about how you are feeling Try to be around people who are caring and positive

Schizophrenia
Childhood-onset schizophrenia Schizophrenia is a complex mental disorder that makes it difficult to:

Tell the difference between real and unreal experiences Think logically Have normal emotional responses, Behave normally in social situations

Causes, incidence, and risk factors

Schizophrenia is a complex illness. Mental health experts are not sure what causes it. However, genetic factors appear to play a role.

Certain environmental events may trigger schizophrenia in people who are genetically at risk for it. You are more likely to develop schizophrenia if you have a family member with the disease.

Schizophrenia affects both men and women equally. It usually begins in the teen years or young adulthood, but may begin later in life. It tends to begin later in women, and is more mild. Childhood-onset schizophrenia begins after age 5. Childhood schizophrenia is rare and can be difficult to tell apart from other developmental disorders of childhood, such as autism.

Symptoms
Schizophrenia symptoms usually develop slowly over months or years. Sometimes you may have many symptoms, and at other times you may only have a few. People with any type of schizophrenia may have difficulty keeping friends and working. They may also have problems with anxiety, depression, and suicidal thoughts or behaviors. At first, you may have the following symptoms:

Irritable or tense feeling Difficulty sleeping Difficulty concentrating

As the illness continues, problems with thinking, emotions and behavior develop, including:

Lack of emotion (flat affect) Strongly held beliefs that are not based in reality (delusions) Hearing or seeing things that are not there (hallucinations) Problems paying attention Thoughts "jump" between unrelated topics ( loose associations) Bizarre behaviors Social isolation

Symptoms can vary, depending on the type of schizophrenia you have. Paranoid schizophrenia symptoms may include:

Anxious Angry or argumentative False believes that others are trying to harm you or your loved ones.

Disorganized schizophrenia symptoms may include:

Problems with thinking and expressing ideas clearly Childlike behavior Showing little emotion

Catatonic schizophrenia symptoms may include:

Lack of activity Muscles and posture may be rigid Grimaces or other odd expressions on the face Does not respond much to other people

Undifferentiated schizophrenia symptoms may include symptoms of more than one other type of schizophrenia. People with residual schizophrenia have some symptoms, but not as many as those who are in a full-blown episode of schizophrenia.

Signs and tests

There are no medical tests to diagnose schizophrenia. A psychiatrist should examine the patient to make the diagnosis. The diagnosis is made based on a thorough interview of the person and family members. The doctor will ask questions about:

How long the symptoms have lasted How the person's ability to function has changed Developmental background Genetic and family history How well medications have worked

Brain scans (such as CT or MRI) and blood tests may help to rule out other disorders that have similar symptoms to schizophrenia.

Treatment
During an episode of schizophrenia, you may need to stay in the hospital for safety reasons. MEDICATIONS Antipsychotic medications are the most effective treatment for schizophrenia. They change the balance of chemicals in the brain and can help control symptoms/ These medications are usually helpful, but they can cause side effects. Many of these side effects can be improved, and should not prevent people from seeking treatment for this serious condition. Common side effects from antipsychotics may include:

Sleepiness (sedation) Dizziness Weight gain

Increased chance of diabetes and high cholesterol Feelings of restlessness or "jitters" Slowed movements Tremor

Long-term use of antipsychotic medications may increase your risk for a movement disorder called tardive dyskinesia. This condition causes repeated movements that you cannot control, especially around the mouth. Call your doctor right away if you think you may have this condition. When schizophrenia does not improve with several antipsychotics, the medication clozapine can be helpful. Clozapine is the most effective medication for reducing schizophrenia symptoms, but it also tends to cause more side effects than other antipsychotics. Schizophrenia is a life-long illness. Most people with this condition need to stay on antipsychotic medication for life. SUPPORT PROGRAMS AND THERAPIES Supportive therapy may be helpful for many people with schizophrenia. Behavioral techniques, such as social skills training, can be used to improve social and work functioning. Job-training and relationship building classes are important. Family members of a person with schizophrenia should be educated about the disease and offered support. Programs that emphasize outreach and community support services can help people who lack family and social support. Family members and caregivers are often encouraged to help people with schizophrenia stick to their treatment. It is important that the person with schizophrenia learns how to:

Take medications correctly and how to manage side effects Notice the early signs of a relapse and what to do if symptoms return Cope with symptoms that occur even while taking medication. A therapist can help. Manage money Use public transportation

Expectations (prognosis)
The outlook for a person with schizophrenia is difficult to predict. Most of the time, symptoms improve with medication. However, others may have difficulty functioning and are at risk for repeated episodes, especially during the early stages of the illness.

People with schizophrenia may need supported housing, job training, and other community support programs. People with the most severe forms of this disorder may not be able to live alone. Group homes or other long-term, structured places to live may be needed. Symptoms will return if a person with schizophrenia does not take their medication.

Complications
Having schizophrenia increases your risk for:

Developing a problem with alcohol or drugs: This is called a substance abuse problem. Using alcohol or other drugs increases the chances your symptoms will return. Physical illness: People with schizophrenia may become physically sick, because of an inactive lifestyle and side effects from medication. A physical illness may not be detected because of poor access to medical care and difficulties talking to health care providers. Suicide

Prevention
There is no known way to prevent schizophrenia. Symptoms can be prevented by taking medication. You should take your medication exactly as your doctor told you to. Symptoms will return if you stop taking your medication. Always talk to your doctor if you are thinking about changing or stopping your medications. See your doctor or therapist regularly.

Psychosis
Psychosis is a loss of contact with reality, usually including false beliefs about what is taking place or who one is (delusions) and seeing or hearing things that aren't there (hallucinations).

Causes, incidence, and risk factors

A number of substances and medical conditions can cause psychosis, including:

Alcohol and certain illegal drugs, both during use and during withdrawal Brain tumors or cysts Dementia (including Alzheimer's disease) Degenerative brain diseases, such as Parkinson's disease, Huntington's disease, and certain chromosomal disorders

HIV and other infections that affect the brain Some prescription drugs, such as steroids and stimulants Some types of epilepsy Stroke

Psychosis is also part of a number of psychiatric disorders, including:

Bipolar disorder (manic or depressed) Delusional disorder Depression with psychotic features Personality disorders (schizotypal, shizoid, paranoid, and sometimes borderline) Schizoaffective disorder Schizophrenia

Symptoms
Psychotic symptoms may include:

Disorganized thought and speech False beliefs that are not based in reality (delusions), especially unfounded fear or suspicion Hearing, seeing, or feeling things that are not there (hallucinations) Thoughts that "jump" between unrelated topics (disordered thinking)

Signs and tests

Psychiatric evaluation and testing are used to diagnose the cause of the psychosis. Laboratory testing and brain scans may not be needed, but sometimes can help pinpoint the diagnosis. Tests may include:

Blood tests for abnormal electrolyte and hormone levels Blood tests for syphilis and other infections Drug screens MRI of the brain

Treatment
Treatment depends on the cause of the psychosis. Care in a hospital is often needed to ensure the patient's safety. Antipsychotic drugs, which reduce hallucinations and delusions and improve thinking and behavior are helpful, whether the cause is a medical or psychiatric disorder. See: Schizophrenia for more information about the treatment of psychosis.

Expectations (prognosis)
How well a person does depends on the cause of the psychosis. If the cause can be corrected, the outlook is often good, and treatment with antipsychotic medication may be brief. Some chronic conditions, such as schizophrenia, may need life-long treatment with antipsychotic medications to control symptoms.

Complications
Psychosis can prevent people from functioning normally and caring for themselves. If the condition is left untreated, people can sometimes harm themselves or others.

Prevention
Prevention depends on the cause. For example, avoiding alcohol abuse prevents alcoholinduced psychosis.

Epilepsy
Temporal lobe epilepsy; Seizure disorder

Epilepsy is a brain disorder in which a person has repeated seizures (convulsions) over time. Seizures are episodes of disturbed brain activity that cause changes in attention or behavior.

Causes, incidence, and risk factors

Epilepsy occurs when permanent changes in brain tissue cause the brain to be too excitable or jumpy. The brain sends out abnormal signals. This results in repeated, unpredictable seizures. (A single seizure that does not happen again is not epilepsy.) Epilepsy may be due to a medical condition or injury that affects the brain, or the cause may be unknown (idiopathic). Common causes of epilepsy include:

Stroke or transient ischemic attack (TIA) Dementia, such as Alzheimer's disease Traumatic brain injury Infections, including brain abscess, meningitis, encephalitis, and AIDS Brain problems that are present at birth (congenital brain defect) Brain injury that occurs during or near bith Metabolism disorders that a child may be born with (such as phenylketonuria) Brain tumor Abnormal blood vessels in the brain Other illness that damage or destroy brain tissue

Epilepsy seizures usually begin between ages 5 and 20, but they can happen at any age. There may be a family history of seizures or epilepsy.

Symptoms
Symptoms vary from person to person. Some people may have simple staring spells, while others have violent shaking and loss of alertness. The type of seizure depends on the part of the brain affected and cause of epilepsy. Most of the time, the seizure is similar to the previous one. Some people with epilepsy have a strange sensation (such as tingling, smelling an odor that isn't actually there, or emotional changes) before each seizure. This is called an aura. For a detailed description of the symptoms associated with a specific type of seizure, see:

Absence (petit mal) seizure Generalized tonic-clonic (grand mal) seizure Partial (focal) seizure

Signs and tests

The doctor will perform a physical exam, which will include a detailed look at the brain and nervous system. An EEG (electroencephalogram) will be done to check the electrical activity in the brain. People with epilepsy will often have abnormal electrical activity seen on this test. In some cases, the test may show the area in the brain where the seizures start. The brain may appear normal after a seizure or between seizures. To diagnose epilepsy or plan for epilepsy surgery:

You may need to wear an EEG recorder for days or weeks while you go about your everyday life. You may need to stay in a special hospital where brain activity can be be watched on video cameras. This is called video EEG.

Tests that may be done include:

Blood chemistry Blood sugar CBC (complete blood count) Kidney function tests Liver function tests Lumbar puncture (spinal tap) Tests for infectious diseases

Head CT or MRI scan often done to find the cause and location of the problem in the brain.

Treatment
Treatment for epilepsy may involve surgery or medication. If epilepsy seizures are due to a tumor, abnormal blood vessels, or bleeding in the brain, surgery to treat these disorders may make the seizures stop. Medication to prevent seizures, called anticonvulsants, may reduce the number of future seizures.

These drugs are taken by mouth. Which type you are prescribed depends on the type of seizures you have. Your dosage may need to be changed from time to time. You may need regular blood tests to check for side effects. Always take your medication on time and as directed. Missing a dose can cause you to have a seizure. Never not stop taking or change medications without talking to your doctor first.

Many epilepsy medications cause birth defects. Women wishing to become pregnant should tell the doctor in advance in order to adjust medications.

Epilepsy that does not get better after two or three anti-seizure drugs have been tried is called "medically refractory epilepsy."

Surgery to remove the abnormal brain cells causing the seizures may be helpful for some patients. Surgery to place a vagus nerve stimulator (VNS) may be recommended. This device is similiar to a heart pacemaker. It can help reduce the number of seizures.

Sometimes, children are placed on a special diet to help prevent seizures. The most popular one is the ketogenic diet. A diet low in carbohydrates, such as the Atkins diet, may also be helpful in some adults. Lifestyle or medical changes can increase the risk for a seizure in a person with epilepsy. Talk with your doctor about:

New prescribed medications, vitamins, or supplements Emotional stress Illness, especially infection Lack of sleep Pregnancy Skipping doses of epilepsy medications Use of alcohol or other recreational drugs

Other considerations:

Persons with epilepsy should wear medical alert jewelry so that prompt medical treatment can be obtained if a seizure occurs. Persons with poorly controlled epilepsy should not drive. Each state has a different law about which people with a history of seizures are allowed to drive. Also avoid machinery or activities where loss of awareness would cause great danger, such as climbing to high places, biking, and swimming alone.

See also: Seizures - first aid.

Support Groups
The stress caused by having epilepsy (or being a caretaker of someone with epilepsy) can often be helped by joining a support group. In these groups, members share common experiences and problems. See: Epilepsy - support group

Expectations (prognosis)
Some people with epilepsy may be able to reduce or even stop their anti-seizure medicines after having no seizures for several years. Certain types of childhood epilepsy go away or improve with age, usually in the late teens or 20s. For many people, epilepsy is a lifelong condition. In these cases, the anti-seizure drugs need to be continued. There is a very low risk of sudden death with epilepsy. However, serious injury can occur if a seizure occurs during driving or when operating equipment.

Complications

Difficulty learning Breathing in food or saliva into the lungs during a seizure, which can cause aspiration pneumonia Injury from falls, bumps, self-inflicted bites, driving or operating machinery during a seizure Permanent brain damage (stroke or other damage) Side effects of medications

Prevention
Generally, there is no known way to prevent epilepsy. However, proper diet and sleep, and staying away from illegal drugs and alcohol, may decrease the likelihood of triggering seizures in people with epilepsy. Reduce the risk of head injury by wearing helmets during risky activities; this can help lessen the chance of developing epilepsy. Persons with uncontrolled seizures should not drive. Each state has a different law that determines which people with a history of seizures are allowed to drive. If you have uncontrolled seizures, you should also avoid activities where loss of awareness would cause great danger, such as climbing to high places, biking, and swimming alone