[Medical Information] Psychological Symptoms and Their Management

 

Psychological Symptoms and Their Management

Depression: Before suspecting depression, hypothyroidism, Cushing's syndrome, electrolyte abnormality, and uses of other medications are should be excluded. Also, before depression medication, what can cause depression such as pain should be treated first. When depression is diagnosed, medication is a important therapy. Usually, SSRI, SNRI are used. With medication, nonpharmacologic interventions such as counseling can be helpful.

 

Delirium: Delirium is a global cerebral dysfunction characterized by alterations in cognition and consciousness. Anxiety, changes in sleep patterns and decreased attention precede. Delirium is acute onset than dementia. Delirium is often occurred in seriously ill patients who get side effects of treatments, malignancy, and chemotherapy. In medications, neuroleptics and anesthetics are used. Haloperidol is first-line therapy especially in hallucination. Benzodiazeptines, such as diazepam, lorazepam are used to sedate patients. Regular schedule and being with familiar person are helpful to delirium patients.

 

Insomnia: There are many things to disturb sleep, e.g., antidepressants, steroids, caffeine, and alcohol. Assessments of insomnia should include specific questions about time to sleep, time to wake up, sleep maintenance, effort to sleep at night and so on. As a doctor, improvement of sleep hygiene is the first thing to recommend to insomnia patients. Regular time for sleep, decreased nighttime distractions, decreased caffeine and other stimulants, waking up regularly, and elimination of napping are those.

 

Existential Needs and Their Management

A Physician is often hesitant about involving themselves in the religious, spiritual, and existential experiences of patients because it seems like private are and non-relevant from medicine. But it is needed for physician to detect spiritual and existential needs of, especially seriously ill, patents. Screening questions are appropriate, not deeper evaluation or intervention.  

[Medical Information] Physical Symptoms and Their Management_2

 

Constipation: Previous treatments before medications are physical activity, adequate hydration, and dietary treatments with fiber. But fiber can be problems, e.g., under opioid use. Common medications are as follows: stimulant and osmotic laxatives, stool softeners, fluids, and enemas. To prevent constipation in presence of opioid, laxative and a stool softener (such as senna and docusate) should be used. If several trials of medications are not helpful, a rectal examination to rule out impaction is necessary.

 

Nausea: Nausea and vomiting are caused by stimulation at these sites: GI tract, the vestibular system, the chemoreceptor trigger zone, and the cerebral cortex. So, medications for nausea act these sites. The reasons of nausea are as follows: liver failure, uremia, hypercalcemia, bowel obstruction, constipation, infection, GERD, vestibular disease, brain metastasis, antibiotics, opioids, and radiation therapy. Also, anxiety. If a patient appeals unspecific sign, initial treatments can be metoclopramide, 5-HT3 receptor antagonist (e.g., ondansetron), dopamine antagonist (e,g., chloropromazine). In specific cases, metoclopramide is used in decreased motility, steroid in inflammation, 5-HT3 antagonist in chemotherapy and radiation therapy, antihistamine in a vesttibular disease, and benzodiazepine in anticipatory nausea.

 

Dyspnea: Dyspnea is the subjective experience of being short of breath. If a patient has a history of COPD or asthma, inhaled bronchodilators and glucocorticoids may be helpful. If a patient has a pulmonary edema, diuretics may be helpful. Low-dose opioids can reduce experience of dyspnea in other patients. Besides, sitting upright, fresh air with sufficient humidity can be helpful.

 

Fatigue: The reasons of fatigue are as follows: dehydration, anemia, infection, hypothyroidism, liver dysfunction, and cancer. Fatigue is also the subjective experience of tiredness or decreased activity. Understanding that fatigue is physiologic and not psychologic can help a patient's will. 

[Medical Information] How to Get Good Health

 

  What is the best health care for a man? It will be prevention of diseases before their onset. Of course, human can get a disease despite all prevention strategy. But to lower its chances, a person should have own plan for health. In point of view from medicine, is there a recommendation for good health?

 

  There are several prevention strategies, tertiary, secondary, primary. Tertiary strategy is for not getting complications while a person gets disease like funduscopy during diabetes. Secondary prevention is for not getting a new disease like colonoscopy when getting old. Primary strategy is to reduce risk of incident disease like exercising.

 

  To individual, not a medical staff, it is important to plan primary prevention(or primordial prevention, which is introduced in 1979). It consists of eating patterns, physical activities, and so on. In aging society, people should keep their own health to reduce the burden of chronic diseases.

 

  US National Health and Nutrition Survey indicated that less than 1% of Americans achieve an optimal healthy eating pattern. There are many standards for health but these are, maybe, not practical. However, just checking health behaviors influences on patient's health behaviors.

 

Health Eating Patterns

  There is the Dietary Guidelines for Americans. It sounds like cliche. "Consume a healthy eating pattern that accounts for all foods and beverages within an appropriate calorie level."

 

Physical Activity

  A simple rule is "If you are doing nothing, do something. and if you are doing something, do more, every day." For adults, the optimal physical activity is 150 min of moderate-intensity or 75 min vigorous intensity aerobic activity per week.

 

  When planning physical activity, it is important to calculate sedentary time. The time has more negative effect than doing nothing. If you have much sedentary time, it is good for you to stand at the desk or stretch. In case of weights activity, more repetitions (e.g., 4 sets of 15 repetitions) and avoiding breath-holding is recommended.

 

Sleep Hygiene

  Sleeping between 7 and 9 h per night is optimal for health in adults aged > 18 years. <7 h is associated with obesity, diabetes, depression, physiologic disturbances, increased pain sensitivity, impaired immune function and so on. 

[Medical Information] About the Practice of Medicine

 

  Harrison is a typical textbook about internal medicine. I'd like to review or summary medical information through Harrison or other articles.

 

Practice of medicine

  Several clinical guidelines are based on statistical data. But when approaching diseases and treatments, we should have deductive reasoning because medicine is also a kind of science. Though a lot of technology has developed, physician's role does not shrink. Never. As a physician meets a patient, he should determine what he does next step by seeing and listening patient's symptom, history, and so on. Physician should find a clinical clue to go next.

 

  To do that, physician should have clinical skills and those are as follows: History taking, Physical examination, Diagnostic studies.

 

  History taking is subjective experience about patient's illness. It could be trivial or irrelevant but patient's narrative may provide a key to approaching medical answer. Also by talking each other, it is a good opportunity to make a physician-patient relationship. When there is a good relationship, patient feels trust to physician, and physician gets more information to patient and good compliance.

 

  Physical examination is to do for checking physical signs of disease. When a physician checks it, he or she should consider patient's comfort and feelings. Physical examination is acted, so far as time permits, from head to toe not to miss a important sign.

 

  After a physician suggests a certain diagnosis, he or she does diagnostic studies to get a definite diagnosis. Especially nowadays, physicians rely on laboratory findings and imaging test more and more. Adequate tests shorten time to get a final diagnosis.

512 Shincheonji Members Donated Recovered COVID-19 Blood Plasma

  Amid the continuous spread of the novel coronavirus infectious disease (COVID-19) around the world, expectations are growing for the development of the treatment as news of the start of the production of COVID-19 medicine for clinical trials in South Korea.

 

  According to GC Green Cross on the 20th, products for clinical trials of "GC5131A," a COVID-19 blood plasma medicine, have begun to be produced. The production is taking place in Cheongju, Korea. The study on blood treatment is being conducted jointly by GC Green Cross with the National Institutes of Health.

 

  GC5131A is a drug developed from the extraction of various antibodies contained in the plasma of recovered patients of COVID-19. Based on the judgment that the safety of the human body has been secured, phase 1 of the clinical trial was exempted, and it will start from phase 2.

 

  Meanwhile, a total of 1,032 people expressed their intention to donate plasma, the GC Green Cross said. Among them, 642 people were reported to have blood plasma collection.

 

  In addition to clinical administration, GC5131A is expected to be used at medical sites for a variety of purposes, including the use of therapeutic purposes.

 

  Kim Jin, head of the GC Green Cross Medical Division, said, "The blood plasma agent is a treatment that is made by lots of the people," adding, "We will do our best to make it available at the medical field in the near future."

 

  Blood treatment agents are made by enriching and sanctioning small amounts of antibodies and immunoglobulins contained in the blood of a complete healer. This requires a lot of blood. However, due to the lack of plasma donors and the need to be suitable for blood collection, GC Green Cross had difficulty developing treatments.

 

  Among the situation, more than 4,000 Shincheonji congregation expressed their intention to donate plasma on the 23rd of June, raising expectations for the development of COVID-19 treatment. On July, a group plasma donation was completed by Shincheonji believers who were confirmed to have been diagnosed with COVID-19.

  "A total of 546 members of the Shincheonji Daegu Church participated group plasma donation from the 13th to the 17th, and 409 people completed the plasma donation, except for 137 unconformable people," said a official of Shincheonji Daegu Church.

 

  Apart from the group plasma donation, 103 Shincheonji members individually donated plasma at Keimyung University Dongsan Hospital.

 

  Meanwhile, Son Yeong-jin (false name, 23, Male), a Shincheonji believer who participated as a plasma donor, said, "I was a little nervous, but I was encouraged to participate because I thought that this plasma donation could help many people suffering from COVID-19."

 

The reference article : http://reurl.kr/2CF91C0FIK

#CoronavirusOutbreak #ShincheonjiChurch #StopFakeNews #CoronaVirus #ShincheonjiPress #FakeNews #FactCheck

Death and Medicine: Definition and Phase of Death

 

   “Human is the only animal that knows he's going to die. But we forget that 'Life is only at this moment' by acting as if we are living forever. The only thing you can see is the present.” - Dennis Porter, a British playwright with late stage pancreatic cancer.

 

   As Dennis Porter mentioned, we usually plan and invest for the future as a matter of course. We naturally make plans for a year on the New Year. We live with the thought that we would not have anything to do with death. But we don't know when to die. One in ten people is killed in a sudden accident. ‘I’ could die tomorrow or this year. It's a medicine that saves people, but people in medicine also learn about death. ‘The definition of death, Psychological phase patients suffer, furthermore, the question about Ontologisch.

 

When will I die? Have you ever thought about your death? Like the following question.

-When, where, why would I die?

-What's the phase of my death?

-Who would watch my death?

-What do I regret most?

-What happens to me after I die?

 

   What's the cause of my death? The most probable answer would be cancer. Cancer is the most cause of death. Where shall I die? The answer would be at medical institution. The main locations of the dead are 57 percent of medical institutions, 30 percent of house, and 10 percent of patient transport. Then what state can we say ‘I'm dead’?

 

   Death, of course, has a mental and social perspective as well as biology and physiology. And most of the cases are preceded by the latter.

-Social death: acknowledge and accept the inevitability of impending death by the people around the patient.

-Psychic death: the patient's own admission of and acceptance of the impending death

-Biological death: brain death as the patient's consciousness disappears.

-Physiological death: Legal death the patient's pulse, breathing, and brain wave stop.

 

   From the late 1960s, the focus of death was shifted from a cardiac arrest to a brain stop. Then, in 1981, a definition of death was established, which means an irreversible stop to all functions of the brain, including the brain stem, with an irreversible stop to cardiopulmonary functions.

 

   What would the patient think before death : fear of pain, a longing for belonging and friendly relations, face with existential questions, a conflict involving spiritual desires, questions of Ontologisch, retrospect of life and so on. And most of patients follow these steps.

 

The psychological stage of death

1. Denial and Isolation: I'm not yet. I don't think so.

2. Anger: Why me? There are a lot of bad people in the world and I have lived uprightly

3. Bargaining: Yes, I admit But if I could live this time...

4. Depression: Yeah, it's my turn, apathy to treatment, only tears.

5. Acceptance: resign myself to my fate

 

   On the contrary, what people want before they die is : not to suffer severely, respect for my decision, no burden to my family, wish to be treated as a human being, wish to continue my bond with my loved ones.

 

   When a person faces death, he or she suffers from demoralization (lack of will in life, different from depression) as he or she loses the meaning of life and does not go the way he or she wants to.

For example, “I live only one or two months. Why should I spend all my money and give my family much trouble ? What's the meaning of my life now?” In reference to Victor Frankel's book, <In the Death camp>, ‘One day, a person suddenly didn’t stand up and do nothing as if they were dead. No one could lift this person up despite of beating and swearing. And this man died a few days later’.

 

Questions to you!

-What would you do if your life were only 6 months away?

-When was the most accomplished and splendid time in your life?

-If you were completely free from the expectations of others in your life, what would you look like now?

-What does spirituality and religion mean to you?

-Where is your life now?

-What is five things you'll regret the most when you die?

 When we take a pill, How does it work on our body?

 Take a pill. It is absorbed through small intestine among digestive system. It goes to the liver and is metabolized. 

 After metabolized, the medicine spreads into whole body by blood circulation. After for a while, it would reach the target organ. it interacts with the organ tissue and ,especially, the receptor in the cell of the organ. the drug have an effect.

Routes of parenteral administration

*Oral (Enteral) administration has low bio-availability because of metabolism by the liver. There is also Parental, mucous, transdermal, not enteral.

 In work on drugs, interaction between drugs and receptors is very important while how drugs spread out and metabolize is also. 

Receptors are on cell membrane

 Some drugs may act on unwanted receptors and show side effect. some receptor can react with a variety of substances, not just one substance. So it is important to make substances that respond prominently to the intended receptors and tissues.

*We simply understand by thinking that drugs are like keys, receptors keyholes. The receptors is keyholes on cells. As if a key open up a keyhole, drugs activate on receptors and then makes effects

 For example, terfenadine cause to reduce reaction of allergy by lower histamine. but the drug also affect on potassium channel on heart so can cause heart arrest.

 To cure glucoma, activating muscarinic receptor and inactivating adrenoreceptor is needed. there are several drugs about this effect.

In case of opioid,,

opioid is used as anagelsia in medicine but known as dope to the public

What is the opioid? It is binding substance to opioid receptor. where did it originate from? opioid is an opium-like substance. opium is a substance that comes from poppy flowers.

Puppy flower

 Let's start to know opioid receptors. there are 3 types of the receptor. (There are 3 types of key holes and the activity may vary depending on which keyhole you open.)

1. Mu receptor : cause on euphoria, analgesia. two subtype of this receptor.

Mu-1 almost exist on extra spinal cord and Mu-2 on CNS. (When opioid bind on Mu-2 receptor, euphoria especially occurs so activating Mu-2 receptor cause addiction.)

2. Kappa receptor : cause on analgesia, dysphoric effect.

3. Delta receptor : exact effects are unknown

 The opioid class acts on as a whole or selectively as the above receptor and show its effect. The opioid is medically used for releasing pain because of activation on the receptors. But at the same time, there is an euphoric effect which is really easy to addiction.

What is the problem if get an addiction? If you continue to take opioid, you will not only have pain releasing, but also nausea, constipation and respiratory arrest. And then if you stop to take the medicine, because drugs have tolerance, you will feel depressed and need more medicine to get the effect.

In opioid class, there are morphine, codeine, oxycodone and so on.

Oxycodone was the talk of the United States recently. Some doctors have increased the dose of oxycodone of patients who have no effect on low oxycodone, not replacing it with longer half-time oxycodone. (The shorter half-life and the more amount, addiction will occur more easily.) So many patients became drug addicts.

The opioid can be pain-releasing, but it is easy to become addicted, so we should eat it carefully and handle it with care. Of course, other drugs are the same.