Suicide Prevention with 988

 September is suicide prevention month

988

988 is the suicide and crisis lifeline formerly known as the national suicide prevention lifeline.

Now you can call and text from your cellphone for access to trained counselors. Also, use this number if a loved one needs crisis support.

JUST TEXT 988 FOR A COUNSELOR.

When someone texts 988, they are responded to by a group of 988 Lifeline crisis centers that answer both chats and texts. This service is currently expanding to increase local and state-level response. Once you are connected, a trained crisis counselor listens to you, works to understand how your problem is affecting you, provides support, and shares resources that may be helpful. Texting is available in both English and Spanish (988 Frequently Asked Questions, n.d.).

DOO 911 AND 988 CORRELATE??

SAMHSA is working towards a long-term vision of strong coordination between the two services so people in crisis get to the most appropriate care needed in that moment. SAMHSA is actively working with 911 counterparts at federal, state, and local levels as our country continues to improve the coordinated and appropriate response to mental health and substance use crises (988 Frequently Asked Questions, n.d.).

THE DIFFERENCE BETWEEN 988 AND 211 

In most states, the 211 system provides health and social service assistance information and referrals. At the same time, 988 crisis counselors will provide support for people in suicidal crisis or mental health-related distress in the very moments they need it most. While generally being different in scope, these systems need to be aligned, and in many cases, local Lifeline centers also respond to 211 contacts. We envision that 988 crisis centers will need to continue to coordinate with 211 and other warmlines. This will help ensure an all-inclusive approach regardless of which number a person may use first (988 Frequently Asked Questions, n.d.).

References

988 Frequently Asked Questions. (n.d.). Www.samhsa.gov. https://www.samhsa.gov/find-help/988/faqs#about-988

‌

Thank You, Harm Reduction Workers

 

Thank You, Harm Reduction Workers

To the harm reduction workers who work tirelessly to help people who use drugs.

Thank you:

• Thank you for providing clean needles and syringes, naloxone, and other harm-reduction supplies.
•  Thank you for offering counseling, case management, and other support services. 
• Thank you for advocating for harm reduction policies and programs. 






Your work is essential. You are helping to save lives and improve the health and well-being of people who use drugs. You are also helping to reduce the stigma associated with drug use. We are grateful for your dedication and commitment. You are making a difference in the world.

Here are some specific examples of the work that harm reduction workers do:

• They provide clean needles and syringes to people who inject drugs, which helps to prevent the spread of HIV and hepatitis C.
• They offer naloxone training to people who use drugs and their loved ones, which can help to reverse an opioid overdose.
• They provide counseling and case management services to people who use drugs, which can help them get their lives back on track.
• They advocate for harm reduction policies and programs, which can help to make it easier for people who use drugs to get the help they need.

Harm reduction workers are on the front lines of the fight against drug use. They are working to save lives and improve the health and well-being of people who use drugs. They are also working to reduce the stigma associated with drug use. We are grateful for the work that harm reduction workers do. They are making a difference in the world. 

If you are interested in getting involved in harm reduction, there are many ways to do so. You can volunteer at a harm reduction program, donate to a harm reduction organization, or advocate for harm reduction policies. Together, we can create a more compassionate and supportive society for people who use drugs.

How Harm Reduction Programs Benefit Society

• Harm reduction is a public health approach that aims to reduce the negative consequences of drug use, rather than requiring people to abstain from drugs altogether. This approach has been shown to be effective in reducing overdose deaths, infectious diseases, and other harms associated with drug use.

• There are many ways that harm reduction programs benefit society. First, they can help to reduce the number of overdose deaths. In fact, a study by the Centers for Disease Control and Prevention found that states with syringe exchange programs had a 43% lower rate of HIV infection among people who inject drugs than states without these programs.

• Second, harm reduction programs can help to reduce the spread of infectious diseases. For example, needle exchange programs provide clean needles and syringes to people who inject drugs, which helps to prevent the spread of HIV and hepatitis C.

• Third, harm reduction programs can help to reduce crime. People who use drugs are more likely to commit crimes in order to support their drug habit. Harm reduction programs can help to reduce crime by providing people with access to treatment and other services that can help them get their lives back on track.

• Fourth, harm reduction programs can help to improve public health. By reducing the negative consequences of drug use, harm reduction programs can help to improve the overall health of individuals and communities.

• Fifth, harm reduction programs can help to reduce stigma. By treating people who use drugs with respect and compassion, harm reduction programs can help to reduce the stigma associated with drug use.

In conclusion, harm reduction programs offer a number of benefits to society. They can help to reduce overdose deaths, infectious diseases, crime, and public health problems. They can also help to reduce stigma. Harm reduction is a compassionate and effective approach to addressing the problem of drug use.

 Some Anatomy on Postoperative Pain

Nociception is the neural processing of injurious stimuli in response to tissue damage ( 2023). Nociception starts at the sensory receptors; however, the perception does not start until the brain gets the signal. There are several of these nociceptive pathways that lead to the brain. Most axons  (which are nerve fibers that conduct electrical impulses) that carry nociceptive information to the brain from the spinal cord project to the thalamus. Their final processing takes place in the primary somatosensory cortex. There is one nociceptive pathway that projects directly to the hypothalamus in the forebrain. This area modulates the cardiovascular and neuroendocrine functions of the autonomic nervous system. This pathway is responsible for stimulating the sympathetic branch of the visceral sensory system, which gives you a fight-or-flight response (2023). 

Afferent neural pathways mediate the sensation of pain. Acute post-surgical pain has three categories

• nociceptive
• occurs in response to stimuli such as direct intraoperative tissue injury (Horn & Kramer 2022).
• inflammatory
• This pain occurs when the nociceptive fibers become sensitized which is in response to the release of inflammatory mediators such as cytokines and can last hours to days.
• neuropathic
• This pain is more chronic and it results from injury to neuronal structures.

.

Postoperative pain is characterized as somatic or visceral.

• Somatic pain is the type of pain you feel in your skin, muscles, joints, and bones. 1 It can feel like a gnawing, aching, cramping or sharp.
• Visceral pain comes from your organs 

The goal for pain management aims to target the afferent pain pathways by different mechanisms such as antagonizing pain receptor activity or blocking the production of proinflammatory mediators

• Approximately 75 percent of patients who undergo surgery experience acute postoperative pain, which is often medium-high in severity (Horn & Kramer, 2022).
• Less than half of patients undergoing surgery report adequate postoperative pain relief.

"Inadequate postoperative pain control may lead to adverse physiologic effects among patients in the immediate postoperative period and places them at increased risk of developing chronic pain associated with the procedure (Horn & Kramer, 2022).

• Severe persistent postoperative pain affects 2 to 10 percent of adults.

References

 Horn, R., & Kramer, J. (2022, September 19). Postoperative Pain Control. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK544298/

(2023). Vitalsource.com. https://bookshelf.vitalsource.com/reader/books/9781938168093/pageid/377

‌

‌

Causal Factors for Eating Disorders

 There is no single cause of eating disorders. They are likely caused by a complex interaction of genetic and environmental factors. Genetic factors: Eating disorders may be partly caused by genes. People who have a family history of eating disorders are more likely to develop them themselves.

Environmental factors

 Eating disorders may also be partly caused by environmental factors. These include cultural pressures to be thin, exposure to dieting and weight loss programs, and traumatic life events.

 

Specific environmental factors (Hooley et al., 2019):

1. Cultural pressure to be thin
2. Exposure to dieting and weight loss programs
3. Traumatic life events
4. Family history of eating disorders
5. History of other mental health conditions, such as anxiety or depression

 The diathesis–stress model helps explain how genetic and environmental factors interact to cause eating disorders.

.

The diathesis-stress model (Hooley et al, 2019):

•  Genes make some people more susceptible to environmental pressures, which can then lead to the development of problematic eating attitudes and behaviors.
• the diathesis -  people who are genetically predisposed to a certain condition 
• When the above meets the right stressor, an eating disorder can develop
• This model is only a theory.

Genetics

• Family studies: Family studies have shown that people with eating disorders are more likely to have relatives with eating disorders or other mental health conditions.
• Twin studies: Twin studies have shown that eating disorders are more likely to be shared by identical twins than fraternal twins. This suggests that genes play a role in the development of eating disorders.

Genome-wide association studies:

•   Genome-wide association studies have identified several genes that are associated with eating disorders. These genes are involved in a variety of biological processes, including
•  metabolism
•  mood regulation
•  development.
• These genes alone do not guarantee an eating disorder will develop.

Brain abnormalities 

 

Hypothalamus:

     The hypothalamus is a part of the brain that plays an important role in regulating eating behavior. Animal studies have shown that lesions to the hypothalamus can lead to overeating or undereating.

 Frontal and temporal cortex:

 The frontal and temporal cortex are also involved in eating behavior. Damage to these areas has been linked to the development of anorexia nervosa and bulimia nervosa.

Network of brain areas:

 Animal research suggests that a network of brain areas, including the hypothalamus, the frontal cortex, and the amygdala, may be involved in the development of eating disorders.

Set point

• Set point theory is a theory that suggests that our bodies have a natural weight range that they try to maintain.
• Hunger is one way that our bodies try to maintain our set point. When we lose weight, our hunger increases in an attempt to get us back to our set point.
• Influenced by a variety of factors, including genetics, metabolism, and environment.

Serotonin

• 
   Serotonin is a neurotransmitter that has been implicated in obsessionality, mood disorders, and impulsivity. It also modulates appetite and feeding behavior.
• Many patients with eating disorders respond well to treatment with antidepressants (which target serotonin), leading some researchers to conclude that eating disorders involve a disruption in the serotonergic system.
• Serotonin is made from an essential amino acid called tryptophan, which can only be obtained from food.

5-HIAA

Product of serotonin metabolism(5 HIAA, n.d.). 

• People with anorexia nervosa have low levels
• People with bulimia nervosa have normal levels.

Serotonin overactivity

It has been suggested that people with may use dieting as a way to regulate this by decreasing the amount of tryptophan available to make serotonin (Hooley et al, 2019).

•  Neurotransmitters like serotonin do not work in isolation and changes in the serotonin system will have implications for other neurotransmitter systems too

 

Reward Sensitivity

• A new direction in eating disorders research centers on the brain pathways and neurotransmitters (such as dopamine) that are involved in reward processing.
• Patients with anorexia nervosa show more activity in brain reward areas when they view pictures of thin rather than healthy models, while controls show the opposite pattern
  
• Reward and punishment systems get contaminated; normally rewarding stimuli such as food become aversive, and stimuli associated with self-starvation become valued.

References

 5 HIAA. (n.d.). TheFreeDictionary.com. Retrieved August 27, 2023, from https://medical-dictionary.thefreedictionary.com/5+HIAA

‌

Psychology: The Prism of Human Behavior

 A Prism of Human Understanding

 The human mind is a complex and fascinating thing. It is capable of great love, creativity, and compassion, but it can also be the source of great pain, suffering, and confusion. Psychology is the study of the human mind and behavior, and it offers a lens through which we can better understand ourselves and others.

Just as a prism can split white light into a rainbow of colors, psychology can help us to see the many different facets of human experience. It can help us to understand our thoughts, feelings, and behaviors, and it can help us to make sense of the world around us.

There are many different approaches to psychology, each with its own unique perspective on the human mind. Some psychologists focus on the biological basis of behavior, while others focus on the social and cultural factors that influence our thoughts and feelings. Still others focus on the individual's unique experiences and personal history.

The Prism of Human Behavior

 Just as a prism refracts light into a spectrum of colors, psychology can be seen as a prism that refracts human behavior into its many different facets. By understanding the different factors that influence human behavior, psychologists can help us to understand ourselves and others better.

The Refraction of Light and Mental Disorders

Just as a prism refracts light into a spectrum of colors, mental disorders can refract our thoughts, feelings, and behaviors into a variety of different expressions. By understanding the different factors that contribute to mental disorders, we can better understand how they can shape our experiences.

Some of the factors that can contribute to mental disorders include:

• Genetics: Some mental disorders, such as schizophrenia and bipolar disorder, have a strong genetic component. This means that if you have a family history of a mental disorder, you are more likely to develop it yourself.
• Environment: Our environment can also play a role in the development of mental disorders. For example, childhood trauma can increase the risk of developing anxiety and depression.
• Brain chemistry: Mental disorders can also be caused by imbalances in brain chemistry. For example, people with depression often have low levels of serotonin, a neurotransmitter that plays a role in mood regulation.
• 
  Lifestyle: Our lifestyle choices can also contribute to the development of mental disorders. For example, smoking and excessive alcohol use can increase the risk of developing mood disorders.
  

When these factors come together, they can create a "prism" that refracts our thoughts, feelings, and behaviors into a variety of different expressions. For example, someone with depression may experience sadness, hopelessness, and fatigue. They may also withdraw from social activities and have difficulty concentrating. Someone with anxiety may experience excessive worry, fear, and restlessness. They may also have difficulty sleeping and concentrating.

By understanding the different factors that contribute to mental disorders, we can better understand how they can shape our experiences. This knowledge can help us to identify the signs and symptoms of mental disorders, seek professional help, and develop effective treatment plans.

 Anorexia Nervosa

With anorexia, the patient thrives on being thin at any cost and this causes the patient's abnormal behaviors that result in a low body weight regardless of the consequences. Amenorrhea is no longer required for someone to be diagnosed with anorexia nervosa. Significantly low weight is defined as a weight that is less than minimally normal for children and adolescents and less than that is minimally expected. The patient has an intense fear of gaining weight or becoming and persistent behavior that interferes with gaining weight, even though they are significantly underweight

    The patient experiences disturbance in the way that they view their body shape and also a persistent lack of recognition of the seriousness of the current low body weight.

There are two types of Anorexia Nervosa

1. The restricting type
1. Patients restrict food intake to maintain their low weight
2. They do not like to eat in front of other people 
2.  Binge-eating/purging type
1. The restrict calories
2. They binge eat and purge

Some example of how patients suffering from anorexia suffer from distorted thinking (Hooley, et al, 2019).

• “I have a rule when I weigh myself. If I’ve gained then I starve the rest of the day. But if I’ve lost, then I starve too.”
• “Bones define who we really are, let them show.”
• “An imperfect body reflects an imperfect person.”
• “Anorexia is not a self-inflicted disease, it’s a self-controlled lifestyle.”
• “It’s not deprivation, it’s liberation.”

Here are some ways someone suffering from anorexia nervosa might try to conceal their weight loss especially if they know that they are about to be weighed.

•  wearing baggy clothes 
•  carrying hidden bulky objects so that they will weigh more when measured by others
• drinking large amounts of water to increase their weight temporarily.

DSM-5 Criteria for. . .

Anorexia Nervosa

1. Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected.
2. Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight.
3. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight (Hooley et al, 2019).

• Anorexia is centuries old.
• Religious literature tells of cases of extreme cases of fasting (Hooley, et al., 2019).
• 1689
• Richard Morton - wrote about the first documented cases of anorexia nervosa. An 18-year-old girl and a 16-year-old boy both suffered from what they called at the time "nervous consumption" ( Hooley, et al., 2019).
• The girl died eventually because she refused the treatment.
• 1873
• Charles Lasègue in Paris and Sir William Gull in London
• Both wrote about two different cases and described the same symptoms. 
• One case was a 14-year-old girl who was starving herself. They treated her by getting her to eat light food every few hours.
  

References

Hooley, J. M., Nock, M. K., & Butcher, J. N. (2019). Abnormal Psychology (18th ed.).

Pearson Education (US). https://bookshelf.vitalsource.com/books/9780135191033

Antiretroviral therapy (ART)

Antiretroviral therapy (ART)

 Antiretroviral therapy (ART) is the treatment for HIV infection. It involves taking a combination of medicines every day. ART is recommended for everyone with HIV, regardless of their CD4 count or viral load.

ART does not cure HIV infection, but it can help people with HIV live long, healthy lives. It can also reduce the risk of spreading HIV to others.

HIV medicines work by reducing the amount of HIV (viral load) in the body. This helps people with HIV in two ways:

1. It gives the immune system a chance to recover. HIV attacks and destroys the body's CD4 cells, which are an important part of the immune system. When there is less HIV in the body, the immune system has a better chance to recover and produce more CD4 cells. This can help people with HIV fight off infections and certain HIV-related cancers(HIV Medicines, n.d.).
2. It reduces the risk of spreading HIV to others. When the viral load is low, it is very unlikely that HIV can be transmitted through sex or sharing needles. This is because there is less virus in the body to be passed on to others.
   
   

FDA-Approved HIV Medicines (NIH, 2021):

•  Nucleoside Reverse Transcriptase Inhibitors (NRTIs)

• Nucleoside reverse transcriptase inhibitors (NRTIs) are a class of antiretroviral drugs that block reverse transcriptase, an enzyme HIV needs to make copies of itself.NRTIs are similar to the building blocks of DNA. When HIV reverse transcriptase incorporates an NRTI into the DNA that it is making, the NRTI stops the DNA from being completed. This prevents HIV from making copies of itself.

• Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)

• Non-nucleoside reverse transcriptase inhibitors (NNRTIs) are a class of antiretroviral drugs that work by binding to and altering the reverse transcriptase enzyme. Reverse transcriptase is an enzyme that HIV needs to make copies of itself. When NNRTIs bind to reverse transcriptase, they prevent the enzyme from working correctly. This prevents HIV from making copies of itself and helps to control the infection.

• Protease Inhibitors (PIs)
• Protease inhibitors (PIs) are a class of antiretroviral drugs that block protease, an enzyme HIV needs to make copies of itself. Protease is responsible for cutting up the HIV protein into smaller pieces that can then be assembled into new viruses. When PIs block protease, they prevent new HIV from being made(Protease Inhibitor (PI) | NIH, n.d.).

• Fusion Inhibitors
• Fusion inhibitors are a class of antiretroviral drugs that work by blocking the fusion of the HIV envelope with the host CD4 cell membrane. This prevents HIV from entering the CD4 cell. Fusion inhibitors work by binding to the HIV envelope protein gp41. GP41 is a protein that is essential for HIV to fuse with the CD4 cell membrane. When fusion inhibitors bind to gp41, they prevent the protein from changing shape, which is necessary for fusion to occur.

• CCR5 Antagonists
• CCR5 antagonists are a class of antiretroviral drugs that work by blocking the CCR5 coreceptor on the surface of certain immune cells. HIV needs to bind to the CCR5 coreceptor in order to enter the cell, so by blocking CCR5, CCR5 antagonists can prevent HIV from infecting the cell.
  


• Integrase Strand Transfer Inhibitor (INSTIs)

• Integrase inhibitors are a class of antiretroviral drugs that work by blocking HIV integrase, an enzyme that HIV needs to make copies of itself. Integrase is responsible for inserting the HIV genetic material into the DNA of the host cell. By blocking integrase, integrase inhibitors can prevent HIV from infecting the cell and making copies of itself.


• Attachment Inhibitors

• Attachment inhibitors are a class of antiretroviral drugs that work by binding to the gp120 protein on the outer surface of HIV. The gp120 protein is essential for HIV to bind to CD4 cells, so by binding to gp120, attachment inhibitors can prevent HIV from entering CD4 cells.

• Post-Attachment Inhibitors

• The gp120 protein is essential for HIV to bind to CD4 cells. When attachment inhibitors bind to gp120, they prevent HIV from binding to CD4 cells and entering the cell. This prevents HIV from infecting the cell and replicating.
• Capsid Inhibitors
•     The capsid is essential for HIV to replicate. When capsid inhibitors bind to the capsid, they interfere with its ability to protect HIV's genetic material and enzymes. This can prevent HIV from replicating and can help to control the infection.

Pharmacokinetic Enhancers

 PKEs work by slowing down the breakdown of HIV medicine in the body. This allows more of the medicine to reach the bloodstream and be effective in fighting HIV.

Resources

 Abacavir - Patient | NIH. (n.d.). Clinicalinfo.hiv.gov. https://clinicalinfo.hiv.gov/en/drugs/abacavir/patient

 HIV Medicines. (n.d.). Medlineplus.gov. https://medlineplus.gov/hivmedicines.html

NIH. (2021, February 8). FDA-Approved HIV Medicines | HIVINFO. Hivinfo.nih.gov. https://hivinfo.nih.gov/understanding-hiv/fact-sheets/fda-approved-hiv-medicines

Protease Inhibitor (PI) | NIH. (n.d.). Clinicalinfo.hiv.gov. https://clinicalinfo.hiv.gov/en/glossary/protease-inhibitor-pi

‌

‌

‌