Inside Diagnostics Spring 2017 (EN) by nal von minden GmbH

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Inside Diagnostics Spring 2017

Performance diagnostics

The basis for successful training

Benzodiazepine

The (un)calming effects of benzodiazepine

Depression

Symptoms, diagnosis & treatment

Rapid Tests Laboratory Diagnosis

this issue:

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Inside Diagnostics

Foreword

Dear reader,

Flag Inside Diagnostics Customer magazine from nal von minden GmbH Responsible according to press law: Thomas Zander Editor in chief: Iris Schubert Editorial Team: Iris Schubert, Krystina Beer, Nicola Barabas, Helen Murr, Daniela Beer, Martina Kastenmaier, Tina Sambs inside-diagnostics@nal-vonminden.com Graphics: Martina Kastenmaier

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Write to: inside-diagnostics@nal-vonminden.com Contact/Editor in chief Iris Schubert • Tel.: 0941 29010-46 inside-diagnostics@nal-vonminden.com

pring is coming and with it many sporting ambitions. Whereas some are just intended to keep us fit, there are increasing numbers of amateur athletes aiming for higher and higher goals with the motto: higher, faster, further. Performance diagnostics is the topic under the magnifying glass in this edition of Inside Diagnostics. In addition, in line with the WHO’s World Health Day on 07.04.2017 (on the topic of Depression – Let’s Talk!’), we will explore the symptoms, diagnosis and various treatments for depression. This edition also takes a look at benzodiazepines, diabetes and substitution, and includes a new competition – this time a Nikon Coolpix A10 camera is up for grabs! Enjoy reading! Your Inside Diagnostics Team

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Inside Diagnostics

Content Topics Performance Diagnostics �� 4 Benzodiazepine �� 8 Pregabalin �� 12 Diabetes �� 14 Substitution �� 15 Depression: Symptoms, diagnosis & treatment �� 16 nvm Inside Prize Draw �� 10 Contact �� 20

Performance Diagnostics | Page 4

Sport medicine has been offering recreational athletes professional performance diagnostics for a long time. But how much medicine do we need in sport? When does it make sense? More on page 4.

Cover © istockphoto.com/peepo

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Sports medicine Performance Diagnostics

Sports medicine Performance diagnostics as a basis for successful training in the modern day

igher, faster, further: these days it’s not only the professionals training. Many of those making a hobby of sport no longer wish to rely solely on hard work. With the aim of raising the bar of their own performance, runners use smart phone apps, electronic diaries and heart rate monitors to document every kilometer run and then compare their performance with others on various social networks.3

How good am I? How should I train in order to get better? Am I healthy? A performance diagnosis can shed light on such questions! They can also be used to give training advice, record progress and identify or exclude medical risks. Whereas some years ago only high performance athletes trained several times per week, this is a trend that has also developed amongst those who do sport in their free time or as a hobby. They generally have less time to dedicate to training, but since goals are being constantly raised, it’s no wonder that modern performance diagnostics has long since found its way into the realm of leisure. In a time when no cost or effort

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is spared when aiming for self-imposed goals, performance diagnostics can help to identify and prevent the wrong kind of training and instead encourage people to take a healthier and more efficient approach.1 Determining current fitness levels A performance diagnosis comprises an examination and test procedure, which provide information on the individual’s current state of health, resilience and performance. Based on these results, it is possible to establish a personal training plan suited to each individual. As a result, their personal sporting goals will be much easier to reach. The principal and most well-known methods of performance diagnoses are lactate testing, heart rate monitoring and ergospirometry. Heart rate measurement was the first milestone in the success story of performance diagnostics in the context of leisure. The mobile measurement of heart rates through wrist monitors and chest straps revolutionised this area. Whereas, several years ago, manual measurement and stop watches were the methods of choice, it is now possible to identify pre-

Sports medicine Performance Diagnostics

higher

faster

further

cisely the maximal pulse of athletes whilst under strain. The digital age facilitates this through the use of fitness trackers and smart watches, which can transfer the information directly to a smart phone for comparison. The ultimate goal of heart rate monitors is to measure the aerobic and anaerobic training range of the given individual. 4 Determining the optimal training range – the difference between aerobic and anaerobic energy metabolism. Aerobic and anaerobic training are often spoken of in the context of fitness and endurance training, but what exactly is the difference? To best shape training to each individual, it is important to be well-informed. Aerobic and anaerobic training are all about energy conversion within the body – particularly the conversion of nutrients such as fats and carbohydrates. Aerobic energy conversion refers to the breaking down and use of carbohydrates and fats using oxygen, whereas anaerobic energy conversion breaks down carbohydrates without the use of oxygen. Oxygen is compulsory for burning fat, and so fat is not burned during anaerobic training.

On the same topic, lactate and lactate acid levels also come into play. Lactate is a lactate acid salt that is produced as a by-product of energy production. The aerobic energy metabolism does not allow the body’s lactate acid levels to rise as high as they do in the case of anaerobic energy metabolism. 2 The aerobic/anaerobic conversion point – fat burning or muscle building? Lactate tests measure the lactate concentration in blood and subsequently determine the aerob/anaerobic conversion point in athletes. For the measurement, the athletes have their blood taken several times during a stress test - usually from the ear. The lactate concentration is an indicator for the intensity of the stress test and shows the point when activity becomes anaerobic for the athlete being tested. As lactate increases, the muscles are no longer getting enough oxygen. At concentrations between 2-4mmol/l (millimol per litre), athletes reach aerob-anaerobic ranges. Concentrations over 4mmol/l indicate the anaerobic range. By simultaneously measuring the heart rate, it is possible to measure precisely at which point the anaerobic threshold of

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Sports medicine Performance Diagnostics

To enhance perfmormance

build muscles,

or to the athlete needs to exercise for a short period of time

at the peak of their

training pulse, thus using

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aerobic as well as anaerobic exercise.

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http://www.sportdiagnostik.de/leistungsdiagnostik/profidiagnostik-ausdauer.html https://www.gesund24h.de/blog/sport/anaerob-und-aerob-der-unterschied.html

Sports medicine Performance Diagnostics

a particular individual lies, and from there a training plan can be put together to suit. It is generally assumed that aerobic ranges are reached before 140 beats per second. This can, of course, differ from person to person depending on their fitness and physical condition. The result is that aerobic endurance training is characterized by the burning of fat and carbohydrates through oxygen consumption. The heart should beat â&#x20AC;&#x201C; depending on the individual threshold - under 140 times per minute. At the beginning of training, it is mostly carbohydrates being burned. After around 20 minutes at an aerobic level, fat burning begins. By the end of the training session, it is mostly only fat being burnt. For those who are looking to burn fat, this means that the heart rate during training should stay below the threshold and the training time extended. Training in an anaerobic range will primarily burn carbohydrates. For this, intensive training at an extremely high heart rate and high exertion is necessary. When this happens, lactate acid levels rise more rapidly in muscles and as a consequence they begin to over-acidify. Depending on the intensity of the training, the body switches back and forth between aerobic and anaerobic energy metabolism. If training solely in the aerobic range, the level of athleticism is not much increased. If individuals should wish to increase their performance or build muscle, they should train more often and for a shorter time at a high intensity â&#x20AC;&#x201C; utilizing both aerobic and anaerobic training. If training just to burn fat, the heart rate should remain at the lower end of the scale and training time increased.2, 4

The respiratory gases of the athlete are analysed using the help of an airtight mouth/nose mask. The device is set to individual athletes depending on which sport the subject is undertaking and which muscle group he/she usually trains. This means that a runner is usually tested on a treadmill, a cyclist on an ergometer and so on. During the stress test, which usually lasts around 10 minutes, the intensity will be increased intermittently. Depending on the individual, this usually happens every 1-2 minutes. The pulse and blood pressure of the subject are monitored by ECG. The purpose of spiroergometry is to determine the performance capability as well as potential limitations of each athlete â&#x20AC;&#x201C; such as heart defects, for example. It enables differentiation between limitations caused by the heart or lungs. High level monitoring of the heart, lungs, circulation and oxygen is of great importance in sports medicine. It can also be used to measure the success of training and to establish training levels.3, 4 Muscle equipment a thing of the past? What is often missing in all these examinations is the muscular and orthopaedic side of things. Though confirmed fit for sport by the aforementioned methods, injuries can occur if the necessary muscles are compromised, such as by a joint problem, for example. How much those practicing sport in their free time wish to use sports medicine as part of their everyday routine remains a decision for the individual.4

The all-rounder in sports medicine The best way of monitoring the heart rate, circulation, lung function and oxygen is by spiroergometry or ergospirometry.

http://www.ultra-marathon.org/index.php/service/sportmedizin/117-allgemeines/102889-leistungsdiagnostik-fuer-jeden-sportler http://www.spiegel.de/gesundheit/ernaehrung/laktattest-und-co-was-die-leistungsdiagnostik-fuer-hobbylaeufer-bringt-a-857048.html

3 4

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Antidepressants Benzodiazepine

Antidepressants The (un)calming effects of benzodiazepine Nowadays, the medical treatment of depression and sleep disorders is common practice. In Germany, the number of those being treated for these conditions exceeds one million, many of whom are being prescribed benzodiazepines for conditions such as sleep deprivation, anxiety disorders or psychological issues. As a result of their calming and anxiolytic effects, they are commonly referred to as 'tranquilisers‘ and, due to this effect, are even used in clinical settings prior to surgical procedures for those with epilepsy, tetanus, febrile seizures, and other conditions that cause muscles to be put under increased stress.

Sedatives can also become addictive and lead to dependency. If taken regularly for several weeks, withdrawal symptoms will begin to show themselves in the form of sweating, panic attacks and sleep disturbance. Often these symptoms, which prompted the prescribing of benzodiazepine, in fact reemerge with more intensity as side effects of its consumption. Medications containing lorazepam are particularly responsible for significant side effects. In depressive patients, it can also induce suicidal thoughts, as well as difficulties in perception. Research is currently underway in order to ascertain whether long-term use can also lead to a higher risk of dementia.

What is happening in the brain following consumption?

Potential damage of various drugs and medication

s a result of benzodiazepine’s direct effects on the central nervous system, the brain‘s stimuli are suppressed. The neurotransmitter 'Gamma-Amino-Butyric acid (GABA)‘ suppresses chemicals such as serotonin, noradrenaline and acetylcholine, which in turn has an effect on memory, concentration, emotions and motor skills.

Heroin Cocaine Tobacco

The various side effects of benzodiazepines

Many long-term patients also complain about the so-called ‘emotional anesthesia‘ caused by the use of benzodiazepines. Through their direct effect on the nervous system, they do not only inhibit sensitivity to fear and anxiety, but also positive emotions such as joy. This ‘dulling‘ frequently has social consequences not only for the patient, but also their partners, families and friends. With such side effects, it can be difficult for people to maintain social relationships.

2 Addiction

Aside from its calming capabilities, the consumption of benzodiazepines also carries high risks and can lead to numerous unwanted side effects. Older patients in particular should discuss with their doctors the fact that the breakdown of such medication in old age takes longer than in young people. There are also a number of complications that may occur.

Methadone Benzodiazepine Buprenophine Amphetamine Cannabis

Barbiturate

Alcohol

GHB Khat

LSD Ecstasy

Poppers

Ketamine 4-MTA Methylphenidate Inhalants

Anabolic Substances

Physical Damage

The potential for physical damage is here laid out against the potential for psychological dependency, and reflects each substance’s individual damage potential. The circle diameters represent the average potential for social damage with regard to economic costs for the community, criminal acts and family conflicts.

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http://www.dhs.de/suchtstoffe-verhalten/medikamente/benzodiazepine.html https://de.wikipedia.org/wiki/Schädlicher_Gebrauch_von_Benzodiazepinen http://www.spiegel.de/gesundheit/diagnose/valium-und-co-die-gefaehrlichen-nebenwirkungen-von-benzodiazepinen-a-883500.html

Antidepressants Benzodiazepine

ÂŠ www.istockphoto.com/dmitry_plukhin

Benzodiazepines are prescribed for conditions such as sleep deprivation, anxiety disorders or psychological issues.

One should also not forget the risk of accidents associated with the use of sedatives. Those consuming benzodiazepines should neither drive nor operate machinery during the course of their medication, as it can severely impair concentration numerous studies have drawn a link between the consumption of benzodiazepines and resulting traffic accidents.

en in conjunction with opiates in an attempt to push a bigger 'highâ&#x20AC;&#x2DC; - though this can lead to respiratory depression or even respiratory arrest.

Dangerous reactions with other substances

What are the alternatives?

A further risk of benzodiazepine consumption is the reactions caused when taken in conjunction with other medications and substances. Benzodiazepines increase the effects of other sedatives, such as barbiturates, opiates and even alcohol.

The consumption of benzodiazepines is something that demands considerable attention. Comprehensive medical consultation prior to their prescription is essential, as their use for depression or for symptoms of stress is not always necessary. In many cases, alternative treatments can have a lasting influence and are mostly free of side effects. Should prescription nevertheless be necessary, patients ought to be made aware of the risks. They may want to consider coming off the drug under the supervision of a doctor or, where possible, be moved onto an alternative medication in order to avoid damaging effects.

The effects of alcohol consumption in conjunction with sedatives are often underestimated, and can even have fatal consequences. An overdose of both substances can, in extreme cases, cause a cardiac arrest. Generally speaking, the combination of drugs with medication should be avoided, as the risks are often unpredictable. Benzodiazepines are often tak-

MK, DB

http://www.emcdda.europa.eu/publications/drug-profiles/benzodiazepine/de http://www.infomed.ch/pk_template.php?pkid=497

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nvm inside Prize Draw

Join in & win! Dear reader,

We would like to congratulate Yvonne Böttcher, the winner of the Jawbone UP2 Fitnesstracker from our last issue. We are pleased to once again give you the opportunity to win a great prize! For the Spring issue, we are giving away a Nikon Coolpix A10 Camera kit. All you need to do is answer the following question:

of What is the effect pregabalin? . a) It is stimulating b) It is relaxing. lacebo. c) Pregabalin is a p Win a Nikon Coolpix A10 Camera! ✓ 16.1 megapixel CCD-Sensor for high quality pictures ✓ 5x-optical zoom (equals 26 - 130 mm in 35 mm format) ✓ Video Clips in HD-quality (720p) ✓ COOLPIX A10 kit silver Participate via the following link: www.nal-vonminden.com/gewinnspiel.html or by email to: gewinnspiel@nal-vonminden.com Otherwise send the following fax form to: +49 941 29010 50

Closing date is 30.04.2017

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Good luck!

Your Inside Diagnostics team

nvm inside Prize Draw

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simply fill in the form & win!

Name

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Signature Conditions of Participation 1. The Promoter is nal von minden GmbH. 2. To enter simply fill in your details on the form here above and fax it to +49 941 290 10-50 or send it by post to: nal von minden GmbH, Iris Schubert, Friedenstrasse 32, 93053 Regensburg, Germany. Participation is also possible by email; please send an email with your answer and your complete address with the subject line as “Prize Draw” to gewinnspiel@nal-vonminden.com. The winner will be chosen at random and be drawn from those who have entered the correct answer. 3. This prize draw is open to European residents aged 18 years or over, with the exception of employees of the Promoter, their families, agents and anyone else connected with this promotion. Only one entry per person. No entrant may win more than one prize. 4. No purchase necessary to enter the prize draw and the participation is free. By entering the prize draw each entrant agrees to be bound by these terms and conditions. Entries must be received by the 30th of March 2017. 5. The winner will be notified via email or post and will receive the prize by post. 6. Prizes are subject to availability. In the event of unforeseen circumstances, the Promoter reserves the right (a) to substitute alternative prizes of equivalent or greater value and (b) in exceptional circumstances to amend or foreclose the promotion without notice. No correspondence will be entered into. 7. The prize is a Nikon Coolpix A10 Camera. No cash or prize alternatives will be offered. The winner‘s entitlement to the prize is not transferable. 8. The Promoter shall not be responsible for damages, losses or liabilities of any kind, including without limitation, direct, indirect or consequential loss or damages arising out of or in relation to the prize draw. 9. Any liability for damages of nal von minden GmbH and their officers, employees and agents in connection with the competition, irrespective of the legal reason, is, as far as legally permissible, limited to cases of intent or gross negligence. 10. The promoter’s decision in respect of all matters to do with the competition will be final and no correspondence will be entered into. Legal recourse is excluded. Data protection 1. Being a responsible entity as defined by the German Federal Data Protection Act, nal von minden GmbH collects, processes, and uses personal data (first name and last name, date of birth, street address, postal code, place, country, and email address) disclosed to nal von minden GmbH in connection with the prize draw only in compliance with the applicable laws and regulations referring to data protection. nal von minden GmbH will not disclose your personal data to any third party. Your personal data will be collected, processed and used exclusively for the purpose of carrying out the prize draw. The promoter is allowed to send future issues of the “Inside Diagnostics” by e-mail. Unsubscribe at any time by sending an informal e-mail to gewinnspiel@nal-vonminden.com 2. You are entitled by law to request free information about the personal data nal von minden has stored in relation to your person, and to request that nal von minden GmbH corrects, blocks or deletes these personal data. Please contact nal von minden GmbH if you want to claim any of these rights referred to above. 3. If you request that your personal data be deleted before the prize draw is completed, your entry into the prize draw is deemed to be terminated as well. In that case, you are no longer eligible for a prize.

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Antidepressants Pregabalin

Pregabalin

The Anxiety Business Fears are normal and even necessary, as they are an evolutionary protective mechanism that keeps us alert and prompt the right behaviour in dangerous situations. This sensitive system can only function, however, if the person is not overwhelmed by too much fear, or if they do not react with too little fear by not recognising the danger at hand. Should fear dominate our everyday lives and have a lasting effect on our emotions, it can lead to both physical and mental illness. Just as the causes can be numerous, so too can the characteristics of the illnesses. It is rare for an anxiety disorder to be diagnosed in isolation – instead they usually occur in conjunction with depressive moods, sleep disorders or similar afflictions. In each case, the causes should be evaluated medically.

he development or elimination of anxiety is determined above all by the roles of three messengers or neurotransmitter systems. The various neurotransmitters are intermediaries to the nervous system. They are responsible for the forwarding and regulating of varied information from one nerve cell to the next, and set various ‘systems’ in motion. For example: •

GABAergic System: Gamma-aminobutyric acid (GABA) is the most important inhibitory messenger in the central nervous system. It plays a role in many neuronal processes, but above all it has a regulatory function in controlling the activity of other nerve cells and neurons. Instances which halt the forwarding of activating (also known as ‘excitatory’) information are necessary as, in their absence, excitatory messengers alone would lead to overstimulation.

GABA inhibits these activating neurotransmitters and thus produces anxiety-relieving, pain-relieving, relaxing and blood pressure-stabilizing effects. Many substances that are intended to dull the central nervous system, such as benzodiazepines or barbiturates, attack the receptors of these systems and thus induce or intensify GABAergic effects. •

Noradrenergic system: As an excitatory neurotransmitter, noradrenaline is involved in many processes, particularly those related to alertness and attention. It also affects learning and memory processes, as well as the processing of anxiety and emotions.

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•

Serotogernic system: Serotonin operates in the centre of the brain, but also outside of the central nervous system. As an inhibitory neurotransmitter, it influences various psychological functions such as sensitivity to pain, memory, sleep, eating and sexual behaviour. It also plays a role in an individual’s emotional state and is known as the ‘happiness hormone’. Behaviour such as aggression, impulsiveness and anxiety are also regulated by serotonin. As well as psycho- and behavioural therapy, medication is a vital element in the treatment of these symptoms.

A possible starting point is the anxiety-relieving effect of GABA. GABA cannot pass the blood-brain-barrier itself, but its derivatives can. These derivatives, such as gabapentin or its successor, pregabalin, are used to treat anxiety disorders by slowing the release of excitatory neurotransmitters. In this way, pregabalin can have many applications. Under the name Lyrica®, it has been used EU-wide since 2004 to treat epilepsy and neuropathy, as well as certain nerve pain.

As well as psychoand behavioural therapy,

medication is a vital element in the treatment of these symptoms.

www.istockphoto.com © Elena Belyakova

Antidepressants Pregabalin

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Antidepressants Pregabalin

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Antidepressiants Pregabalin

On the basis of its anxiety relieving effects, pregabalin can be used in cases where an individual’s anxiety is getting out of control. The various fields of application could not be more different: As if a light switch were being turned on, pregabalin turns off the excess of activating information that would otherwise poise the body for action. Sensitivity to pain is reduced, seizures halted, the body relaxes and symptoms of anxiety are alleviated. With revenue in the region of 220 million euros in 2009, pregabalin was the 12th highest-selling patented medication in Germany. However, at a cost of 170 million euros in 2015, Lyrica® meant a continuation of high costs for health insurance companies - probably not least because doctors were initially unsure of the admission spectrum of more generic drugs, and rumours spread that they were not permitted as well as Lyrica® for use in neuropathic pain.

Pregabalin passes through much of the body unchanged, and only a small number of other medications and substances will lead to a cross-reaction. Nevertheless, this should be closely monitored if other medications are also being taken. Pregabalin can intensify the effects of other substances that dull the central nervous system, and caution should be exercised with regard to the simultaneous consumption of sedatives or sleeping pills based on benzodiazepines or opiates/ opioids – these are often used in particularly strong pain relief medications. It is alarming that many patients going through heroin-withdrawal develop a dependency on pregabalin. It remains unclear why the number of prescriptions for the drug has not decreased despite the warnings surrounding the potential for dependency. It appears that the danger has been severely underestimated and prescriptions therefore made out in generous numbers.

Pregabalin can also be potentially worryingly addictive, due to its sedating and relaxing effects. In addition to its characteristics in the treatment of epilepsy, neuropathic pain and general anxiety disorders, pregabalin can also be potentially worryingly addictive, due to its sedating and relaxing effects. Also, euphoric states can prompt excessively high dosing, which puts it at a high risk for misuse – indeed, emergency services have reports of patients taking more than 10 times the maximum dose.

Criticism has been voiced by many on numerous occasions. Insurance companies often cite the immense costs incurred through the high number of prescriptions. The European Monitoring Centre for Drugs and Addiction has placed pregabalin on their list of monitored substances, as the problems associated with it are international. The hope remains that the intensive distribution of information on the topic of pregabalin will in turn significantly ease the issue.

http://dr-bieger.de/gamma-amino-buttersaeure-gaba-neurotransmitter-mit-angst-loesender-wirkung/ http://www.diss.fu-berlin.de/diss/servlets/MCRFileNodeServlet/FUDISS_derivate_000000003260/1_Kapitel1.pdf.pdf?hosts http://www.kvwl.de/arzt/verordnung/arzneimittel/info/agavm/pregabalin_agavm.pdf

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Diagnostics Diabetes

Diabetes

The onset of diabetes: what to look out for

his is true only for Type 2 diabetes – where a lack of insulin produced by the body means that glucose cannot be broken down. Type 1 diabetes, which accounts for around 10% of cases, occurs when no insulin is produced at all. Diabetes has become a common consequence of modern life for many around the world – and its diagnosis is continuing to rise throughout the western world, with 1 in 3 Americans suffering from prediabetes – the precursor to diabetes characterized by high blood sugar levels. Though unfortunately a common condition, little is known by the general population about the implications of diabetes and, as a result, many fail to take steps to avoid the triggers or to spot their symptoms early. Early diagnosis is particularly important for diabetes, as the longer a person fails to treat it, the more at risk they are from heart disease, kidney disease, blindness and even amputation. Early symptoms of diabetes or its onset can take years to become apparent and are not always easy to distinguish. Early signs that a person should consult a medical professional can include the following: 1. Increased need to urinate – this is a result of your body attempting to flush itself of excess glucose, which cannot be broken down by usual means.

2. As a result, and as part of a vicious cycle, you feel increasingly thirsty. 3. Fatigue – A predictable symptom, as the body is not able to convert fuel (ie. sugar) into energy. Other symptoms may include blurred vision, slow-healing cuts, and unexplained weight loss. Additionally, those with a BMI exceeding 25 and those over 45 years old are advised to present themselves for diabetes testing. Once suspected, diabetes can be tested for by several means. A blood glucose test known as the glycated haemoglobin test (A1C test) measures the percentage of blood sugar attached to haemoglobin. The test is repeated several times over a period, and repeated heightened percentages indicate diabetes. Two further blood tests, random and after fasting, indicate diabetes with levels over 200mg/dL or 126mg/DL respectively. Such tests can also be used to monitor those who have already been diagnosed as diabetic. Glucose tolerance tests, which include digesting a glucose drink between testing, are also capable of indicating diabetes. This is more common for Type 2. Of course, such levels are indicators that diabetes has already developed. A diagnosis with prediabetes still offers the chance to avoid the onset of the condition by a serious change in lifestyle and close monitoring.

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http://www.rd.com/health/conditions/signs-diabetes/ http://www.nhs.uk/Conditions/Diabetes-type2/Pages/Symptoms.aspx http://www.mayoclinic.org/diseases-conditions/diabetes/basics/tests-diagnosis/con-20033091

Diabetes is a condition which develops when there is an excess of glucose (sugar) in the blood system - a result of the body’s inability to process it properly and convert it into energy. The causes for this can be both genetic and environmental – that is to say that, in many cases, the development of diabetes can be potentially avoided through the maintenance of a healthy lifestyle.

Medicine Substitution

Substitution

Drugs under prescription Substituting one drug addiction for another in the name of rehabilitation is a controversial issue worldwide. The most well-known form of drug replacement therapy is the substituting of heroin for methadone, though it is not the only drug substituted.

he arguments for drug replacement therapy include the potential to wean addicts off illegal substances safely and methodically, and doing so in a controlled environment - many patients are required to consume their methadone dose in front of a pharmacist. An additional benefit of this, in theory, is to keep the patient ‘off the streets’ – they are on the map, so to speak, and partaking in therapy can be a large step down the road to change and recovery.

one works by blocking certain receptors in the brain to eliminate the pleasure associated with drinking alcohol, though total abstinence from alcohol is neither necessary nor expected during the programme – which may lead many to question its use in the same way they might question the point of methadone. It is not difficult to see the argument from both points of view. Even those who advocate the use of drug replacement therapy do not advise it as the sole form of treatment for an addict. Other approaches to therapy have been shown to bolster the effect of substitution, and can include sessions in counseling or cognitive behavioural therapy.

However, many believe that drug substitution is merely the replacement of one drug with another, both of which are highly addictive and dangerous. An overdose of methadone can still be fatal, whereas other heroin substitutions such as Suboxone are unlikely to quell withdrawal symptoms, which could lead to relapse. Substitution is also largely focused on maintenance and patients can expect to be prescribed methadone, for example, for a period of at least 1 year. Many treatments are in fact intended as long term ‘solutions’. For this reason, substitution therapies are avoided or even illegal in many countries. In Russia, a country where opiate misuse is widespread, substitution with methadone or buprenorphine is forbidden by law and treatment is instead abstinence-based. Other countries, such as China, have actually found that drug replacement therapy has doubled as an effective weapon against the spread of HIV/AIDS. India, also realizing this benefit, is striving, yet struggling, to open more drug replacement services in a country where heroin is the drug of choice for 35% of users. Such therapy is not confined to treatment for heroin use. The so-called Sinclair Method is a means of treating alcohol dependency through the use of naltrexone. Its use is somewhat similar to the idea of heroin substitution, in that its use is intended to wean the addict off the original substance. Naltrex-

http://www.well.com/user/woa/revia/reviafaq.htm http://www.who.int/bulletin/volumes/86/3/08-010308/en/ http://patient.info/health/methadone-replacement-for-heroin http://www.newbeginningsdrugrehab.org/drug-replacement-therapy/ https://www.addiction.com/expert-blogs/why-isnt-the-sinclair-method-used-more-often/

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Depression Symptoms, diagnosis & treatment

Depression

So sad, so tired, so scared – the symptoms, diagnosis and treatment of depression. Though known by many as such, depression is far from being just a dulled state of mind. Instead, it is a mental illness characterized by enduring feelings of sadness, fatigue and despondency.

n every day usage, the word ‘depressive‘ is commonly interpreted as grumpy, moody etc. From a medical point of view, depression is a serious illness requiring immediate attention, something which must be combated through the willpower and self-discipline of the patient. Although now talked about more and more openly, it remains a taboo subject for many. For those affected, it is common to be ashamed or even in denial that they require medical attention and, as a result, go untreated. In fact, in the case of depression, an early diagnosis and the commencement of treatment is of great importance. What are the symptoms?

Depression is labelled a mental illness due to the excruciating melancholy that it induces. Ongoing feelings of emptiness, fear, hopelessness and a loss of motivation take their toll on depressed people, affecting their everyday lives. In addition to the psychological symptoms, depression can manifest itself physically in the form of headaches and stomach aches, as well as insomnia and the inability to concentrate properly. It is common for the symptoms to be particularly prevalent at certain times of the day – often in the morning. Despite their high level of suffering, many feel unable to go to the doctor and talk about their illness. However, depression is absolutely nothing to be ashamed of – rather an illness like all others. Affecting approximately 4 million people in Germany, depression is one of the most common afflictions in society along with heart attacks and cancer. Experts estimate that roughly 60% of those with depression go untreated. There are several reasons behind this. Firstly, it is not always easy for a doctor to diagnose depression, as the symptoms for each person can vary greatly. As the illness sometimes only prompts physical symptoms, it is often these that are treated while the psychological issues go undetected.

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Conversely, there is also the possibility that physical afflictions cause psychological symptoms which would otherwise not be present. When should a doctor be sought? If feelings of depression last longer than two weeks and do not appear to be influenced by external factors, then it is recommended to visit a doctor. Those individuals who are diagnosed early are likely to make a successful recovery and less likely to fall back into depression. Diagnosing depression As with other illnesses, a diagnosis of depression takes into account many factors. Crucial is the assessment of the patient’s history (both biographical and medical), their current personal situation as well as their physical and psychological state. It is also important at this stage that other physical illnesses, which could present similar symptoms are ruled out. To this purpose, along with a discussion with the patient, physical assessments (such as blood tests and brain scans) should be carried out. These examinations play a large role, because symptoms such as low blood pressure, vitamin B12 deficiency, dementia, hypothyroidism and changes in the brain can also be causes of depression-like symptoms. Depression is diagnosed on the basis of the ICD-10 diagnosis system (International Classification of Disorders) from the World Health Organisation (WHO). Depending on the number, severity and duration of certain symptoms, the following categories of depression are diagnosed: •

depressive episodes within the scope of unipolar depression, which can be defined as mild, moderate or severe

•

depressive episodes within the scope of bipolar affective disorder (an illness alternating between depressive and manic phases)

•

dysthymia (formerly known as the chronic form of depression, which in most occurs in early adulthood)

Depression Symptoms, diagnosis & treatment

Treating depression Depression is a very common and also relatively treatable illness. Treatment depends on the type and severity of the depression. In many cases, for example, mild depression can be treated with ambulant psychotherapy. In cases of moderate depression, a mix of treatments, medicines, and psychotherapy are commonly used. This can also be the case with severe depression, though treatment is often undertaken on an in-patient basis in a psychiatric ward. Staying in a clinic allows for more comprehensive care for the patient by doctors, and offers the possibility for targeted adjustments to medication. In addition, it offers the patient a proper structure to their day.

As well as the aforementioned forms of treatment, there are a diverse number of further approaches to treatment, which are used for certain forms of depression or in severe cases. These include, amongst others, methods such as sleep deprivation (for in-patients) or light therapy, which can be used as a supplement to psychotherapy or medication â&#x20AC;&#x201C; particularly in the cases of winter depression. Please be aware that this article is merely an overview of depression, its diagnosis and treatment. Under no circumstances should self-diagnosis suffice or replace a visit to the doctor. IS

http://www.apotheken-umschau.de/Depression http://www.netdoktor.de/krankheiten/depression/ https://www.therapie.de/psyche/info/index/diagnose/depression/

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