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Chapter 3 - Part A Nervous System Conditions. Introduction Chronic Degenerative Disorders Infectious Disorders Psychiatric Disorders. Chapter 3 - Part A Nervous System Conditions: Introduction. Function:

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chapter 3 part a nervous system conditions
Chapter 3 - Part ANervous System Conditions
  • Introduction
  • Chronic Degenerative Disorders
  • Infectious Disorders
  • Psychiatric Disorders
chapter 3 part a nervous system conditions introduction
Chapter 3 - Part ANervous System Conditions: Introduction
  • Function:
    • Nerves are bundles of fibers that carry messages to and from the CNS (motor vs. sensory)
  • Structure:
    • Each neuron has a dendrite, cell body, and axon
    • Sensory neurons have long dendrites, cell bodies just outside the spine (dorsal root ganglia), short axons
    • Motor neurons have tiny dendrites, cell bodies in spinal cord; long axons to muscles or glands
    • Interneurons in spinal cord allow quick response to stimuli (reflex arc) (Fig. 3.1)
chapter 3 part a nervous system introduction cont
Chapter 3 - Part ANervous System: Introduction, cont.
  • Long fibers in PNS have two layers:
    • Myelin (speeds transmission, insulates; also present in CNS)
    • Neurilemma (allows for regeneration; not present in CNS) (Fig. 3.2)
  • General neurologic problems:
    • Damage to peripheral nerves (good prognosis)
    • CNS damage (poorer prognosis, but maybe not as bleak as generally considered)
    • Psychiatric disorders
chronic degenerative disorders
Chronic Degenerative Disorders
  • Alzheimer’s Disease
  • Amyotrophic Lateral Sclerosis
  • Multiple Sclerosis
  • Parkinson’s Disease
  • Peripheral Neuropathy
  • Tremor
alzheimer s disease
Alzheimer’s Disease
  • Progressive degeneration of the brain, leading to memory loss, personality changes, and death
  • Incidence:
    • Affects 5% of the U.S. population (4.5 million);
    • 50% of people over 85 years old;
    • Estimated 16 million people by 2050
alzheimer s disease cont
Alzheimer’s Disease, cont.
  • Features:
    • Plaques: sticky deposits of beta amyloid trigger an inflammatory response
    • Neurofibrillary tangles: tau proteins degenerate, causing neurons to collapse and move out of relationship to each other
    • Low neurotransmitters: as neurons degenerate, less neurotransmitters are produced; fewer synapses are functional
    • Genetics: Some people are genetically predisposed, especially to the development of plaques
alzheimer s disease cont7
Alzheimer’s Disease, cont.
  • Signs and symptoms (7 phases):

1. No impairment

2. Very mild decline (“pre Alzheimer’s”)

3. Mild dementia (some memory and word loss)

4. Moderate dementia (loss of some skills; social withdrawal)

5. Moderately severe dementia (assistance is needed for complex tasks)

6. Severe dementia (profound memory loss, personality changes, disorientation, loss of bladder/bowel control)

7. Very severe dementia (loss of language, muscle control)

alzheimer s disease cont8
Alzheimer’s Disease, cont.
  • Diagnosis:
    • Not definitive until death
    • Mental tests, ruling out other causes
  • Differential diagnosis:
    • Vascular dementia
    • Stroke/TIA
    • Parkinson’s
    • Other
alzheimer s disease cont9
Alzheimer’s Disease, cont.
  • Treatment:
    • Some drugs can slow progress, if caught early
  • Massage?
    • Touch is calming influence, even in advanced stages
    • Beware of other accumulated disorders, inability to communicate verbally
    • See Figs. 3.3a, 3.3b
amyotrophic lateral sclerosis
Amyotrophic Lateral Sclerosis
  • Progressive destruction of motor neurons in CNS and PNS
    • Lou Gehrig’s disease
  • Incidence:
    • 4,000 to 5,000 diagnoses per year,
    • Mostly 40–70 years old
  • Three types:
    • Sporadic (most common)
    • Familial
    • Mariana Island type
amyotrophic lateral sclerosis cont
Amyotrophic Lateral Sclerosis, cont.
  • Etiology (current theories):
    • Neural tangles and plaque (like Alzheimer’s, but only on motor neurons)
    • Glutamate accumulates and kills postsynaptic neurons
    • Free radical damage (especially for familial ALS)
amyotrophic lateral sclerosis cont12
Amyotrophic Lateral Sclerosis, cont.
  • Signs and symptoms:
    • Stiffness, loss of coordination, usually starts distally and progresses toward the core
    • May become painful as muscles atrophy and the skeleton collapses
    • No impact on intellect
  • Diagnosis:
    • Rule out other similar presentations; no specific test
amyotrophic lateral sclerosis cont13
Amyotrophic Lateral Sclerosis, cont.
  • Treatment:
    • Palliative
    • Some drugs may limit glutamate, prolong function
  • Prognosis:
    • Death within 2–10 years from pneumonia or renal infection
    • Some survive for decades (Stephen Hawking)
amyotrophic lateral sclerosis cont14
Amyotrophic Lateral Sclerosis, cont.
  • Massage?
    • This is a motor dysfunction; sensation stays intact
    • Massage may help with pain related to degeneration
    • Work with health care team
multiple sclerosis
Multiple Sclerosis
  • Inflammation, degeneration of myelin sheath in CNS
  • Incidence:
    • Most common in people who live far from the equator;
    • Whites more than other groups
    • Women more than men (2:1) in youth; more or less equal among older;
    • Approximately 350,000 people in United States have MS;
    • Approximately 9,000 diagnoses per year
multiple sclerosis cont
Multiple Sclerosis, cont.
  • Myelin in CNS is attacked and replaced with scar tissue
  • Electrical insulation is lost; electrical impulses short-circuit
  • Probably autoimmune
    • Flare and remission
    • Inflammation damages myelin, and ultimately the nerve tissue as well
multiple sclerosis cont17
Multiple Sclerosis, cont.
  • Signs and symptoms:
    • Weakness
    • Spasm
    • Changes in sensation (paresthesia, reduced sensation, numbness)
    • Optic neuritis
    • Urologic dysfunction
    • Sexual dysfunction
    • Difficulty walking
    • Loss of cognitive function
    • Depression
    • Lhermitte’s sign (electrical sensation when neck is in flexion)
    • Digestive disturbance
    • Fatigue
multiple sclerosis cont18
Multiple Sclerosis, cont.
  • Progression:
    • Relapse/remitting (flare/remission)
    • Primary progressive (steady decline in function)
    • Benign MS (1 flare only)
    • Malignant MS (rapidly progressive)
multiple sclerosis cont19
Multiple Sclerosis, cont.
  • Diagnosis:
    • Diagnostic criteria:
      • Objective evidence of at least two episodes
      • Episodes of flare are separated by at least one month and by location of affected function
      • No other explanation for symptoms can be found
    • Differential diagnosis is a long process; can take years
multiple sclerosis cont20
Multiple Sclerosis, cont.
  • Treatment:
    • Symptomatic
    • Steroids, immune suppressants
    • Exercise, physical therapy for maintenance
  • Massage?
    • Most appropriate when in remission
    • MS patients have poor tolerance for rapid changes in temperature; avoid heat and cold (warm and cool are better)
    • Watch for accurate sensation; be conservative in numb areas
parkinson s disease
Parkinson’s Disease
  • “Shaking palsy”: degeneration of motor center in brain
  • Incidence:
    • 1%–2% of people over 50; men more than women (3:2); 500,000 in United States; 50,000 diagnoses/year
  • Anatomy review:
    • Basal ganglia is one motor center deep in brain
      • Basal ganglia cells need dopamine
      • Dopamine is manufactured by nearby substantia nigra (“black stuff”)
parkinson s disease cont
Parkinson’s Disease, cont.
  • Etiology:
    • Substantia nigra dies off; insufficient dopamine to basal ganglia; loss of motor function
    • Causes:
      • Mostly unknown
      • Environmental exposures?
      • Pugilistic parkinsonism (repeated head trauma)
      • Premature death of substantia nigra cells
parkinson s disease cont23
Parkinson’s Disease, cont.
  • Signs and symptoms (Fig. 3.4):
    • Primary:
      • Nonspecific pain, fatigue
      • Resting tremor
      • Bradykinesia (difficulty initiating movement)
      • Rigidity (especially of trunk flexors, facial muscles)
      • Poor postural reflexes
parkinson s disease cont24
Parkinson’s Disease, cont.
  • Signs and symptoms:
    • Secondary:
      • Shuffling gait (festinating gait: loss of center of gravity)
      • Changes in speech
      • Changes in handwriting (“micrographia”)
      • Sleep disorders
      • Depression
      • Mental degeneration (unclear whether part of disease, or part of medication side effects)
parkinson s disease cont25
Parkinson’s Disease, cont.
  • Treatment:
    • Supplementing dopamine is problematic
      • Blood-brain barrier
      • Resistance
      • Different activity in different places in the brain
    • Deep brain stimulation
    • Surgery to alter thalamus, other structures
    • Physical, speech, occupational therapy
parkinson s disease cont26
Parkinson’s Disease, cont.
  • Massage?
    • May be appropriate, helpful with muscle stiffness and quality of life issues
      • Clients have trouble with tables
      • Elderly clients may have other conditions as well
      • Rigidity is safer for massage than spasticity
peripheral neuropathy
Peripheral Neuropathy
  • A complication of other pathologic conditions leading to peripheral nerve damage
    • Mononeuropathy/polyneuropathy
  • Possible causes:
    • Alcoholism
    • Vitamin deficiency
    • Toxic exposure
    • HIV/AIDS
    • Lupus
    • Scleroderma
    • Rheumatoid arthritis
    • Mechanical pressure related to carpal tunnel syndrome, disc disease, thoracic outlet syndrome, etc…
peripheral neuropathy cont
Peripheral Neuropathy, cont.
  • Signs and symptoms:
    • Usually slow onset, often in hands or feet
    • Hypersensitivity, often followed by numbness
    • Motor neuron damage can lead to specific muscle weakness
  • Treatment:
    • Depends on cause
      • Pain relievers, topical applications, TENS units, biofeedback, acupuncture, relaxation techniques, massage…
peripheral neuropathy cont29
Peripheral Neuropathy, cont.
  • Massage?
    • Depends on cause, client
      • Numbness is always a caution!
      • May exacerbate or soothe hypersensitivity
  • Rhythmic oscillation of antagonistic muscles in a fixed plane
  • Classes of tremor
    • Resting tremor
    • Postural tremor (occurs when holding a limb up against gravity: arm in flexion)
    • Kinetic tremor (occurs in large muscle groups for general movement)
    • Activity-specific (occurs in hands for fine-motor control)
    • Psychogenic (disappears when patient is distracted)
tremor cont
Tremor, cont.
  • Further classifications:
    • Physiologic (worse with stress, fear, etc.)
    • Pathologic (idiopathic or related to underlying disorder)
  • Types of tremor:
    • Essential tremor (most common diagnosis)
      • Slowly progressive, usually appears around age 45
    • Huntington’s disease
      • Hereditary degeneration of neural tissue
    • Parkinson’s disease
      • Degeneration of substantia nigra and loss of basal ganglia
    • Others
      • More rare causes for tremor
tremor cont32
Tremor, cont.
  • Treatment:
    • Depends on cause; can include…
      • Dopamine precursors, Botox, beta blockers, anti-seizure medications…
      • Surgery at globus pallidus or thalamus
  • Massage?
    • Often useful, but should be diagnosed for cause
    • Work with health care team for best results
infectious disorders
Infectious Disorders
  • Encephalitis
  • Herpes Zoster
  • Meningitis
  • Polio, Postpolio Syndrome
  • CNS infection, usually viral
  • Used to be endemic to certain areas; now many are worldwide
  • Incidence:
    • Relatively rare, even with West Nile Virus: <5,000 infections/year
encephalitis cont
Encephalitis, cont.
  • Etiology:
    • Usually vector-borne (mosquitoes, some ticks)
    • Viral attack on brain, sometimes spinal cord
    • Infants, elderly, immune-suppressed are most vulnerable
  • Signs and symptoms:
    • Mild to life-threatening
    • Fever, headache, irritability, stupor, coma; can cause personality and memory changes
encephalitis cont36
Encephalitis, cont.
  • Treatment:
    • “Supportive therapy”: antivirals and good care
  • Massage?
    • Fever, especially with headache, contraindicates massage
    • Clients with a history of encephalitis may be safe; get information about any permanent loss of function
west nile virus
West Nile Virus
  • August, 1999: 6 people in Queens, NY go to the hospital with high fever and headache
  • In nearby boroughs, birds were dying and horses were getting sick
  • At end of season, 56 cases of WNV were confirmed among humans; 7 deaths (all people older than 68 years)
  • 2002: 4,000+ confirmed cases; 284 deaths
    • Most develop flu-like symptoms; 1:150 develop neurologic symptoms
herpes zoster
Herpes Zoster
  • Viral attack on sensory dendrites in skin
    • Also called “shingles”
  • Incidence: Approximately 300,000 /year
  • Etiology:
    • Causative agent is Varicella zoster (same as chicken pox)
    • Member of the herpes family; never fully expelled
    • Virus is dormant in dorsal root ganglia until a drop in immune function; then it resurfaces as shingles along the affected dermatome
      • Triggers include stress, age, immune suppression, or other infections
herpes zoster cont
Herpes Zoster, cont.
  • Signs and symptoms:
    • Painful blisters on a red base
    • Unilateral on affected dermatome
      • Trunk and buttocks are most frequent (Fig. 3.5)
      • Can affect the face through trigeminal nerve
  • Complications:
    • Secondary bacterial infection of blisters
    • Damage to trigeminal nerve: Ramsey-Hunt syndrome
    • Postherpetic neuralgia
herpes zoster cont40
Herpes Zoster, cont.
  • Treatment:
    • Antiviral medication, topical anesthetics, anti-inflammatories, painkillers
  • Massage?
    • Active shingles is extremely painful!
    • Communicability is an issue if the massage therapist has no history of chicken pox or chicken pox vaccine
    • During recovery, be guided by tolerance of the client
  • Inflammation of meninges (pia and arachnoid)
  • Incidence:
    • Mostly children < 5 years old;
    • About 300 deaths/year;
    • Very young, very old, and immune suppressed are most vulnerable
  • Can be bacterial or viral
    • Bacterial: Streptococcus pneumoniae or Neisseria meningitides; more severe infections with a high risk of permanent damage; responsive to antibiotics
    • Viral: many agents, including herpes simplex; lower risk of long-term damage
meningitis cont
Meningitis, cont.
  • Signs and symptoms:
    • High fever and chills
    • Deep red or purple rash
    • Extreme headache
    • Aversion to bright light
    • Stiff, painful neck
    • More extreme:
      • Drowsiness, slurred speech, nausea, vomiting, delirium, convulsions, coma
meningitis cont43
Meningitis, cont.
  • Diagnosis:
    • Spinal tap (important to know the causative agent!)
  • Treatment:
    • Antibiotics for bacterial infection; supportive therapy for viral; prognosis is generally good
  • Communicability:
    • Mucous secretions (like cold or flu)
    • Not every exposed person develops symptoms (1:1000)
meningitis cont44
Meningitis, cont.
  • Prevention:
    • Vaccine against Haemophilus influenzae (bacterial causative agent)
    • Vaccines against meningococci recommended for travelers
  • Massage?
    • Not appropriate during acute infection
    • Afterward, get information about permanent damage, if any
polio postpolio syndrome
Polio, Postpolio Syndrome
  • Polio: viral attack on motor neurons in spinal cord
    • Also called infantile paralysis
  • Postpolio Syndrome (PPS): progressive muscular weakness that may develop years or decades after polio infection
  • Incidence:
    • 300,000 polio survivors in the United States;
    • Approximately 25% have symptoms of PPS (overlap with arthritis and other orthopedic problems)
polio post polio syndrome cont
Polio, Post Polio Syndrome, cont.
  • Polio etiology:
    • Virus enters through mouth, goes through GI tract and ends up in spinal cord
    • 1:100 people exposed develop symptoms
    • Practically extinct in the wild, especially in Western hemisphere
    • Affected motor neurons degenerate, leading to specific muscle weakness
      • Other motor nerves serving muscles in same groups may compensate (Fig. 3.6)
    • Usually in lumbar spine, can affect diaphragm, heart
polio post polio syndrome cont47
Polio, Post Polio Syndrome, cont.
  • Postpolio syndrome etiology:
    • Not a resurgence of original infection
    • Cumulative wear and tear leads to progressive muscle weakness later in life
  • Postpolio syndrome symptoms:
    • Sudden onset of new pattern of weakness, fatigue
    • Sleep, breathing, other difficulties
    • Cycles of degeneration and recovery
polio post polio syndrome cont48
Polio, Post Polio Syndrome, cont.
  • Treatment:
    • Motor dysfunction (not sensory): hydrotherapy and massage are safe and effective
    • Adjustments to supportive tools (crutches, braces, etc.)
    • Careful exercise to avoid over-stressing motor neurons and damaged muscles
polio post polio syndrome cont49
Polio, Post Polio Syndrome, cont.
  • Prevention:
    • Two effective vaccines
      • Need to be administered fully to avoid outbreaks of cultured virus
    • Polio survivors need to exercise carefully, emphasizing uninvolved muscles
  • Massage?
    • Because sensation is intact, massage is safe and appropriate
    • Work to improve nutrition, efficiency, function of damaged muscles
psychiatric disorders
Psychiatric Disorders
  • Attention Deficit Hyperactivity Disorder
  • Anxiety Disorders
  • Chemical Dependency
  • Depression
  • Eating Disorders
attention deficit hyperactivity disorder
Attention Deficit Hyperactivity Disorder
  • Neurobiochemical disorder leading to…
      • Inattentiveness
      • Hyperactivity
      • Poor impulse control
  • Incidence:
    • Estimates: 3%–5% of school-age children
    • Statistics vary widely; underdiagnosed among some groups, overdiagnosed among others
    • Boys diagnosed 3:1 over girls
      • Girls tend to manifest with withdrawal, not hyperactivity
    • Up to 4% adults have ADHD
      • Coping skills may be better developed
      • Often raising children with ADHD as well
attention deficit hyperactivity disorder cont
Attention Deficit Hyperactivity Disorder, cont.
  • Etiology:
    • Largely unknown
    • Dopamine, noradrenaline pathways are disrupted
    • Genetic predisposition
    • Maternal exposures during pregnancy
  • Signs and symptoms:
    • Any combination of…
      • Inattentiveness
      • Hyperactivity
      • Impulsivity
attention deficit hyperactivity disorder cont53
Attention Deficit Hyperactivity Disorder, cont.
  • Diagnosis:
    • By observation in different settings
    • Determining what is ADHD vs. other problems vs. age-appropriate behavior
  • Differential diagnosis:
    • Depression, anxiety disorders, sleep disorders, learning disability, fetal alcohol syndrome, etc…
  • Coexisting conditions:
    • Oppositional defiant disorder, depression, anxiety disorders
attention deficit hyperactivity disorder cont54
Attention Deficit Hyperactivity Disorder, cont.
  • Complications:
    • People with untreated ADHD have a higher than normal risk of…
      • Poor self esteem, poor school performance, difficulty maintaining relationships and jobs…
      • Substance abuse
      • Other addictive behaviors
      • Motor vehicle accidents
attention deficit hyperactivity disorder cont55
Attention Deficit Hyperactivity Disorder, cont.
  • Treatment:
    • Psychostimulants
      • methylphenidates or dextroamphetamines
      • norepinephrine reuptake inhibitor
    • Learning coping skills along with medications
  • Massage?
    • No particular risks
    • May help to improve behavior in children
    • May have to adapt technique for client’s tolerance
anxiety disorders
Anxiety Disorders
  • Irrational fears, sometimes connected to behaviors that attempt to control them
  • Incidence:
    • Estimates up to 19 million people
    • Often cannot hold job, lowest socioeconomic standing
  • Basic etiology:
    • “Am I safe?” “Probably not.”
anxiety disorders cont
Anxiety Disorders, cont.
  • Stimuli are interpreted as threatening
    • Hypervigilance, sympathetic state
    • Affects limbic system (for memory), basal ganglia (movement control); frontal lobe (judgment, decision-making)
    • Neurotransmitters involved:
      • Norepinephrine, GABA, serotonin
anxiety disorders cont58
Anxiety Disorders, cont.
  • Signs and symptoms: types of anxiety disorders (5 out of dozens)
    • General anxiety disorder (GAD)
      • Chronic worry, anticipation of disaster
      • 4 million people, women >men, 2:1
    • Panic disorder
      • Sudden onset of sympathetic reaction (pounding heart, dry mouth, hyperventilation, feeling of impending doom); lasts several minutes to hours
      • 2.4 million people, women >men, 2:1
      • Complicated by fear of having an episode, leading to agoraphobia
      • Treated most successfully before agoraphobia develops
anxiety disorders cont59
Anxiety Disorders, cont.
  • Posttraumatic stress disorder (PTSD)
    • 5.2 million in United States, mostly men
    • AKA “shell shock”
    • Persistent, visceral memories of an ordeal—as a participant or a witness; leads to hypervigilance
    • Can spontaneously resolve, or be a lifelong issue
  • Obsessive–compulsive disorder (OCD)
    • Unwelcome thoughts (obsessions) and efforts to control them (compulsions)
    • 3.3 million people; men = women
    • Obsessions usually around contamination, sexuality, or violence
    • Compulsions include handwashing, checking locks, etc., avoiding touching people, counting, and creating symmetry
anxiety disorders cont60
Anxiety Disorders, cont.
  • Phobias: social and specific:
    • Social phobia (social anxiety disorder):
      • Fear of being judged, embarrassed
      • 5.3 million people
      • Men more likely to seek treatment
    • Specific phobia:
      • Intense, irrational fear of something not inherently dangerous (closed spaces, open spaces, bridges, elevators, feathers, the number 13…)
      • 6.3 million people
anxiety disorders cont61
Anxiety Disorders, cont.
  • Treatment:
    • Depends on disorder
      • Medication plus therapy
      • Antidepressants, anti-anxieties, beta blockers
  • Massage?
    • Various relaxation techniques are recommended; massage can be appropriate too
    • Client must perceive it to be safe and nurturing
      • This may mean altering the way the work is conducted
chemical dependency
Chemical Dependency
  • Use, abuse, dependence (addiction)
    • Use: using a substance to change mood or physical experience
    • Abuse: use of a substance in a way that is potentially harmful to user or people close by; use interferes with normal function; user’s behavior is unacceptable to others; use continues, in spite of repeated problems it incurs
    • Dependence:progressive tolerance; physical addiction develops (withdrawal symptoms)
chemical dependency cont
Chemical Dependency, cont.
  • Incidence:
    • 19.5 million over 12 years of age use illicit drugs/year
    • 14 million abuse alcohol
  • Etiology of chemical dependency:
    • Most stimulants slow dopamine reuptake
    • Postsynaptic neurons can become desensitized: takes more drug for same effect
  • Etiology of alcoholism:
    • Depresses CNS, but loss of inhibitions can feel like stimulant
    • Brain chemistry ultimately changes so that it cannot function well without alcohol
chemical dependency cont64
Chemical Dependency, cont.
  • Risk factors:
    • Genetic predisposition
    • Other mental illness (depression, anxiety disorders)
    • Environmental factors (peer pressure, availability)
    • Age
    • Medical history (addiction to sleeping pills, anti-anxieties, painkillers…)
chemical dependency cont65
Chemical Dependency, cont.
  • Types of addiction:
    • Psychological: Using feels good!
    • Physical: Not using feels like I’m going to die!
      • Need to avoid withdrawal symptoms
  • No delineation between legal and illegal substances: caffeine and nicotine can create the same patterns as crack
  • The higher the tolerance, the harder to break the addiction
chemical dependency cont66
Chemical Dependency, cont.
  • Signs and symptoms (4 main):
    • Persistent craving
    • Unable to voluntarily control use
    • Increasing tolerance
    • Withdrawal symptoms
    • Others:
      • Increasing time is invested in use and recovery; responsibilities are neglected; user lives in denial
chemical dependency cont67
Chemical Dependency, cont.
  • Complications (chemical dependency):
    • Vary, depending on substance
      • Paranoia, coma, convulsions, death
      • Increased spread of HIV
      • Accidents (car, boat, industrial)
      • Child abuse and neglect
chemical dependency cont68
Chemical Dependency, cont.
  • Complications (alcoholism):
      • Digestive system: gastritis, liver damage, ulcers, pancreatitis, increased risk of stomach/esophageal cancer
      • Cardiovascular system: decreased force of heartbeat, arrhythmia; cardiomyopathy; agglutination of red blood cells; (ultimately can interfere with clotting, leading to bleeding)
      • Nervous system: memory loss, slowed reflexes, organic brain syndrome
      • Immune system: suppressed activity, vulnerability to infection
      • Reproductive system: reduced sex drive, fetal alcohol syndrome
      • Others: ½ car fatalities; 40% industrial accidents; 65% adult drownings; 100,000 deaths/year
chemical dependency cont69
Chemical Dependency, cont.
  • Treatment:
    • Recognize that a problem exists
    • Detoxification (may be treated with other meds)
    • Rehabilitation
      • New coping skills
    • After-care is the most important feature
  • Massage?
    • Can be used to help with withdrawal symptoms
    • Be careful about other conditions that may exist
      • Hepatitis B, C; HIV/AIDS, cirrhosis, etc.
    • Clients who are drunk or high during a session are not good candidates for massage
  • Genetic predisposition + CNS chemical imbalances + triggering event leads to persistent sense of loss and hopelessness
  • Incidence:
    • Estimates of 10%–20% of the U.S. population (not all seek help):
    • 11–19 million people/year
depression cont
Depression, cont.
  • Factors (all overlap each other):
    • Neurotransmitter imbalance
      • Serotonin, norepinephrine, dopamine; too low? Or too high, leading to resistance?
    • Hormonal imbalance
      • Estrogen, progesterone, endorphins, cortisol
    • Hypothalamus-pituitary-adrenal axis (HPA axis)
      • Stress response system between hypothalamus, pituitary, adrenal gland; high CRF levels means more stress responses
    • Atrophy in hippocampus
      • May be related to hypersecretion of cortisol
depression cont72
Depression, cont.
  • Causes:
    • Genetics
    • Environmental triggers
    • Personality traits
    • Chronic illness
    • Other
      • Hypothyroidism, chemical dependency, nutritional deficiencies, etc
depression cont73
Depression, cont.
  • Signs and symptoms (6 main ones):
    • Persistent sad or empty feeling
    • Less enjoyment from activities
    • Deep sense of guilt or disappointment with self
    • Hopelessness: things will never get better
    • Irritability
    • Change in sleeping habits
    • Others:
      • Poor concentration; weight changes; loss of energy; persistent physical pain (headaches, indigestion); suicidal thoughts or behaviors
depression cont74
Depression, cont.
  • Types of depression (5 of many)
    • Major depressive disorder
      • Severe symptoms, 2+ weeks; untreated episodes can last 6–18 months, with 4–6 in a lifetime (10 years of feeling awful!)
    • Dysthymia
      • Less severe symptoms, much longer lasting (months or years)
    • Bipolar disease
      • Aka, manic depression; cycles from mania to depression
    • Seasonal affective disorder
      • Related to lack of sunlight, melatonin
    • Postpartum depression
      • Combination of hormonal swings, unmet expectations, sleep deprivation
depression cont75
Depression, cont.
  • Treatment:
    • Antidepressants:
      • SSRIs, MAOIs, tricyclics
        • Can take weeks to take effect, side effects at the beginning
      • Lithium for bipolar
        • “smooth out” mood swings
    • Psychotherapy
    • Other therapies
      • Light therapy for SAD
      • Electroconvulsive therapy
      • St. John’s Wort
depression cont76
Depression, cont.
  • Complications:
    • 15% of major depressives successfully commit suicide
    • Correlation to other disorders:
      • Heart attack and other cardiovascular disease
  • Massage?
    • Improved efficiency of HPA axis
    • Sympathetic to parasympathetic state
      • Reduction in cortisol, improvement in serotonin
    • Changes brain activity to more balanced emotional state
    • Risks:
      • Respect medications, doctor’s role in prescribing them
      • Respect appropriate boundaries with emotionally fragile clients
eating disorders
Eating Disorders
  • Poor eating habits that ultimately can become life-threatening
    • Anorexia nervosa
    • Bulimia nervosa
    • Compulsive overeating
  • Incidence:
    • Usually girls between adolescence and college (for anorexia and bulimia);
    • Girls > boys by 10:1
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Eating Disorders, cont.
  • Etiology of anorexia and bulimia:
    • Over-achievers, exerting power and control
    • Serotonin disturbance (?)
    • Can reach the point where it is difficult or impossible to return to healthy eating
  • Etiology of overeating:
    • Touch deprivation
    • Protection (touch abuse survivors)
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Eating Disorders, cont.
  • Signs and symptoms:
    • Anorexia:
      • Avoid eating in public
      • Distorted self image
      • Restrictive: self-starvation
      • Purge-type: barely sufficient nutrition + behaviors to eliminate it (vomiting, laxatives, excessive exercise)
      • Lanugo
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Eating Disorders, cont.
  • Signs and symptoms:
    • Bulimia
      • Appear to eat normally; binge in private
      • Binges triggered by stress
      • Followed by purging or exercise
    • Compulsive overeating
      • Public and private eating
      • Not compensated with purging, exercise
      • May have rapid weight gain
      • Long-term problems generally more manageable than with anorexia, bulimia
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Eating Disorders, cont.
  • Complications:
    • Anorexia:
      • Arrhythmia, bradycardia, hypotension; infertility, osteoporosis; purging can cause colon dysfunction, esophageal damage
    • Bulimia:
      • Erosion of tooth enamel; esophageal ulcers, strictures, rupture; colon dysfunction; electrolyte imbalances
    • Compulsive overeating:
      • Cardiovascular disease, arthritis
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Eating Disorders, cont.
  • Treatment:
    • Must focus on control issues, not eating
    • Address neurotransmitter imbalances
    • Address overlap with other psychiatric disorders
      • OCD, depression, etc.
  • Massage?
    • Can be a wonderful positive body experience
    • Watch for cardiovascular problems (arrhythmia, etc.)