Private Counseling Services

MY Confidential provides individual and marriage counseling services. Our counselors are skilled, trained and experienced in dealing with other concerns including:

Relationships
Adjustment Issues
Depression
Death or other loss
Past hurts
Worry
Anger
Procrastination
Time Management
Career Choices
Self-Esteem
Sexual identity/issues
Alcohol and Drugs
Family Issues
Burn-out
Life Goals
Marital Difficulties

We specialize in providing private counseling services for locals who need extra confidentiality and expatriates who prefer counselors who conduct counseling sessions in English or other ethnic languages.

To view our counselors profiles, please click Directory

Feel free to contact the principal via email for further information regarding the services available. All enquiries are welcomed. Although you might want to check out the FAQ to see if we've already answered your questions for you there. You may also contact the counselor of choice directly via their mobile phone numbers as listed in the directory. We are more than willing and able to be of assistance to those in need.

Relevant books, journals, research findings as well as articles related to mental health will be posted here periodically. Don't ever give up. Help is just a phone call away.

Sunday, November 1, 2009

Nutrition and Mental Health



Vitamin and mineral supplements can be used to avoid many of the mental problems that a deficiency can cause. Of these, the various members of the vitamin B complex is that which is indicated most, and also zinc and magnesium supplementation are amongst the essential minerals required.

The connection between mental health and supplements is well known, if not fully understood.
It is universally accepted that vitamins and minerals are essential for good health, and there is no reason why this should only apply only to bodily health and not also to mental health.
In fact, can the two be treated as separate entities? When a body suffers from a deficiency of vitamins and minerals, the organs do not work as effectively as they should. Certain conditions occur that can be ascribed to a lack of this vitamin or that mineral. The brain is part of the human body, and there is no reason why a nutritional deficiency should not also cause problems with the way that the brain works.

Vitamins and minerals are essential chemicals that take part in the biochemical reactions of the body that are responsible for the synthesis of complex enzymes that allow such functions as digestion, metabolism of food into energy and the proper functioning of brain cells and the neurotransmitters responsible for passing messages from the brain throughout the body.
These messages are passed through a massive network of electrical connections and nerve cells. If anything goes wrong with this system then the mental functioning of what is known as the mind can be disrupted due to faults in these electrical connections and signals within the brain. People have no conscious control over these connections, and when depressed cannot just 'shake out of it'. Their problems are as medically genuine as those with any other disorder, and due to an imbalance in the chemistry of the body.

It is important to understand the effect of specific deficiencies on the brain and the mind, that can cause extreme sadness and helplessness in what is commonly termed depression. Mental health is frequently regarded as being connected with the condition of the mind as opposed to the brain as an organ. Naturally, any deficiency that interferes with the chemical processes necessary for the correct operation of the brain as a physical entity will interfere with human consciousness or psyche that is an abstract manifestation of the way the brain works.

Vitamins known and accepted as affecting mental processes include the B vitamins, of which even slight deficiencies can have an adverse effect on mental health. Significant deficiencies can be related to serious mental illnesses such as severe depression. Each one of the B vitamins is known to have a specific effect.

Thiamine (Vitamin B1) deficiency can lead to depression, anxiety, fearfulness and irritability. The B vitamins are used to create specific enzymes needed for some of the functions in the brain, and it is a lack of these enzymes that ultimately leads to psychiatric disorders. Studies have determined a thiamine deficiency in a large proportion of psychiatric patients. Alcoholics and patients suffering from malnutrition have also been found to suffer from psychiatric disorders, and both of these conditions can lead to a deficiency in thiamine.

Riboflavin, too, has been studied in relation to psychosis. A few studies have indicated a deficiency of riboflavin, vitamin B2, to be associated with increased levels of depression and hysteria. Riboflavin, like thiamine, is essential for the formation and proper use of brain enzymes. The other B vitamins are also known to be essential in the biochemistry of the brain, and depression is a common result of a vitamin B12 deficiency. Other symptoms include psychosis, memory defects and a slowing of the mental processes in general.

In all of these cases, a vitamin B complex supplement appears to have fairly rapid positive results, especially in the treatment of depression. Whether the more severe conditions are helped or not is uncertain since vitamin treatment has rarely been a significant part of the treatment of severe cases of psychosis. It is difficult to see how it could do harm, though while it makes sense for any deficiency to be treated with a corresponding supplement, the damage is generally caused by the presence, or lack of, a chemical farther down the biochemical pathway.

It is well known and accepted that depression is a symptom of insufficient vitamin C intake. Vitamin C is a powerful antioxidant, and is also needed for the production of serotonin. Produced by the pineal gland deep in the brain, serotonin is a neurotransmitter responsible for mood and depression, and sometimes called the 'molecule of happiness'. A lack of serotonin leads to depression.

It is not only vitamins that are essential for good mental health, however. Mineral deficiencies also feature in some mental problems, particularly magnesium and zinc. Take zinc first: this mineral is responsible for a large number of enzyme syntheses in the body, and influences nerve impulse transmissions and also the activity of the thyroid gland. A deficiency will give several symptoms including depression and bevioural problems.

Magnesium takes part in hundreds of biochemical reactions, and a deficiency can be caused by stress since stress increases the demand for magnesium. The deficiency then affects the ability of the heart to react to the stress, and it becomes a vicious circle. The magnesium deficiency manifests in the form of personality changes, depression, irritability and anxiety.

These are known effects and many studies have been carries out to confirm that knowledge. Many more vitamins and minerals, such as folic acid, manganese, iron and potassium, are known to be necessary components of the human biochemical pathways that lead ultimately to chemicals essential for the proper functioning of the brain as an organism, and deficiencies of which can affect the mind. Mild depressions have been significantly reduced by use of the appropriate supplements but should not be regarded as a cure.

Since these known deficiencies cause known psychiatric defects, particularly depression and anxiety, it is only sensible to assume that intelligent and appropriate supplementation should help to avoid them, if not cure them. Some deficiencies are due to alcoholism and malnutrition. In alcoholism, the B vitamins are rapidly depleted in the body by the alcohol, even though there is no deficiency in the diet. Malnutrition speaks for itself, and while supplements can have a dramatic effect in that case, alcoholics must be cured for the effects of vitamin supplements to take real effect.

Vitamin and mineral supplements can be used to avoid many of the mental problems that a deficiency can cause. Of these, the various members of the vitamin B complex is that which is indicated most, and also zinc and magnesium supplementation are amongst the essential minerals required.

The treatment of minor disorders with supplements has had a degree of success but it is doubtful if any significant advantages can be gained by using them for severe symptoms. The more traditional methods have been found to be more effective, though some herbal supplements such as St. John's Wort might have some beneficial effects. These remedies, however, cannot be regarded as cures for depression or any other psychiatric disorder. The connection between mental health and supplements can be used towards finding a cure for many mental conditions.

- By Darrell Miller - 2007-08-20
Disabled World.

And last but not least, a word from Dr. Mehmet Oz.

Sunday, July 19, 2009

When Love Isn't Enough.


Looking for love? Society and culture tell us that love cures all and that to be truly happy, we need to find the one who "completes us." Look at Sleeping Beauty and Cinderella, or Meg Ryan and Tom Hanks (who's apparently no longer "Sleepless in Seattle"). And once we find love, we marry and then it’s bliss. Right?

Well, researchers from the Australian National University report that love isn’t what will make us live "happily ever after." The study, "What’s Love Got to Do with It," followed 2,500 couples (married or living together) for six years to see which couples stayed together and why.

Here's a rundown of factors that played a significant role in whether those marriages lasted or failed:
1. Blending families—20 percent of marriages with kids from prior relationships end in divorce.
2. Second/third marriages—90 percent of these couples are likely to separate or divorce.
3. Age—If a man is under 25 when he marries or if he’s nine or more years older than his wife, he’s twice as likely to get a divorce than a man who is older than 25 or closer in age to his wife.
4. Desire to have children—If the women has a much stronger desire to have kids than her spouse, the marriage is not likely to succeed.
5. Relationship status of parents—If couples come from separated or divorced parents, 17 percent were headed toward the same result, as compared to 10 percent who come from stable homes.
6. Smoking—Relationships in which only one person smokes is also a factor toward failure.
7. Money—The root of all evil? Well not exactly, but 16 percent of self-reported "poor" relationships in which the man was unemployed ended in separation or divorce. Only 9 percent of couples who had a healthy bank account went south.

Is there anything that won't send us to divorce court? The study identified these as non-issues in the success or failure rates of those studied:
- How many kids a couple has
- Whether or not the wife is employed
- Number of years the couple is employed

Another study, published in the journal Motivation and Emotion, revealed that photos of your spouse in his or her high school yearbook can tell you a lot about whether your marriage will survive. The study ranked the intensity of a person’s smile in the photos and then compared those scores to marriage success. Those with strong smiles (in the top 10 percent) had not divorced. For those in the bottom 20 percent of smilers, 25 percent had divorced. While this seems a bit far-fetched to me, psychologists claim that those with a generally happy disposition had better success rates in marriage. (I guess it's too bad for those folks who may have been dumped by a boyfriend or girlfriend or missed the bus on photo day.)

In the examination of marriage and relationships, other studies have suggested that we may be predestined to fail or succeed. For example, researchers from the Karolinska Institute in Stockholm reported on the ‘bonding gene’—a gene modulating the hormone vasopressin, which was strongly tied to how well men fare in marriage. The study suggests that if a man has more vasopressin in the brain, the more likely he'll want to stick with his partner.

While a lot of these factors contributing to success or failure seem like common sense, many of us still ignore the obvious hurdles (kids, prior divorces, age differences) and follow the strong scent of love instead. The so-called love hormone factors in, bringing a whole system of pleasure into play, and we forgo logic and reason for romantic love.

The reasons we are drawn to another person are sometimes curious. Factor in the realities of life and the journey involved in a relationship, and the reasons we stay together are even more mysterious and complicated.

- Source: MSN Health & Fitness

Friday, June 19, 2009

Father-Daughter Relationships

I feel that the childhood relationships you had with the parent of the opposite sex has had the most influence on the adult you. How you feel about yourself as a woman goes back to how your Daddy treated his Little Girl.

Did he listen to what you had to say?
Did he respect your opinions and welcome your contributions to the conversation?
Did he ever ask you for input regarding family issues?
Did he treat women in general like second-class citizens?
Did he respect your mother and show her affection?
Was your mother his equal partner?
Did he participate in family functions or did his work come first?
Was he active in your school activities, or was he an absentee father?
Did he keep his promises, or did you often wait by the window for him after the last guest left your party and the ice cream had melted?
Was he aggressive or abusive to you or your mother?

Look at the relationships that you have had with other men. Do you gravitate to men like your father? Are they usually kind and loving men, or are they uncaring or abusive? Daughters need to know that the first man in their life loved them unconditionally, as every man in her life thereafter will be patterned after her first love --- good, bad, or indifferent.

I hope that you were fortunate enough to have a father who enriched your life. If he made you feel like his beautiful princess and also valued you as an intelligent and independent individual, then I'm fairly certain that your relationships with the men in your life have been positive experiences. If, on the other hand, you lived with a father who discounted you and made you feel miserable, or you had an absentee father who was not a part of your life, then it's likely that you have picked the same kind of men as an adult. One would think that living with an alcoholic, abusive, or inattentive, emotionally unavailable father would make you more aware and thus more cautious and selective. Unfortunately, this is the opposite of the established patterns. Surprisingly enough, you tend to choose the same man as your father, regardless of his positive or negative affect on your life.

The psychology behind this phenomenon is really quite interesting: being treated in an abusive way as a child diminishes your self-worth and thus your expectations of yourself and the way others should treat you. You forget that you deserve choices in your life, and tend to accept whatever circumstances befall you. Moreover, as most abusive, aggressive men prefer women they can easily dominate, your diminished self-image makes you a target for abuse. A vicious cycle of reduced self-worth and abusive relationships ensues because abusive treatment only enforces the poor self-esteem. Women will marry or live with an abusive man like 'Dear Old Dad ' or seek our a man whom they can never trust to be there for them. Incredibly, when they finally find the courage to leave him, more often than not they will become involved with another man just like him!

I have counseled many young women who, as adults, still wanted to have a father/daughter relationship with their absentee father and continued to try to reconnect with a man who had left little more than tire tracks on the paths of their lives. One woman actually wanted her father to walk her down the aisle, and she was afraid to ask him. She was afraid that he would say no, or even worse that he would say yes, and not show up. Like daughters of alcoholic and abusive fathers, they still cling to the possibility of a normal relationship, but continue to seek out the same type of man.

Breaking the pattern is essential if you are ever to enjoy a healthy relationship with the opposite sex.

First you must acknowledge that you have the problem. Work on building your self-esteem and give up the role of victim. Now you must identify the traits that are predominant in the men that you choose.

Is the individual power hungry?
Does he need to be in control at all times?
Does he have an inflated ego?
Does he make promises only to break them?
Is he jealous?
Is he possessive? Is he aware of your needs?
Does he discount your opinions?
Does he want to change your hair, clothes, personality, etc.?
Does he need to be right most of the time?
Is he there for his family and friends when they need him?
Does he embarrass you in public or does he ignore you?
Does he discount your feelings?
Has he ever abused you --- psychologically, verbally, or physically?
Is he quick to say, "You made me do that," or "It won't happen again?"
Do you trust him with your heart?

Any of these can be red flags, and now you may be aware of others. If you love this individual and you both want to work on the relationship, I suggest couple's counseling. With a clear perspective and information from an impartial therapist, you may decide that you are willing to overlook some of his negative behavior. If you are certain that you cannot live with the imperfections of this individual --- even if some of the traits are seemingly benign ---- do not count on changing them after you have made a final commitment. Ask that 'little girl' inside of you," Did my Father change?" Find an opposite type and give him a chance. You will finally be on your way to establishing new patterns of behavior.

I'm Here For You,
by Dr. Beverly Block

Unsung Heroes

By MEERA DEVI DARAN
Today’s dads are no longer removed from their children’s upbringing – they actually seek happiness in fatherhood.

Are fathers, through no fault of their own, sometimes made to feel inferior next to mothers? The notion that mothers are natural caregivers, to the extent of being biologically-engineered for it, continues to prevail much to the chagrin of fathers.

Certainly the ability to give birth (and lactate!) is an unparalleled feat, but when fathers are demoted as secondary parents due to biological shortcomings, you have to wonder if all the flak they receive is justified.

Admittedly, from the time a baby is born, fathers are relegated to the sidelines, where they can only watch and fret. It is this paternal detachment, which supposedly continues throughout the developmental process of children, that is frequently used against fathers to question the degree of their involvement in families.


Dr Goh Chee Leong

These are not random rumblings of discontent either; in fact, early psychology theorists like Sigmund Freud and John Bowlby laid much of the groundwork for the dad-bashing that we have now become accustomed to.

In the United States, Father’s Day has increasingly become a no-holds-barred assault on fathers, with talk of the deadbeat dad – he who abandons his family and shirks all responsibility – dominating the headlines.

With so much resentment and negativity surrounding the issue, harsh remarks have been made about fathers and the role they play; last year, a prominent US magazine went so far as to ask if fathers, as a collective, have done enough to deserve a Father’s Day at all.

Ironically enough, Mother’s Day is often celebrated in less punishing terms, with past sins and wrongdoings more readily set aside. At the end of the day, mums emerge unscathed as saint-like creatures that can do no wrong.

“While mothers are often seen as nurturers who play a pivotal role in the healthy development of their children, the role of fathers is often reduced to mere breadwinner,” said Lee Wee Min, executive director of Focus on the Family Malaysia, with noticeable regret.

“In certain cultures, fathers are seldom encouraged to spend time with their children and are often perceived as cold disciplinarians,” he says.

Nevertheless, the decline of a classically patriarchal system, as well as emerging gender benders have contributed to a changed landscape for fatherhood over the years.

Where once a father was looked upon as the authoritative head of the family who had responsibilities and obligations to fulfil, the modern-day dad is far more approachable and involved in the lives of his children; he seeks actual happiness in fatherhood.

Counselling psychologist Johana Johari, who runs her own private practice in Kuala Lumpur, is firm in her beliefs about paternal involvement in Malaysian families.

“Our traditional definitions of how fathers should behave have certainly changed; we are increasingly exposed and educated as parents now. But our parenting styles must adapt to new belief systems so that we can break the vicious cycle of fathers doing unto their children what their fathers did unto them.”

Johana Johari

The 43-year-old principal of MY Confidential, a nationwide network of private counsellors in Malaysia, spoke at length about the roles of fathers that are often discounted. “Fathers are instrumental role models for their children, especially sons, who need a male adult to emulate. A daughter, on the other hand, learns how to communicate and establish healthy relationships with men as a result of the interactions with her father,” she explains.

“Fathers can do many things for their children that mothers cannot, and vice versa. Both parents are definitely essential in complementing each other.”

Director of HELP University College’s Centre for Psychology Dr Goh Chee Leong echoed her sentiments. “There is enough research in developmental psychology to suggest that fathers contribute significantly to the emotional wellbeing of a child and the development of their character, their ambitions, their sense of morals and their perception of responsibility,” he says.

“The bottom line is this: for a child to develop in a balanced and healthy manner, they need a home environment that is secure, happy, stimulating and loving. Fathers have an equal responsibility in shaping this environment. With more practice, there is no reason to believe that fathers have a lower capacity for love, care and nurturing,” he explains.

Even science has come to the defence of fathers recently; a study on the effects of hormonal changes during newfound fatherhood by Psychology Today, a respected US journal on clinical psychology, has shown that men may be a lot more similar to women after all, as fathers were found to have high levels of prolactin (a hormone associated with lactating mothers) towards the end of a partner’s pregnancy.

In a redefined understanding of masculinity and fatherhood, it was also established that fathers experience testosterone reduction and elevated levels of estrogen 30 days before birth, a condition that continues to last up to 12 weeks. The study offers pioneering evidence that to nurture is part of man’s nature after all.

So all is fine and well then?

Not quite, the roles of fathers in separated families or in the aftermath of a divorce are still sketchy at best.

US statistics claiming that more than half of divorced fathers lose contact with their kids within a few years are alarming, but Johana is quick to point out that in her line of work, parents usually make an effort to maintain normalcy and lessen the impact of divorce on their children.

“From my observations, it is the mother that usually plays an important role in determining the father’s involvement after divorce; but the bond cannot be completely erased regardless of whether the split is an amicable one or not. You can be an ex-husband, but never an ex-father,” she says succinctly.

Considering that there is a prevalent bias in society for maternal custody of children after divorce, Johana argues that credit should be given where credit is due. “I have worked with many single fathers who continue to fight for custody of their children without remarrying, but you don’t hear about these stories very often,” she says.

We may not have an existing movement to champion fathers’ rights in Malaysia, such as that of the controversial superhero protesters known as Fathers 4 Justice in Britain, but lest we forget, all fathers will be regarded as heroes in their own right this Father’s Day.

Dr Goh offers one last piece of advice: “What is important is that we focus on the kind of fathers we know we should be, rather than the type of fathers society thinks we are.”


Tuesday June 10, 2008

Monday, May 11, 2009

Chronic Fatigue Syndrome



Definition
Chronic fatigue syndrome (CFS) is a complicated disorder characterized by extreme fatigue that doesn't improve with bed rest and may worsen with physical or mental activity.

Chronic fatigue syndrome may occur after an infection, such as a cold or viral illness. The onset can be during or shortly after a time of great stress, or chronic fatigue syndrome come on gradually without a clear starting point or obvious cause.

Women are diagnosed with chronic fatigue syndrome far more often than men are. However, it's unclear whether chronic fatigue syndrome affects women more frequently or if women report it more often than men do.

Treatment for chronic fatigue syndrome focuses on a combination of approaches to relieve signs and symptoms.

Symptoms
Chronic fatigue syndrome is a flu-like condition that can drain your energy and, sometimes, last for years. People previously healthy and full of energy may experience a variety of signs and symptoms.

People with chronic fatigue syndrome exhibit signs and symptoms similar to those of most common viral infections. Unlike flu (influenza) symptoms, which usually subside in a few days or weeks, the signs and symptoms of CFS can last much longer. They may come and go frequently with no identifiable pattern.

Primary signs and symptoms
In addition to persistent fatigue, not caused by other known medical conditions, chronic fatigue syndrome has eight possible primary signs and symptoms. Chronic fatigue syndrome symptoms include:

Loss of memory or concentration
Sore throat
Painful and mildly enlarged lymph nodes in your neck or armpits
Unexplained muscle soreness
Pain that moves from one joint to another without swelling or redness
Headache of a new type, pattern or severity
Sleep disturbance
Extreme exhaustion lasting more than 24 hours after physical or mental exercise

According to the International Chronic Fatigue Syndrome Study Group — a group of scientists, researchers and doctors brought together by the Centers for Disease Control and Prevention (CDC) to determine a standard method for defining and diagnosing chronic fatigue syndrome — a person meets the diagnostic criteria of chronic fatigue syndrome when unexplained persistent fatigue occurs for six months or more along with at least four of the eight primary signs and symptoms.

Additional signs and symptoms
In addition, people with chronic fatigue syndrome have reported other various signs and symptoms that aren't part of the official definition. These include:

Abdominal pain
Allergies or sensitivities to foods, alcohol, odors, chemicals, medications or noise
Bloating
Chest pain
Chronic cough
Diarrhea
Dizziness, balance problems or fainting
Dry mouth
Earache
Irregular heartbeat
Jaw pain
Morning stiffness
Nausea
Chills and night sweats
Psychological problems, such as depression, irritability, anxiety disorders and panic attacks
Shortness of breath
Tingling sensations
Visual disturbances, such as blurring, sensitivity to light, eye pain and dry eyes
Weight loss or gain

If you have chronic fatigue syndrome, your symptoms may peak and become stable early on, and then come and go over time. Some people go on to recover completely, while others grow progressively worse.

Causes
Of all chronic illnesses, chronic fatigue syndrome is one of the most mysterious. Unlike definite infections, it has no clear cause. Several possible causes have been proposed, including:

Depression
Iron deficiency anemia
Low blood sugar (hypoglycemia)
History of allergies
Virus infection, such as Epstein-Barr virus or human herpesvirus 6
Dysfunction in the immune system
Changes in the levels of hormones produced in the hypothalamus, pituitary glands or adrenal glands
Mild, chronic low blood pressure (hypotension)

The cause of chronic fatigue syndrome may be an inflammation of the pathways of the nervous system as a response to an autoimmune process, but with nothing measurable in the blood as in other autoimmune diseases, such as rheumatoid arthritis and lupus. Chronic fatigue syndrome may also occur when a viral illness is complicated by a dysfunctional immune system. Some people with CFS may have a low blood pressure disorder that triggers the fainting reflex.

In many cases, however, no serious underlying infection or disease is proved to specifically cause chronic fatigue syndrome. Lack of medical knowledge and understanding of CFS has made determining and describing the characteristics of the condition difficult.

Risk factors
Women are diagnosed with chronic fatigue syndrome two to four times as often as men, but sex isn't a proven risk factor for this condition. It may be that women are simply more likely than men are to report their symptoms to their doctor.

The condition is most common in people in their 40s and 50s, but it can affect people of all ages.

Because the cause of the condition is unknown, doctors have yet to determine and confirm definite risk factors for the disease.

When to seek medical advice
Fatigue can be a symptom of many illnesses, such as infections or psychological disorders. In general, see your doctor if you have persistent or excessive fatigue. Severe fatigue that prevents you from fully participating in activities at home, work or school may be a symptom of an underlying medical problem.

Tests and diagnosis
A diagnosis of chronic fatigue syndrome is based on exclusion. This means that before arriving at a diagnosis, a doctor has ruled out any other disease or condition that may be causing your fatigue and related symptoms.

In general, doctors find it difficult to diagnose chronic fatigue syndrome because it has some of the same signs and symptoms as many other diseases. There's no diagnostic or laboratory procedure to confirm the presence of chronic fatigue syndrome.

Doctors exclude certain conditions before considering a diagnosis of chronic fatigue syndrome. These include:

Having an active, identifiable medical condition that often results in fatigue, such as low levels of thyroid hormones (hypothyroidism) or sleep apnea
Using medicines that may cause fatigue
Having a relapse of a previously treated illness that can result in fatigue, such as cancer
Having had a past or current diagnosis of a major depressive disorder or other psychiatric illness, such as schizophrenia or an eating disorder
Abusing alcohol or another substance
Being severely obese, as defined by a body mass index (BMI) of 45 or greater

Over time, be alert to any new cues that might indicate that the problem is caused by something other than chronic fatigue syndrome. When other diseases or conditions are excluded, your doctor may then determine if your illness meets the CFS-specific criteria.

Complications
Possible complications of chronic fatigue syndrome include:

Depression, related both to symptoms and lack of diagnosis
Side effects and adverse reactions related to medication treatments
Side effects and adverse reactions associated with lack of activity (deconditioning)
Social isolation caused by fatigue
Lifestyle restrictions
Missing work

Treatments and drugs
There's no specific chronic fatigue syndrome treatment. In general, doctors aim to relieve signs and symptoms by using a combination of treatments, which may include:

Moderating daily activity.
Your doctor may encourage you to slow down and to avoid excessive physical and psychological stress. However, too much rest can make you weaker, worsening your long-term symptoms. Your goal should be to maintain a moderate level of daily activity and gently increase your stamina over time.

Gradual but steady exercise.
Often with the help of a physical therapist, you may be advised to begin an exercise program that slowly becomes more challenging. Research has proved that gradually increasing exercise can improve the symptoms of chronic fatigue syndrome. In one study, 70 percent of participants with CFS reported feeling better after completing a supervised program of graduated exercise.

Cognitive behavior therapy.
This treatment, often used in combination with graduated exercise, also has been found to improve the symptoms of chronic fatigue syndrome. In cognitive behavior therapy, you work with a mental health professional to identify negative beliefs and behaviors that might be delaying your recovery and replace them with healthy, positive ones.

Treatment of depression.
If you're depressed, medications, such as tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs), may help. Antidepressants may also help improve sleep and relieve pain. Tricyclic antidepressants include amitriptyline (Limbitrol, a multi-ingredient drug that contains amitriptyline), desipramine (Norpramin) and nortriptyline (Aventyl, Pamelor). SSRIs include fluoxetine (Prozac, Sarafem), paroxetine (Paxil), sertraline (Zoloft) and bupropion (Wellbutrin).

Treatment of existing pain.
Acetaminophen (Tylenol, others) and nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen (Advil, Motrin, others), may be helpful to reduce pain and fever.

Treatment of allergy-like symptoms.
Antihistamines, such as fexofenadine (Allegra) and cetirizine (Zyrtec), and decongestants that contain pseudoephedrine (Sudafed) may relieve allergy-like symptoms such as runny nose.

Treatment of low blood pressure (hypotension).
The drugs fludrocortisone (Florinef), atenolol (Tenormin) and midodrine (ProAmatine, Orvaten) may be useful for certain people with chronic fatigue syndrome.

Treatment for problems of the nervous system.
Symptoms such as dizziness and extreme skin tenderness can sometimes be relieved by clonazepam (Klonopin). Your doctor may prescribe medications such as lorazepam (Ativan) and alprazolam (Xanax) to relieve symptoms of anxiety.

Experimental therapies
Research aimed at finding new treatments for chronic fatigue syndrome has included studies of the following medications:

Methylphenidate (Ritalin, Concerta).
This psychostimulant appears to boost and balance levels of the brain chemicals called neurotransmitters. It's commonly used to treat attention-deficit/hyperactivity disorder (ADHD). One study found that methylphenidate improved fatigue and concentration in some people with chronic fatigue syndrome.

D-ribose.
Also called ribose, this form of sugar is an essential energy source for your cells. Scientists believe that impaired cellular metabolism — some kind of disorder in the way your cells do their work — may play a role in chronic fatigue syndrome. Some research has found that natural D-ribose supplements may significantly improve the symptoms of chronic fatigue syndrome, with particular benefit in study participants' energy level and overall well-being.

Acupuncture.
Acupuncture has been studied as a treatment for the symptoms of fibromyalgia, a disease that is considered similar to CFS and is also characterized by fatigue and muscle soreness. In one clinical trial, half the participants received acupuncture, while the other half received a placebo treatment. Those treated with acupuncture experienced a significant improvement in their symptoms — especially fatigue and anxiety — compared with the nonacupuncture group.

Corticosteroids.
Some studies have found that oral hydrocortisone may improve symptoms of chronic fatigue syndrome, while other studies have found no benefit.

Immune globulins and interferons.
These medications are used to boost your immune system's ability to fight infection. Studies have not found them to be consistently effective in treating chronic fatigue syndrome, and participants have experienced severe side effects.

Antiviral drugs, such as acyclovir.
The possible connection between chronic fatigue syndrome and Epstein-Barr virus led researchers to test whether powerful antiviral medications could improve the symptoms of chronic fatigue syndrome. This approach has not been found effective, and the connection between Epstein-Barr virus and chronic fatigue syndrome has since been disproved.

Cholinesterase (ko-lin-ES-tur-ase) inhibitors, such as galantamine.
These drugs improve the effectiveness of acetylcholine, a chemical messenger that is believed to be important for memory, thought and judgment. Galantamine is used in the treatment of Alzheimer's disease, but has not been found beneficial for chronic fatigue syndrome.

Prevention
Because the cause of chronic fatigue syndrome remains unknown, there's no known way to prevent the illness from occurring. Be aware of the symptoms and signs of chronic fatigue syndrome and seek the help of your doctor to manage them if they occur.

Lifestyle and home remedies
Learning how to manage fatigue can help you improve your level of functioning and your quality of life despite your symptoms. You may work with a rehabilitation medicine specialist who can teach you how to plan activities to take advantage of times when you usually feel better.

These important self-care steps can help you to maintain good general health:

Reduce stress.
Develop a plan to avoid or limit overexertion and emotional stress. Allow yourself time each day to relax. That may mean learning how to say no without guilt. If possible, don't change your routine totally. People who quit work or drop all activity tend to do worse than those who remain active.

Get enough sleep.
Getting sufficient sleep is essential. In addition to allotting enough time for sleep, practice good sleep habits, such as going to bed and getting up at the same time each day and limiting daytime napping.

Exercise regularly.
You may need to start slow and build up gradually. But exercising regularly often improves symptoms. Many people find exercises such as walking, swimming, biking and water aerobics to be helpful. A physical therapist may help you develop a home-exercise program. Stretching, good posture and relaxation exercises also can be helpful.

Pace yourself.
Keep your activity on an even level. If you do too much on your good days, you may have more bad days.

Maintain a healthy lifestyle.
Try to eat a balanced diet, drink plenty of fluids, limit your caffeine intake, stop smoking, get adequate rest and exercise regularly. Find a hobby or career that's enjoyable and fulfilling for you.

Coping and support
The experience of chronic fatigue syndrome varies from person to person. For many people, however, the symptoms are more bothersome early in the course of the illness and then gradually decrease. Some people recover completely with time. Emotional support and counseling may help you and your loved ones deal with the uncertainties and restrictions of chronic fatigue syndrome.

You may find it therapeutic to join a support group and meet other people with chronic fatigue syndrome. Support groups aren't for everyone, and you may find that a support group adds to your stress rather than relieves it. Experiment and use your own judgment to determine what's best for you.

Alternative medicine
Some makers of various dietary supplements and herbal remedies claim these substances have potential benefits for people with chronic fatigue syndrome, but the effectiveness of these substances for treating the condition hasn't been proved in controlled studies. Though a product may be of "natural" origin, that doesn't ensure its safety. Dietary supplements and herbal preparations can have potentially harmful side effects and may dangerously interfere or interact with prescription medications.

Some complementary therapies can benefit people with chronic fatigue syndrome by reducing anxiety and promoting a sense of well-being. These include deep-breathing and muscle-relaxation techniques, massage and healing touch, and movement therapies such as stretching, yoga and tai chi.

Talk to your doctor before using any unprescribed remedy or new complementary therapy.

Source: MayoClinic.com

Saturday, January 31, 2009

Grieving

Background
For many years, people with terminal illnesses were an embarrassment for doctors. Someone who could not be cured was evidence of the doctors' fallibility, and as a result the doctors regularly shunned the dying with the excuse that there was nothing more that could be done (and that there was plenty of other demand on the doctors' time).
Elizabeth Kübler-Ross was a doctor in Switzerland who railed against this unkindness and spent a lot of time with dying people, both comforting and studying them. She wrote a book, called 'On Death and Dying' which included a cycle of emotional states that is often referred to (but not exclusively called) the Grief Cycle.
In the ensuing years, it was noticed that this emotional cycle was not exclusive just to the terminally ill, but also other people who were affected by bad news, such as losing their jobs or otherwise being negatively affected by change. The important factor is not that the change is good or bad, but that they perceive it as a significantly negative event.

The Grief Cycle
The Grief Cycle can be shown as in the chart below, indicating the roller-coaster ride of activity and passivity as the person wriggles and turns in their desperate efforts to avoid the change.



The initial state before the cycle is received is stable, at least in terms of the subsequent reaction on hearing the bad news. Compared with the ups and downs to come, even if there is some variation, this is indeed a stable state.
And then, into the calm of this relative paradise, a bombshell bursts...

Shock stage: Initial paralysis at hearing the bad news.
Denial stage: Trying to avoid the inevitable.
Anger stage: Frustrated outpouring of bottled-up emotion.
Bargaining stage: Seeking in vain for a way out.
Depression stage: Final realization of the inevitable.
Testing stage: Seeking realistic solutions.
Acceptance stage: Finally finding the way forward.

Sticking and cycling
Getting stuck
A common problem with the above cycle is that people get stuck in one phase. Thus a person may become stuck in denial, never moving on from the position of not accepting the inevitable future. When it happens, they still keep on denying it, such as the person who has lost their job still going into the city only to sit on a park bench all day.

Getting stuck in denial is common in 'cool' cultures (such as in Britain, particularly Southern England) where expressing anger is not acceptable. The person may feel that anger, but may then repress it, bottling it up inside.

Likewise, a person may be stuck in permanent anger (which is itself a form of flight from reality) or repeated bargaining. It is more difficult to get stuck in active states than in passivity, and getting stuck in depression is perhaps a more common ailment.

Going in cycles
Another trap is that when a person moves on to the next phase, they have not completed an earlier phase and so move backwards in cyclic loops that repeat previous emotion and actions. Thus, for example, a person that finds bargaining not to be working, may go back into anger or denial.

Cycling is itself a form of avoidance of the inevitable, and going backwards in time may seem to be a way of extending the time before the perceived bad thing happens.

Source:
Elisabeth Kübler-Ross, On Death and Dying, Macmillan, NY, 1969.