The SCID-D is a semi-structured interview, which means that the examiner's questions are open-ended and allow the patient to describe experiences of depersonalization in some detail—distinct from simple "yes" or "no" answers. In addition to these instruments, a six-item Depersonalization Severity Scale, or DSS, has been developed to discriminate between depersonalization disorder and other dissociative or post-traumatic disorders, and to measure the effects of treatment in patients.

Treatments Depersonalization disorder sometimes resolves on its own without treatment. Specialized treatment is recommended only if the symptoms are persistent, recurrent, or upsetting to the patient.

Insight-oriented psychodynamic psychotherapy , cognitive-behavioral therapy , and hypnosis have been demonstrated to be effective with some patients.

There is, however, no single form of psychotherapy that is effective in treating all patients diagnosed with depersonalization disorder. Medications that have been helpful to patients with depersonalization disorder include the benzodiazepine tranquilizers, such as lorazepam Ativan , clorazepate Tranxene , and alprazolam Xanax , and the tricyclic antidepressants, such as amitriptyline Elavil , doxepin Sinequan , and desipramine Norpramin. As of , newer, promising medications called selective serotonin reuptake inhibitors SSRIs became available.

SSRIs act on brain chemicals that nerve cells use to send messages to each another. These chemical messengers neurotransmitters are released by one nerve cell and taken up by others. Those that are not taken up by other cells are taken up by the ones that released them.

This is called "reuptake. Unfortunately, there have been very few well-designed studies comparing different medications for depersonalization disorder. Because depersonalization disorder is frequently associated with trauma, effective treatment must include other stress-related symptoms, as well. Relaxation techniques have been reported to be a beneficial adjunctive treatment for persons diagnosed with depersonalization disorder, particularly for those who are worried about their sanity.

Prognosis The prognosis for recovery from depersonalization disorder is good. Most patients recover completely, particularly those who developed the disorder in connection with traumas that can be explored and resolved in treatment.

A few patients develop a chronic form of the disorder; this is characterized by periodic episodes of depersonalization in connection with stressful events in their lives. Twin studies may overestimate the effect of genes on variability in personality disorders due to the complicating factor of a shared family environment. Increased cortisol production is also associated with an increased risk of suicidal behavior.

Caregivers were also reported to have failed to provide needed protection and to have neglected their child's physical care. Parents of both sexes were typically reported to have withdrawn from the child emotionally and to have treated the child inconsistently.

Thus, researchers examine developmental causes in addition to childhood trauma. Research published in January by Dr. Anthony Ruocco at the University of Toronto has highlighted two patterns of brain activity that may underlie the dysregulation of emotion indicated in this disorder: Risk factors for Alzheimer's disease: New triterpenoids and other constituents from a special microbial-fermented tea-Fuzhuan brick tea.

No association between coffee consumption and adverse outcomes of pregnancy. J Med ; 3: Focus on therapy of hypnic headache. J Headache Pain ;11 4: J Cell Physiol ; 3: Dietary caffeine intake and bone status of postmenopausal women. Effect of caffeine on simulator flight performance in sleep-deprived military pilot students.

Augmentation strategies in electroconvulsive therapy. Coffee consumption and risk of stroke in women. Parkinsonian signs in older people: Caffeine and behavioral stress effects on blood pressure in borderline hypertensive Caucasian men. Consumption of methylxanthine-containing beverages and the risk of breast cancer.

Coffee and methylxanthines and breast cancer: Coffee, caffeine, and risk of depression among women. Mountain Dew or mountain don't?: J Sch Health ;79 8: J Caffeine Res ;1 4: Caffeine protects against alcoholic liver injury by attenuating inflammatory response and oxidative stress.

Caffeine does not augment markers of muscle damage or leukocytosis following resistance exercise. J Sports Physiol Perform. Caffeine does not increase resistance exercise-induced microdamage. Metabolic and hormonal effects of caffeine: Leaf alkaloids, phenolics, and coffee resistance to the leaf miner Leucoptera coffeella Lepidoptera: Does caffeine intake protect from Alzheimer's disease?

Green tea catechin consumption enhances exercise-induced abdominal fat loss in overweight and obese adults. J Nutr ; 2: Are "social drugs" tobacco, coffee and chocolate related to the bipolar spectrum? J Affect Disord ; Sensitivity to change in cognitive performance and mood measures of energy and fatigue in response to morning caffeine alone or in combination with carbohydrate.

Diet and nutrition in ulcer disease. Med Clin North Am ;75 4: Caffeine consumption and benign breast disease: Public Health ;72 6: Combined neuroprotective modalities coupled with thrombolysis in acute ischemic stroke: Caffeine and alcohol intakes have no association with risk of multiple sclerosis.

Acute caffeine effects on urine composition and calcium kidney stone risk in calcium stone formers. Caffeine and the elderly. Drugs Aging ;13 1: Catechin safely improved higher levels of fatness, blood pressure, and cholesterol in children. Influence of coffee and caffeine consumption on atrial fibrillation in hypertensive patients. The effects of caffeine ingestion on time trial cycling performance.

J Sports Med Phys. Oral sumatriptan for acute migraine. The impact of prior coffee consumption on the subsequent ergogenic effect of anhydrous caffeine.

Caffeine effects on physical and cognitive performance during sustained operations. Space Environ Med ;78 9: New England Journal of Medicine ; Caffeine and chronic back pain. Comparing the benefits of caffeine, naps and placebo on verbal, motor and perceptual memory. Behav Brain Res ; 1: Effect of caffeine on cerebral blood flow response to somatosensory stimulation. Blood Flow Metab ;25 6: Effects of caffeine as an adjuvant to morphine in advanced cancer patients.

A randomized, double-blind, placebo-controlled, crossover study. Diagnosing urological disorders in ageing men. Hormonal contraceptives and caffeine elimination]. Effects of caffeine on alertness as measured by infrared reflectance oculography. Coffee, tea, and caffeine consumption and incidence of colon and rectal cancer. Clinical and biochemical studies on methylxanthine-related fibrocystic breast disease. Increased caffeine consumption is associated with reduced hepatic fibrosis.

Caffeinated coffee consumption impairs blood glucose homeostasis in response to high and low glycemic index meals in healthy men. Am J Clin Nutr ;87 5: Consumption of caffeinated coffee and a high carbohydrate meal affects postprandial metabolism of a subsequent oral glucose tolerance test in young, healthy males. Randomized double-blind placebo-controlled crossover study of caffeine in patients with intermittent claudication.

Long-term consequences of neonatal caffeine on ventilation, occurrence of apneas, and hypercapnic chemoreflex in male and female rats. Pediatr Res ;59 4 Pt 1: Caffeine in the neonatal period induces long-lasting changes in sleep and breathing in adult rats. Risk-factors for Parkinson's disease: Pathophysiological roles for purines: Timing of blood pressure measurement related to caffeine consumption.

Caffeine for cognition Protocol. Coffee and acute ischemic stroke onset: Effect of caffeine on perceptions of leg muscle pain during moderate intensity cycling exercise. The effects of caffeine on simulated night-shift work and subsequent daytime sleep. Caffeine for the management of apnea in preterm infants. Int Health ;1 2: Xanthines as adenosine receptor antagonists. The efficacy of caffeine in the treatment of recurrent idiopathic apnea in premature infants.

Pharmacological treatment during the weaning of mechanical ventilation in preterm infants. High dose caffeine and ventricular arrhythmias. Caffeine as a possible cause of ventricular arrhythmias during the healing phase of acute myocardial infarction.

A green tea extract high in catechins reduces body fat and cardiovascular risks in humans. Ingestion of a tea rich in catechins leads to a reduction in body fat and malondialdehyde-modified LDL in men. Am J Clin Nutr ;81 1: A catechin-rich beverage improves obesity and blood glucose control in patients with type 2 diabetes.

The effect of life stress on symptoms of heartburn. When chewing gum is more than just a bad habit. Caffeine and related methylxanthines: Psychiatry ; View abstract. A retrospective study of smoking in Parkinson's disease.

Is caffeine a cognitive enhancer? Caffeine and the central nervous system: Plasma and salivary pharmacokinetics of caffeine in man. J Clin Pharmacol ;21 1: Tea consumption and cognitive impairment and decline in older Chinese adults. Am J Clin Nutr ;88 1: J Appl Physiol ; 5: Blood pressure response to chronic intake of coffee and caffeine: Caffeine intake is independently associated with neuropsychological performance in patients with obstructive sleep apnea. Caffeine-induced diuresis and atrial natriuretic peptides.

Caffeine has a small effect on 5-km running performance of well-trained and recreational runners. J Sci Med Sport ;11 2: Consumption of coffee, green tea, oolong tea, black tea, chocolate snacks and the caffeine content in relation to risk of diabetes in Japanese men and women.

J Nutr ; 3: Prevalence and incidence of hypertension in adolescent girls. Methylxanthines, inflammation, and cancer: Caffeine levels in beverages from Argentina's market: Contam Part A Chem. Effects of 2 adenosine antagonists, quercetin and caffeine, on vigilance and mood. Effects of administration of caffeine on metabolic variables in neonatal pigs with peripartum asphyxia. Methylxanthines and the kidney. The effect of caffeine on retrobulbar hemodynamics.

Eye Res ;33 9: Fourteen well-described caffeine withdrawal symptoms factor into three clusters. Psychopharmacology Berl ; 4: Risk factors for parkinson's disease: Polymorphisms of caffeine metabolism and estrogen receptor genes and risk of Parkinson's disease in men and women. A risk-benefit assessment of paracetamol acetaminophen combined with caffeine.

Pain Med ;11 6: Efficacy and harms of nasal calcitonin in improving bone density in young patients with inflammatory bowel disease: Comparison of the nutrient and chemical contents of traditional Korean Chungtaejeon and green teas. Plant Foods Hum Nutr ;65 2: Little effect of caffeine ingestion on repeated sprints in team-sport athletes. Caffeinated chewing gum increases repeated sprint performance and augments increases in testosterone in competitive cyclists.

Comparative efficacy of theophylline and caffeine in facilitating extubation of preterm infants with respiratory distress syndrome. Dose-dependent effects of caffeine on behavior and thermoregulation in a chronic unpredictable stress model of depression in rats.

Behav Brain Res ; 2: High rates of muscle glycogen resynthesis after exhaustive exercise when carbohydrate is coingested with caffeine.

J Appl Physiol ; 1: Influence of caffeine ingestion on perceived mood states, concentration, and arousal levels during a min university lecture. A blinded, randomized, placebo-controlled trial to compare theophylline and doxapram for the treatment of apnea of prematurity. J Pediatr ; 4: Caffeine and the control of cerebral hemodynamics. Pharmacokinetics of caffeine in plasma and saliva, and the influence of caffeine abstinence on CYP1A2 metrics.

Coffee consumption and blood pressure: Clin Sci Lond ;72 4: Efficacy of diclofenac sodium softgel mg with or without caffeine mg in migraine without aura: Caffeine-induced uncoupling of cerebral blood flow and oxygen metabolism: OTC analgesics in headache treatment: The effects of coffee and napping on nighttime highway driving: Ann Intern Med ; Caffeine withdrawal symptoms following brief caffeine deprivation.

Does long-term coffee intake reduce type 2 diabetes mellitus risk? Acute blood pressure elevations with caffeine in men with borderline systemic hypertension. Effects of caffeine on vascular resistance, cardiac output and myocardial contractility in young men.

Indian J Med Res ; Tolerability and efficacy of a combination of paracetamol and caffeine in the treatment of tension-type headache: J Headache Pain ;9 6: Chronic caffeine treatment during prepubertal period confers long-term cognitive benefits in adult spontaneously hypertensive rats SHR , an animal model of attention deficit hyperactivity disorder ADHD.

Effects of caffeine on glucose tolerance: Analgesic efficacy of ibuprofen alone and in combination with codeine or caffeine in post-surgical pain: Urticaria caused by caffeine. Prior treatment priming with caffeine sensitizes D2-dopamine-mediated contralateral rotational behavior in 6-hydroxydopamine-lesioned rats. Caffeine consumption and weekly sleep patterns in US seventh-, eighth-, and ninth-graders. Effects of caffeine on repeated sprint ability, reactive agility time, sleep and next day performance.

Caffeine protects against oxidative stress and Alzheimer's disease-like pathology in rabbit hippocampus induced by cholesterol-enriched diet. Biol Med ;49 7: Effects of caffeine in Parkinson's disease: Parkinson's disease and environmental factors.

Matched case-control study in the Limousin region, France. Treatment of caffeine toxicity with esmolol. Coffee, tea and VPB. Effects of sodium bicarbonate, caffeine, and their combination on repeated m freestyle performance.

Saponins in yerba mate tea Ilex paraguariensis A. Respiratory adverse reactions included nasal congestion, cough, and apnea. Geriatric Use Clinical trials of Lamotrigine for epilepsy and bipolar disorder did not include sufficient numbers of patients aged 65 years and older to determine whether they respond differently from younger patients or exhibit a different safety profile than that of younger patients.

In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function and of concomitant disease or other drug therapy. Hepatic Impairment Experience in patients with hepatic impairment is limited. Based on a clinical pharmacology study in 24 subjects with mild, moderate, and severe liver impairment [see Clinical Pharmacology No dosage adjustment is needed in patients with mild liver impairment.

Escalation and maintenance doses may be adjusted according to clinical response [see Dosage and Administration 2. Renal Impairment Lamotrigine is metabolized mainly by glucuronic acid conjugation, with the majority of the metabolites being recovered in the urine. In a small study comparing a single dose of Lamotrigine in subjects with varying degrees of renal impairment with healthy volunteers, the plasma half-life of Lamotrigine was approximately twice as long in the subjects with chronic renal failure [see Clinical Pharmacology Initial doses of Lamotrigine should be based on patients' AED regimens; reduced maintenance doses may be effective for patients with significant renal impairment.

Few patients with severe renal impairment have been evaluated during chronic treatment with Lamotrigine. Because there is inadequate experience in this population, Lamotrigine should be used with caution in these patients [see Dosage and Administration 2. Epilepsy and many other illnesses for which AEDs are prescribed are themselves associated with morbidity and mortality and an increased risk of suicidal thoughts and behavior. Should suicidal thoughts and behavior emerge during treatment, the prescriber needs to consider whether the emergence of these symptoms in any given patient may be related to the illness being treated.

Patients, their caregivers, and families should be informed that AEDs increase the risk of suicidal thoughts and behavior and should be advised of the need to be alert for the emergence or worsening of the signs and symptoms of depression, any unusual changes in mood or behavior, the emergence of suicidal thoughts or suicidal behavior, or thoughts about self-harm.

Behaviors of concern should be reported immediately to healthcare providers. Patients should be closely monitored for clinical worsening including development of new symptoms and suicidality, especially at the beginning of a course of treatment or at the time of dose changes. In addition, patients with a history of suicidal behavior or thoughts, those patients exhibiting a significant degree of suicidal ideation prior to commencement of treatment, and young adults are at an increased risk of suicidal thoughts or suicide attempts and should receive careful monitoring during treatment [see Suicidal Behavior and Ideation ].

Prescriptions for LAMICTAL should be written for the smallest quantity of tablets consistent with good patient management in order to reduce the risk of overdose. Aseptic Meningitis Therapy with lamotrigine increases the risk of developing aseptic meningitis. Because of the potential for serious outcomes of untreated meningitis due to other causes, patients should also be evaluated for other causes of meningitis and treated as appropriate.

Postmarketing cases of aseptic meningitis have been reported in pediatric and adult patients taking lamotrigine for various indications.

Symptoms upon presentation have included headache, fever, nausea, vomiting, and nuchal rigidity. Rash, photophobia , myalgia , chills, altered consciousness, and somnolence were also noted in some cases. Symptoms have been reported to occur within 1 day to one and a half months following the initiation of treatment.

There are many kinds of generalized seizures. These seizures are sometimes referred to as petit mal seizures, which is an older term. Tonic seizures cause stiffening of muscles of the body, generally those in the back, legs, and arms. Clonic seizures cause repeated jerking movements of muscles on both sides of the body. Myoclonic seizures cause jerks or twitches of the upper body, arms, or legs. Atonic seizures cause a loss of normal muscle tone.

The affected person will fall down or may drop his or her head involuntarily. Tonic-clonic seizures are sometimes referred to by an older term: Not all seizures can be easily defined as either focal or generalized. Some people have seizures that begin as focal seizures but then spread to the entire brain. Other people may have both types of seizures but with no clear pattern.

Society's lack of understanding about the many different types of seizures is one of the biggest problems for people with epilepsy. People who witness a non-convulsive seizure often find it difficult to understand that behavior which looks deliberate is not under the person's control. In some cases, this has led to the affected person being arrested or admitted to a psychiatric hospital. To combat these problems, people everywhere need to understand the many different types of seizures and how they may appear.

Just as there are many different kinds of seizures, there are many different kinds of epilepsy. Doctors have identified hundreds of different epilepsy syndromes -- disorders characterized by a specific set of symptoms that include epilepsy.

Some of these syndromes appear to be hereditary. For other syndromes, the cause is unknown. Epilepsy syndromes are frequently described by their symptoms or by where in the brain they originate. People should discuss the implications of their type of epilepsy with their doctors to understand the full range of symptoms, the possible treatments, and the prognosis. People with absence epilepsy have repeated absence seizures that cause momentary lapses of consciousness.

These seizures almost always begin in childhood or adolescence, and they tend to run in families, suggesting that they may be at least partially due to a defective gene or genes. Some people with absence seizures have purposeless movements during their seizures, such as a jerking arm or rapidly blinking eyes. Others have no noticeable symptoms except for brief times when they are "out of it. However, these seizures may occur so frequently that the person cannot concentrate in school or other situations.

Childhood absence epilepsy usually stops when the child reaches puberty. Absence seizures usually have no lasting effect on intelligence or other brain functions. Temporal lobe epilepsy, or TLE, is the most common epilepsy syndrome with focal seizures. These seizures are often associated with auras. TLE often begins in childhood. Research has shown that repeated temporal lobe seizures can cause a brain structure called the hippocampus to shrink over time.

The hippocampus is important for memory and learning. While it may take years of temporal lobe seizures for measurable hippocampal damage to occur, this finding underlines the need to treat TLE early and as effectively as possible. Neocortical epilepsy is characterized by seizures that originate from the brain's cortex, or outer layer.

The seizures can be either focal or generalized. They may include strange sensations, visual hallucinations, emotional changes, muscle spasms, convulsions, and a variety of other symptoms, depending on where in the brain the seizures originate. There are many other types of epilepsy, each with its own characteristic set of symptoms. Many of these, including Lennox-Gastaut syndrome and Rasmussen's encephalitis, begin in childhood. Children with Lennox-Gastaut syndrome have severe epilepsy with several different types of seizures, including atonic seizures, which cause sudden falls and are also called drop attacks.

This severe form of epilepsy can be very difficult to treat effectively. Rasmussen's encephalitis is a progressive type of epilepsy in which half of the brain shows continual inflammation. It sometimes is treated with a radical surgical procedure called hemispherectomy.

Some childhood epilepsy syndromes, such as childhood absence epilepsy, tend to go into remission or stop entirely during adolescence, whereas other syndromes such as juvenile myoclonic epilepsy and Lennox-Gastaut syndrome are usually present for life once they develop.

Seizure syndromes do not always appear in childhood, however. Epilepsy syndromes that are easily treated, do not seem to impair cognitive functions or development, and usually stop spontaneously are often described as benign. Benign epilepsy syndromes include benign infantile encephalopathy and benign neonatal convulsions. Other syndromes, such as early myoclonic encephalopathy, include neurological and developmental problems.

However, these problems may be caused by underlying neurodegenerative processes rather than by the seizures.

Several types of epilepsy begin in infancy. The most common type of infantile epilepsy is infantile spasms, clusters of seizures that usually begin before the age of 6 months. During these seizures the infant may bend and cry out. Anticonvulsant drugs often do not work for infantile spasms, but the seizures can be treated with ACTH adrenocorticotropic hormone or prednisone. When Are Seizures Not Epilepsy? While any seizure is cause for concern, having a seizure does not by itself mean a person has epilepsy.

First seizures, febrile seizures , nonepileptic events, and eclampsia are examples of seizures that may not be associated with epilepsy. First Seizures Many people have a single seizure at some point in their lives. Often these seizures occur in reaction to anesthesia or a strong drug, but they also may be unprovoked, meaning that they occur without any obvious triggering factor.

Unless the person has suffered brain damage or there is a family history of epilepsy or other neurological abnormalities, these single seizures usually are not followed by additional seizures. One recent study that followed patients for an average of 8 years found that only 33 percent of people have a second seizure within 4 years after an initial seizure.

People who did not have a second seizure within that time remained seizure-free for the rest of the study. For people who did have a second seizure, the risk of a third seizure was about 73 percent on average by the end of 4 years.

When someone has experienced a first seizure, the doctor will usually order an electroencephalogram , or EEG , to determine what type of seizure the person may have had and if there are any detectable abnormalities in the person's brain waves. Thedoctor also may order brain scans to identify abnormalities that may be visible in the brain.

These tests may help the doctor decide whether or not to treat the person with antiepileptic drugs. In some cases, drug treatment after the first seizure may help prevent future seizures and epilepsy. However, the drugs also can cause detrimental side effects, so doctors prescribe them only when they feel the benefits outweigh the risks.

Evidence suggests that it may be beneficial to begin anticonvulsant medication once a person has had a second seizure, as the chance of future seizures increases significantly after this occurs.

Febrile Seizures Sometimes a child will have a seizure during the course of an illness with a high fever. These seizures are called febrile seizures febrile is derived from the Latin word for " fever " and can be very alarming to the parents and other caregivers.

In the past, doctors usually prescribed a course of anticonvulsant drugs following a febrile seizure in the hope of preventing epilepsy. However, most children who have a febrile seizure do not develop epilepsy, and long-term use of anticonvulsant drugs in children may damage the developing brain or cause other detrimental side effects.

Experts at a consensus conference coordinated by the National Institutes of Health concluded that preventive treatment after a febrile seizure is generally not warranted unless certain other conditions are present: The risk of subsequent non-febrile seizures is only 2 to 3 percent unless one of these factors is present. Researchers have now identified several different genes that influence the risk of febrile seizures in certain families.

Studying these genes may lead to new understanding of how febrile seizures occur and perhaps point to ways of preventing them. Nonepileptic Events Sometimes people appear to have seizures, even though their brains show no seizure activity. This type of phenomenon has various names, including nonepileptic events and pseudoseizures. Both of these terms essentially mean something that looks like a seizure but isn't one. Nonepileptic events that are psychological in origin may be referred to as psychogenic seizures.

Psychogenic seizures may indicate dependence, a need for attention, avoidance of stressful situations, or specific psychiatric conditions. Some people with epilepsy have psychogenic seizures in addition to their epileptic seizures. Other people who have psychogenic seizures do not have epilepsy at all.

Psychogenic seizures cannot be treated in the same way as epileptic seizures. Instead, they are often treated by mental health specialists. Other nonepileptic events may be caused by narcolepsy, Tourette syndrome , cardiac arrythmia, and other medical conditions with symptoms that resemble seizures.

Because symptoms of these disorders can look very much like epileptic seizures, they are often mistaken for epilepsy.

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