Thursday, July 12, 2012

What Are Tapeworms? What Causes Tapeworm Infection?

Tapeworms, or cestodes, are intestinal parasites; they are worms that are flattened like a tape measure. A tapeworm cannot live freely on its own - it survives within the gut (intestine) of an animal, including a human.

A parasite is an animal or plant that lives in a host; another animal or plant.

Tapeworm eggs generally enter the human host from animals through ingested food, especially raw or undercooked meat. Humans can also become infected if there is contact with animal stools or contaminated water. When an infection is passed from an animal to a human it is called zoonosis.

Most people who have a tapeworm experience no symptoms and are unaware of hosting one. If signs and symptoms are present, they usually include tiredness, abdominal pain, weight loss and diarrhea.

A human who has a tapeworm will need treatment to get rid of it. Treatment is 95% effective and lasts just a few days.

The most common tapeworms to infect humans in Western Europe and USA/Canada are:
  • Taenia solium - the pork tapeworm. Also known as the armed tapeworm or measly tapeworm.

  • Taenia saginata - the beef tapeworm. Also called the unarmed tapeworm.

  • Hemynolepis nana - the dwarf tapeworm.
Taenia solium and echinococcus granulosus (dog tapeworm) can cause other illnesses if their larvae get out of the host's intestine and settle elsewhere in the body.

According to the National Health Service (NHS), UK, in 2005 there were 71 reported incidences of beef and pork tapeworms among humans in England and Wales, and just 1 in Scotland. Authorities do not know whether the hosts became infected in the UK or while they were abroad. There were 11 cases of hydatid disease, an infection caused by the dog tapeworm in England and Wales in 2005 - two of these people had had a recurrence of the disease.

According to the CDC (Centers for Disease Control and Prevention), USA, tapeworm incidence in the USA has been rising, mainly because of increased raw fish consumption.

According to Medilexicon's medical dictionary, a tapeworm is:
    "An intestinal parasitic worm, adults of which are found in the intestine of vertebrates; the term is commonly restricted to members of the class Cestoidea. Tapeworms consist of a scolex, variously equipped with spined or sucking structures by which the worm is attached to the intestinal wall of the host, and strobila having several to many proglottids that lack a digestive tract at any stage of development.

    The ovum, entering the intestine of an appropriate intermediate host, hatches and the hexacanth penetrates the gut wall and develops into a specific larval form (cysticercoid, cysticercus, hydatid, strobilocercus), which develops into an adult when the intermediate host is ingested by the proper final host. A three-host cycle with a swimming coracidium, procercoid and plerocercoid (sparganum) larva, and adult intestinal worm is found in aquatic life cycles, as in Diphyllobothrium latum (broad fish tapeworm) and other pseudophyllid cestodes.

    Other important species of tapeworm are Echinococcus granulosus (hydatid tapeworm), Hymenolepis nana or H. nana var. fraterna (dwarf or dwarf mouse tapeworm), Taenia saginata (beef, hookless, or unarmed tapeworm), T. solium (armed, pork, or solitary tapeworm), and Thysanosoma actinoides (fringed tapeworm of sheep)."

What are the risk factors for tapeworms?

A risk factor is something that increases the risk of developing an illness, condition or infection. For example, poor dental hygiene increases the risk of developing gum disease. Therefore, poor dental hygiene is a risk factor for gum disease. The following are considered risk factors for tapeworm infection:
  • General lack of hygiene - if you wash your hands infrequently the risk of transferring infection into your mouth is greater.

  • Working with or exposure too animals - this is especially the case in areas where feces are not disposed of effectively.

  • Traveling to or living in certain parts of the world - countries, and parts of some countries where sanitation practices are poor, the risk of becoming infected with a tapeworm is much greater.

  • Consuming raw or undercooked meats and fish - larvae and eggs present in meats and fish may infect people if eaten raw or undercooked. Experts say that sushi (raw fish) is safe if it has been frozen beforehand - the risk with fish is mainly freshwater fish.

What are the signs and symptoms of tapeworm infection?

A symptom is something the patient feels and reports, while a sign is something other people, including a doctor or nurse may detect. For example, pain may be a symptom while a rash may be a sign.

It is not uncommon for an infected person to have no apparent signs and symptoms. Even if symptoms are present, they may be so mild that many people believe they are caused by something else.

If signs or symptoms are present, they may include the following (may vary depending on the type of tapeworm):
  • Eggs, larvae or segments from the tapeworm in stools. The segments will contain tapeworm eggs.

  • Abdominal pain. This may include epigastric pain - pain in the abdomen, just above the stomach.

  • Vomiting

  • Nausea

  • General weakness

  • Inflammation of the intestine (enteritis), which often causes diarrhea as well.

  • Diarrhea

  • Weight loss

  • Altered appetite - sometimes there may be a loss of appetite. Hosts with the pork tapeworm may experience a rise in appetite.

  • Sleeping difficulties

  • Dizziness

  • Convulsions

  • Malnutrition - because the tapeworm is grabbing an important proportion of essential nutrients.

  • Vitamin B12 deficiency - this is very rare and only among hosts infected with Diphyllobothrium latum (fish tapeworm)
Invasive infection signs and symptoms

If the tapeworm larvae made their way out of the intestines and formed cysts in tissues elsewhere in the body, there is a risk of tissue damage. The following symptoms may be possible:
  • Fever
  • Abdominal pain or discomfort
  • Jaundice
  • Cystic lumps or masses
  • An allergic reaction to larvae
  • Bacterial infections
  • Seizures and other neurological symptoms
  • Blindness
  • Intracranial pressure (pressure inside the skull
Signs and symptoms will depend on what type of tapeworm it is, how severe the infection is, and which tissues (which part of the body) are infected.

What are the causes of tapeworm infection?

In human beings, tapeworm infection is most commonly caused by:
    The pork tapeworm (Taenia solium), beef tapeworm (Taenia saginata), dwarf tapeworm (Hymenolepis nana), and fish tapeworm (Diphyllobothrium latum) from raw freshwater fish.
Most people become infected after ingesting tapeworm eggs or larvae.
  • Ingestion of eggs - eggs get into humans via food, water or contaminated soil (mainly contaminated with infected animal feces). If a host, such as a pig, has a tapeworm inside, proglottids (worm segments) or eggs may be present in its feces, which drop onto the soil. Each segment may have thousands of eggs. A human can become infected by drinking contaminated water, being close to the animals and contaminated soil, or consuming contaminated food. The eggs hatch into larvae (baby tapeworms) and make their way into the gut, or even outside and infect other parts of the body. This type of infection is most common with tapeworms that come from infected pigs, and much less common if the original host was cattle or fish.

  • Eating infected meat/fish - if the meat or fish has larvae cysts and is undercooked or raw, they can reach the intestine where they mature into adult tapeworms. An adult tapeworm can live as long as 20 years, they can also be up to 50 feet long. Many of them attach themselves to the walls of the intestine, while others will go straight through the digestive system and end up in the toilet when the human passes a stool.

    Fish tapeworm infection is more common in countries where the consumption of raw fish is common practice, such as Eastern Europe, Scandinavia and Japan. Undercooked or raw freshwater fish, such as salmon, are the most common sources.

  • Human-to-human transmission - the dwarf tapeworm can be transmitted from human-to-human. It is the only tapeworm that can go through its entire life cycle, eggs-larvae-mature tapeworms, in one single host. Dwarf tapeworm infection is the most common tapeworm infection globally.

  • Insect-to-human transmission - fleas and some types of beetles may pick up the eggs by eating the excrements (droppings) of infected rats or mice. These insects can infect humans. The insects are called intermediate hosts - the tapeworm exists in them in between the egg and adult stages. This type of infection occurs with dwarf tapeworms, and is much more common in areas where hygiene practices are poor.

  • Re-infecting yourself - during treatment humans can reinfect themselves if they do not follow good hygiene practices. The eggs will be present in the human stools. If the individual does not wash his/her hands after going to the toilet, there is a risk of reinfection.

  • Dog tapeworm - called echinococcosis, hydatid disease, or unilocular hydatid disease. Unilocular means the tapeworm larvae (cyst containing larvae) settles and stays in just one place in the body. Humans, especially children, may accidentally touch dog stools and eventually swallow the eggs when they touch their mouths with their hands. Infection is also possible by having close contact with dogs.

    This type of tapeworm is more common in some parts of Australia, Greece, southern Spain, North and South America, Turkey and Asia. It is also more common in rural, rather than urban areas. The National Health Service, UK, says that hydatid disease is rare in the UK, with virtually all cases occurring in sheep-farming areas.

Diagnosing tapeworm infection

Any individual who suspects tapeworm infection, or has the signs and symptoms described above should see their GP (general practitioner, primary care physician). Some patients may notice infection themselves by checking their stool for parts of the adult tapeworm. However, a doctor is still needed to check the stool (by sending samples to a lab).

Diagnosis of adult tapeworms - this is done by searching for and detecting eggs, larvae or segments of tapeworms in the patient's stool. If infection is with a pork or beef tapeworm the segments will be motile (they wiggle, move). The patient will be asked to provide a sample of his/her stool in a sterile container.

Laboratories may use microscopic identification methods to try to detect eggs or tapeworm segments in the feces. It may be necessary to collect two or more samples over a given period to detect the parasite because eggs and tapeworm segments are not released in a regular pattern into the stool.

The doctor may also examine the area around the patient's anus for signs of eggs or larvae.

Diagnosing tapeworm larvae infection - the following diagnostic aids may be used, depending on the type of tapeworm larvae infection:
  • Blood tests - the aim here is to look for antibodies to infection.

  • Imaging scans - this could include a chest X-ray, ultrasound scan, computerized tomography (CT) scan, or a Magnetic Resonance Imaging (MRI) scan.

  • Organ tests - the doctor may want to check that the organs are working properly.

What are the treatment options for tapeworm infection?

Treating tapeworm larvae infection is more complicated than treating an adult tapeworm infection. While the adult tapeworm stays in the gut, the larvae may settle in other parts of the body. When larvae infection finally produces symptoms, the infection may have been present for years. In some rare cases larvae infection can be life-threatening.
  • Oral medications for treating tapeworms - oral medications such as, praziquantel (Biltricide) or albendazole (Albenza), and niclosamide may be prescribed. Niclosamide is not currently available in the USA (November, 2009). In the UK, niclosamide and praziquantel are only available on a named-patient basis - because tapeworm infections in the UK are so rare, the doctor or pharmacist may have to make special arrangements to get hold of the medication.

    Our digestive system does not absorb these drugs well. They either dissolve or attack (and kill) the adult tapeworm.

    The tapeworm's scolex (neck and head) needs to come out of the patient's intestine in their stools. If the scolex is not destroyed the tapeworm can grow again.

    A doctor may advise the patient to take a laxative to help the tapeworm come out in the stools. If the patient has a pork tapeworm infection, in order to prevent vomiting, which can lead to reinfection by swallowing the tapeworm larvae, they may be given an anti-emetic (prevents vomiting) medication.

    These medications to do not target the eggs. It is therefore very important for patients to wash their hands thoroughly after going to the toilet and before eating so that they do not reinfect themselves.

    The patient's stools will be checked several times one to three months after the course of medication. These medications, if procedures are followed properly, are 95% effective.

    Medication used for treating adult tapeworm infection is often referred to as anthelmintic medication. Anthelmintic means that it kills the parasitic worm, and makes the worm pass out of the gut in the patient's stools.

  • Anti-inflammatory medication - if the infection affects tissues outside the intestine, the patient may have to take a course of anti-inflammatory steroid to reduce swelling caused by the development of cysts.

  • Surgery - if the patient has life-threatening cysts that have developed in vital organs, such as the lungs or liver, surgery may be required. The doctor may inject a cyst with medication, such as formalin, to destroy the larvae before removing the cyst. In some cases the patient may need organ transplantation. If surgery to remove a cyst is not possible because it is too close to major blood vessels or organs, the doctor may prescribe albendazole to try to slow down or control the cyst's growth.

What are the possible complications of tapeworm infection?

The risk of complications depends on several factors, including the type of tapeworm and whether or not the patient receives treatment.
  • Beef tapeworm - as the beef tapeworm lives in the gut and can easily be treated it is relatively harmless.

  • Cysticercosis - if a human ingests pork tapeworm eggs there is a risk of larvae infection (cysticercosis). The larvae can exit the intestine and infect tissues and organs elsewhere in the body, resulting in lesions or cysts. Lesions or cysts can eventually affect the normal function of an organ. In some cases they can rupture.

  • Neurocysticercosis - a dangerous complication of pork tapeworm infection. The brain and nervous system are affected. The patient has headaches and vision problems, as well as convulsions (seizures), meningitis, and possibly dementia. In very severe cases the infection can be fatal.

  • Echinococcosis (hydatid disease) - the echinococcus tapeworm, which is most commonly found in sheep and dogs, can cause an infection called echinococcosis. The larvae leave the gut and infect organs, most commonly the liver. The infection can result in large cysts, which place pressure on nearby blood vessels and affect circulation. Sometimes the blood vessels may rupture. In severe cases surgery or liver transplantation is required. Infection may start during childhood, but symptoms may not become apparent for many years.


  • Good hygiene - wash your hands thoroughly with soap and water after using the toilet and before eating.

  • Food precautions - if you are in an area where tapeworms are common, make sure you wash and cook all fruits and vegetables with clean water.

  • Livestock - properly dispose of animal and human feces. Minimize animal exposure to tapeworm eggs.

  • Meat - cook meat to a temperature of at least 66C (150F) thoroughly. This will kill larvae or eggs.

  • Meat and fish - freeze fish for at least 24 hours and meat for at least 12 hours. This will kill tapeworm eggs and larvae.

  • Raw foods - do not consume raw or undercooked pork, beef and fish.

  • Dogs - make sure your dog is treated for tapeworms. Follow your veterinarian's advice about treating your dog regularly with de-worming medication. Take special care with your own personal hygiene. Sheepdogs are especially vulnerable to tapeworm infection because sheep are intermediate hosts for the dog tapeworm. Make sure your dog only eats cooked meat and fish.

  • Kitchen hygiene - make sure all work surfaces are regularly cleaned and disinfected. Do not allow raw foods to touch other foods. If you have touched raw meat/fish wash your hands before moving on to touching other things.
Experts say that smoking or drying meat or fish are not considered reliable ways of killing larvae or eggs.
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What Is Fever (Pyrexia)? What Causes Fever?

Fever, pyrexia or controlled hyperthermia is when a human's body temperature goes above the normal range of 36-37C (98-100F) - it is a common medical sign. As the individual's body temperature goes up, there may be a sensation of cold until the temperature plateaus (stops rising).

An elevated body temperature (fever) is one of the ways our immune system attempts to combat an infection. Usually the rise in body temperature helps the individual resolve an infection. However, sometimes it may rise too high, in which case the fever can be serious and lead to complications.

Doctors say that as long as the fever is mild, we do not generally need to try and bring it down - if the fever is not severe it is probably having an effect in neutralizing the bacterium or virus that is causing the infection. Medications to bring down a fever are called antipyretics. If the fever is causing undue discomfort, an antipyretic may be recommended. US and UK doctors say that when the fever reaches or exceeds 39.4C it is no longer mild.

According to Medilexicon's medical dictionary:

Fever is: A complex physiologic response to disease mediated by pyrogenic cytokines and characterized by a rise in core temperature, generation of acute phase reactants, and activation of immune systems.

What are the signs and symptoms of fever?

A symptom is something the patient reports and feels, while a sign is something other people, including a doctor may detect. For example, a headache may be a symptom while a rash may be a sign.

When somebody has a fever, signs and symptoms are linked to what is known as sickness behavior, and may include:
  • Feeling cold when nobody else does
  • Shivering
  • Anorexia - lack of appetite
  • Dehydration - preventable if the patient drinks plenty of fluids
  • Depression
  • Hyperalgesia - the individual is much more sensitive to pain
  • Lethargy
  • Problems concentrating
  • Sleepiness
  • Sweating
If the fever is high there may also be extreme irritability, confusion, delirium and convulsions.

Febrile seizure (children)

Children with a high temperature may develop a febrile seizure, also known as a febrile fit or febrile convulsion, most of which are not serious and may be the result of an ear infection, gastroenteritis, or a respiratory virus (a cold). Less commonly, febrile seizures may be caused by something more serious, such a meningitis, a kidney infection or pneumonia.

Febrile seizures most commonly occur in children aged 6 months to 6 years, and affect boys more often than girls.

The seizure occurs because the body temperature rises too fast, rather than because it has been sustained for a long time.

There are two types of febrile seizures:
  • Simple febrile seizure - the seizure lasts no longer than 15 minutes (in most cases less than 5 minutes) and does not occur again during a 24-hour period.

    It typically involves the whole body - a generalized tonic-clonic seizure. Most febrile seizures are of this type. Symptoms - the body becomes stiff and the arms and legs start to twitch, the patient loses consciousness (but the eyes stay open).

    There may be irregular breathing and the child may urinate and/or defecate. There may also be vomiting.

  • Complex febrile seizure - the seizure lasts longer, comes back more often, and tends not to affect the whole body, but rather only part of the body.

    This type of seizure is a cause for more concern that simple febrile seizures.
In the majority of cases, a child with a febrile seizure does not need treatment. Temperature may be controlled with acetaminophen (paracetamol) or sponging. If necessary an anticonvulsant, such as sodium valproate or clonazepam may be prescribed.

What are the causes of fever?

  • An infection - such as strep throat, flu, chickenpox or pneumonia
  • Rheumatoid arthritis
  • Some medications
  • Over-exposure of skin to sunlight (sunburn)
  • Heat stroke - may be caused either by exposure to high temperatures (nonexertional heat stroke) or prolonged strenuous exercise.
  • Silicosis - a type of lung disease caused by long-term exposure to silica dust.
  • Amphetamine abuse
  • Alcohol withdrawal

How is fever diagnosed?

Diagnosing a fever is straightforward - the patient's temperature is taken, if the reading is high, he/she has a fever. It is important to take the person's temperature when they are at rest, because physical activity can warm us up.

A person is said to have a fever if:
  • The temperature in the mouth is over 37.7C (99.9F)
  • The temperature in the rectum (anus) is over 37.5-38.3C (100-101F)
  • The temperature under the arm or ear is over 37.2C (99F)
As a fever is a sign rather than a disease, when the doctor has confirmed there is an elevated body temperature, certain diagnostic tests may be ordered, depending on what other signs and symptoms exist, these may include blood tests, urine tests, x-rays and other imaging scans.

What is the treatment for fever?

NSAIDs (non-steroidal anti-inflammatory drugs) such as Tylenol (paracetamol) or ibuprofen can help bring a fever down. However, a mild fever may be helping combat the source of the infection (bacterium/virus) - it may not be ideal to bring it down.

If the fever has been caused by a bacterial infection the doctor may prescribe an antibiotic.

If a fever has been caused by a cold, which is caused by a viral infection, NSAID's may be used to relieve uncomfortable symptoms. Antibiotics have no effect against viruses, but may sometimes be prescribed to prevent secondary infections.

Fluid intake - the patient with a fever should consume plenty of fluids (liquids) to prevent dehydration.

Heat stroke - NSAIDs will not be effective if the person's fever was caused by hot weather or sustained strenuous exercise. The patient needs to be cooled. If they are confused or unconscious they should be treated by a doctor straight away.

How to prevent fever?

Hygiene - fevers are commonly caused by bacterial/viral infections. Good hygiene practices help reduce the risk of developing an infection. This includes hand washing before and after meals, and after going to the toilet.

A person with a fever caused by an infection should have as little contact as possible with other people, to prevent the infection from spreading. Whoever is caring for the patient should regularly wash their hands with warm soap and water.
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What Are Chilblains (Pernio)? What Causes Chilblains?

Chilblains also known as chilblain, pernio and perniosis are small, itchy swellings on the skin, which are not painful at first, but can become painful - they are acral ulcers; ulcers affecting the extremities. They are a localized form of vasculitis that occur when a predisposed individual is exposed to cold. Exposure to the cold can damage tiny blood vessels (capillaries) in the skin, resulting in redness, blisters, itching and inflammation. The itching, swelling and blistering red patches may occur on the toes, fingers, ears and nose.

Treatment for chilblains, which consist mainly of topical remedies and medications, is usually effective and the patient makes a full recovery within a couple of weeks. If left untreated though, there is a risk of complications, such as skin ulcers, cracked or broken skin, and infections.

Vulnerable individuals who wrap up warmly, or stay away from the cold as much as possible are much less likely to develop chilblains.

According to Medilexicon's medical dictionary:

Chilblains are Erythema, itching, and burning, especially of the dorsa of the fingers and toes, and of the heels, nose, and ears caused by vascular constriction on exposure to extreme cold (usually associated with high humidity); lesions can be single or multiple, and can become blistered and ulcerated. (synonym: periniosis)

What are the signs and symptoms of chilblains?

A symptom is something the patient feels and reports, while a sign is something other people, such as the doctor detect. For example, pain may be a symptom while a rash may be a sign.

Chilblains signs and symptoms generally appear a short while after being in the cold. There will be a burning and itching sensation, usually in the extremities, such as the feet, hands, nose or ears. Symptoms get worse if the individual walks into somewhere warm.

The skin of the affected area may go red and become inflamed (swollen). Sores and blisters may appear (rare).

Doctors say that signs and symptoms will usually go away within a couple of weeks on their own if the patient avoids exposure to cold. More rarely, recovery may take months.

What causes chilblains?

Our blood vessels narrow when exposed to cold. When returning to warmth , the blood vessels expand again. For some people, this change results in blood leaking out of the blood vessels, causing inflammation and chilblain symptoms, especially if the change from cold to warmth is abrupt.

The following groups of people are more susceptible to getting chilblains when exposed to cold:
  • Individuals with close family members who have/had chilblains
  • Patients with circulation problems
  • Patients with lupus
  • People whose homes are draughty and cold (not well insulated)
  • Tobacco smokers
  • Very thin individuals

What are the complications of chilblains?

Chilblains may sometimes lead to infections, skin ulcers, and scarring. Complications are generally linked to an underlying condition/illness.

How are chilblains diagnosed?

Diagnosing chilblains is straightforward. If symptoms are present and the patient has been exposed to the cold, a doctor will diagnose chilblains.

What is the treatment for chilblains?

The patient can treat chilblains that have not developed into and infection or skin ulcer with OTC medications purchased at a pharmacy.

According to the National Health Service, UK patients have had good results by applying a mixture of friar's balsam and a weak iodine solution (ask your pharmacist).

A corticosteroid cream may also help with symptoms of inflammation and itching. If the skin is cracked you should see your doctor.

How are chilblains prevented?

To prevent chilblains:
  • When it is cold, dress appropriately, this includes warm footwear (shoes and socks), gloves, a hat and scarf. In other words, wear clothing that protects your feet, hands and ears from the cold. You can protect your nose by wrapping something like a scarf around part of your face.
  • Some people find that placing cotton wool between their toes helps circulation
  • If you are particularly susceptible, try to avoid exposure to cold as much as possible

  • When coming back from the cold, do not expose susceptible areas to sudden warmth (a gradual process is better).

  • Exercise - do plenty of exercise at least four times a week; this helps maintain good circulation
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What Is Psychotherapy? What Are The Benefits Of Psychotherapy?

Psychotherapy consists of a series of techniques for treating mental health, emotional and some psychiatric disorders. Psychotherapy helps the patient understand what helps them feel positive or anxious, as well as accepting their strong and weak points. If people can identify their feelings and ways of thinking they become better at coping with difficult situations.

According to Medilexicon's medical dictionary, psychotherapy is "Treatment of emotional, behavioral, personality, and psychiatric disorders based primarily on verbal or nonverbal communication and interventions with the patient, in contrast to treatments using chemical and physical measures." Simply put, psychotherapy aims to alleviate psychological distress through talking, rather than drugs.

Psychotherapy is commonly used for psychological problems that have had a number of years to accumulate. It only works if a trusting relationship can be built up between the client and the psychotherapist (in psychology "client" can mean "patient"). Treatment can continue for several months, and even years. Psychotherapy may be practiced on a one-to-one basis, or in pairs, and even in groups. Generally, sessions occur about once a week and last one hour.

Some people refer to psychotherapy as "talking treatment" because it is generally based on talking to the therapist or group of people with similar problems. Some forms of psychotherapy also used other forms of communication, including writing, artwork, drama, narrative story or music. Sessions take place within a structured encounter between a qualified therapist and a client or clients. Purposeful, theoretically based psychotherapy started in the 19th century with psychoanalysis; it has developed significantly since then.

A psychotherapist may be a psychologist, marriage and family therapist, occupational therapist, licensed clinical social worker, counselor, psychiatric nurse, psychoanalyst, or psychiatrist. In the UK psychotherapy will be free if the patient is referred by a GP (general practitioner, primary care physician).

One of the main problems with psychotherapy, according to experts, is that the client stops coming to sessions. A study carried out by researchers from Northwestern University's Feinberg School of Medicine found that when patients receive psychotherapy for depression over the phone, most of them continue with the therapy.

Talking versus drugs

Psychologists generally view individual distress as the result of human relationship problems, rather than as the result of a personal disorder. A psychologist who specializes in psychotherapy will generally consider the wider context of relations within a family or at work. Psychiatrists and medical doctors tend to take a more medical approach to mental health and are more inclined to prescribe drugs to alleviate stress. This is a general difference between a psychologist's approach and a psychiatrist's - however, there are many psychiatrists who also use psychotherapy.

Many psychologists comment that medical approaches usually see distress as a symptom of a disorder in the same way they may view a signs or symptoms of physical problems, illnesses, and conditions. Therefore, a psychiatrist or perhaps a neurologist will link a diagnosis of, e.g. OCD (obsessive-compulsive disorder), depression, or post-traumatic stress disorder to the prescription of specific medications, as well as possible psychological interventions.

Many studies have demonstrated that the most effective treatments for mental illnesses and problems, especially depression, involve a combination of both medication and psychotherapy - this study found that a combination of psychotherapy and antidepressant medication appears to be the most effective treatment for adolescents with major depressive disorder.

The majority of psychiatrists, however, do say that psychotherapy is a crucial part of mental health treatment, and is often the only necessary effective treatment in many cases. The American Psychiatric Association stated "Many mental health problems can be resolved with psychotherapy alone, and psychotherapy is often a crucial component in the success of treatment with medication". However, what people say and what they actually do not always match - this study found that a declining number of office-based psychiatrists appear to be providing psychotherapy to their patients.

In a study, German scientists demonstrated that cellular biological markers could be associated with response to psychotherapy.

Some types of psychotherapies

  • Behavior therapy

    This type of therapy focuses on helping the client understand how changing his/her behavior can eventually lead to changes in how they are feeling. Emphasis is made on focusing on increasing the person's engagement in positive or socially reinforcing activities. This approach carefully measures what the client is doing and then tries to increase the probability that he/she has positive experiences.

    Put simply, behavior therapy aims to substitute undesirable behavior responses with desirable ones.

  • Cognitive therapy

    How we feel is determined by what we think - this is the theory behind cognitive therapy. For example, if a person has depression it may be the result of having the wrong thoughts and/or beliefs. If these faulty beliefs are corrected then the client's view of events and his/her emotional state may change for the better. According to several studies, people with depression often have erroneous beliefs about themselves - they may relate negative events to themselves without any evidence, they may see life situations in absolute terms (black and white), and they may see only the negative aspects of things and commonly distort the importance of particular events.

    Put simply, the way we think about things affects how we feel emotionally. Cognitive therapy's thrust is on our current thinking, behavior and communication, rather than looking into the past.

    The cognitive therapist works with the client to confront, or challenge the erroneous thoughts by pointing out other ways of viewing situations. By doing this it is hoped that the client's mood improves. Cognitive therapy has been found to be especially effective in treating post-traumatic stress disorder (PTSD), as this article explains.

    There are doubts about the effectiveness of cognitive therapy for elderly people with depression. This study, which explains that further studies are required, found that there was not enough compelling evidence showing the effectiveness of cognitive therapy for elderly patients with depression.

    A counseling method called cognitive behavioral therapy (CBT) seems to amplify tinnitus patients' quality of life, even when the volume of the noise remains the same, a study revealed. (tinnitus = ringing in the ears).

  • Family therapy

    A family therapist sees the client's symptoms in the context of the family. For example, if a client has depression, this could be because of an issue within the family, such as may be the case with a teenager whose parents are having marital problems. Cognitive therapy, behavior therapy, and especially interpersonal therapy may be employed in family therapy.

    Put simply, family therapy identifies family patterns that contribute to behavior disorder or mental illness - it helps family members break those habits/patterns.

    Family therapy generally involves discussion and problem-solving sessions with the client and his/her family - session may be in a group, in couples, or one-to-one.

    A family therapist may use a genorgam - this is a family tree constructed by the therapist. It looks at past relationships and events and what impact these may have had on the client's emotional state. Often, family therapy focuses on improving communication within the family - clients are taught to listen, ask questions and respond openly rather than defensively.

    Researchers into post-partum depression at Boston University School of Social Work found that, unlike other psychotherapies, the presence and contribution of the infant are unique to mother-infant treatment and act to catalyze change throughout the therapeutic process.

    Patients suffering from bulimia, aged 12-19, respond better to family-based treatments than supportive psychotherapy, according to researchers from the University of Chicago.

  • Interpersonal therapy

    Here the client's interpersonal relationships are the focus. For example, a depressed client's problem may be treated by improving his/her communication patterns - how he/she relates to others may be having an impact on his/her depression. The therapist may start by helping the client identify what his emotion is and where it is coming from. The client will also be helped in learning how to express emotions in a healthy way. For example, if a client usually responds to a feeling of being neglected by his spouse with anger and sarcasm - this results in the spouse reacting negatively. The client will learn to express his hurt and anxiety calmly, increasing the chances that the spouse will react in a more positive way.

    Put more simply, interpersonal psychotherapy focuses on the client's relationship with family members and peers and the way the client sees himself/herself. It explores issues in relationships with other people. The aim is to help the client identify and modify interpersonal problems, understand them, and to manage relationship problems.

    The majority of women with recurrent depression may be able to prevent subsequent depressive episodes with monthly maintenance interpersonal psychotherapy, say researchers from the University of Pittsburgh School of Medicine.

  • Group therapy

    In group therapy there are usually between 6 to 12 clients and one therapist in a session. All the clients have related problems. The clients benefit from the therapist, and also by observing how other clients suffer and respond to feedback. Getting feedback from other people with related problems gives the clients a different perspective and is frequently helpful in triggering improvement and change.

    Taking part in group psychotherapy can help men who have erectile dysfunction to overcome their problem, and adding sildenafil (Viagra) to group therapy was found to be more effective than sildenafil alone, according to a team of Cochrane researchers.

  • Psychodynamic therapy

    This is also called insight-oriented therapy. It focuses on the automatic processes as they are exhibited in a person's current behavior. This type of therapy aims to increase the client's self-awareness and understanding of the impact of the past on present behavior. It enables the client to take a good look at unresolved issues and symptoms that arise from past dysfunctional relationships and exhibit themselves in the need and desire to abuse substances.

    Put simply, psychodynamic therapy helps people understand the roots of emotional distress, usually by exploring unconscious motives, needs and defenses.

    Psychodynamic therapy is especially effective for people with complex mental disorders, personality and chronic mental disorders, as this meta-analysis revealed. Another study carried out by researchers at the NewYork-Presbyterian Hospital/Weill Cornell Medical Center found that psychodynamic therapy is efficacious in treating panic disorder.

What does psychotherapy treat?

Psychotherapy is used for treating many different problems. Some alone, and some in combination with drugs. The most commons ones are listed below:
  • Depression
  • Anxiety
  • Post-traumatic stress disorder
  • Low self-esteem
  • Anxiety disorder, including phobias
  • Emotional crises
  • Marital problems
  • Family disputes
  • Obsessive-compulsive disorder
  • Personality disorders
  • Alcoholism
  • Addiction
  • Problems stemming from child abuse
  • Behavioral problems
  • Bipolar disorder (in combination with drugs)
  • Schizophrenia (in combination with drugs)

What are the benefits of psychotherapy?

Professor Mick Cooper, of the University of Strathclyde, England, writes that the most important factor in successful therapy is the client, not the therapist.

Participating in psychotherapy offers a number of benefits for the client. It is usually helpful to have somebody who really does understand you. Therapy may give the client a fresh perspective on a difficult problem and direct the client towards a solution. Most patients will say that the benefits of psychotherapy include:
  • Being able to understand yourself and your personal goals and values better.
  • Developing skills for improving relationships.
  • It helps the client overcome certain problems, such as an eating disorder, depression, or anxiety.
  • Obtaining a solution to the problems or concerns that made the client seek therapy.

What are the disadvantages of psychotherapy

  • Some clients may find that the treatment results in changes they had not expected, or did not want.
  • Some people do not like to have to relive unpleasant events (not all psychotherapy techniques make the client do this).
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Obama's Health Plan

President Barack Obama's health budget outlines eight principles of reform to expand coverage and bring down costs, and comes with a price ticket of 76.8 billion dollars for fiscal year 2010.

The budget also proposes a reserve fund of more than 630 billion dollars over 10 years to finance the overhaul, half funded from new revenue and half from savings anticipated to accrue from increasing efficiency and accountability, aligning incentives to quality and sharing responsibility, said the 2010 Health and Human Services Department budget outline released from the White House earlier this week.

According to a report in the Los Angeles Times (LAT), the president wants to raise nearly 318 billion dollars over the next ten years by capping itemized income tax deductions for families earning more than 250,000 dollars a year so that they would only get 28 per cent of deductions like charitable donations back, instead of the higher amounts allowed under current regulations.

According to the LAT, such a proposal means that a couple in the 35 per cent tax bracket would only get back 2,800 dollars compared to the 3,500 dollars they can currrently claim back for a 10,000 dollar charity donation.

The president also sees more than 316 billion in extra revenue coming from changes to the way central government pays for Medicare and Medicaid, where more than 175 billion would come from cutting payments to insurers that contract with the government through the Medicare Advantage program.

Also, the budget proposal stresses that the reserve fund will not be enough to "put the Nation on a path to health insurance coverage for all Americans". Additional funds will be needed to cover the cost of the plan; it will require "an effort beyond this down payment", says the White House.

The 8 principles of Obama's health plan are to:
  1. Speed up use of electronic health records and information technology.

  2. Support more research into comparing treatments so doctors and patients have better information on what works best.

  3. Double research on cancer, including a 6 billion injection at the National Institutues of Health.

  4. Improve services for American Indians and Alaskan Natives.

  5. Recruit more health professionals, including 330 million dollars for more doctors, nurses and dentists in regions of shortage.

  6. Expand child care such as Early Head Start and Head Start and create Nurse Home Visitation to support first time mothers.

  7. Strengthen quality and efficiency of Medicare, the government insurance program for seniors.

  8. Increase food safety and prevention of foodborne illness by investing over 1 billion dollars for more Food and Drug Administration inspections, labs, and surveillance.
In this plan one sees much influence from recently published reasearch, such as the High Performance Health System that the Commonwealth Fund released last week and America's Uninsured Crisis: Consequences for Health and Health Care that the Institute of Medicine published earlier this week.

In their report, the Commonwealth Fund proposes a set of recommendations for insurance, payment and system reforms that could "guarantee affordable coverage for all by 2012, improve health outcomes, and slow health spending growth by 3 trillion dollars by 2020", as long they are enacted now and put in place in 2010.

Central to their proposal is the idea of a national insurance exchange that offers consumers a choice of affordable and accessible private plans and a new public plan that also cost less to administer.

With this as the foundation the focus then shifts to other areas such as reforming how care is paid for. For this they propose moving from a fee-for-service system to more "bundled" methods of paying that "encourage coordinated care and hold providers accountable for improving health outcomes and prudent use of resources".

The Commonwealth Fund also recommends increasing the use of information technology and the creatiion of a center for "comparative effectiveness to enhance knowledge and appropriate use of evidence-based care".

Click here for the White House health budget plan for 2010 (opens as PDF).

Sources:, Commonwealth Fund, Institute of Medicine, LA Times.
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