Depression

 In the current healthcare of the patients with multiple sclerosis (MS) based on a thorough investigation and knowledge highly complex and diverse, it has been required the creation of a team of specialists who can cover extensive range of data from the biochemical, pathological and bioelective on the clinical and psychological. In this system of health, all data and results are intended to a specific knowledge of the morbid processes, of its etnopathogeny, of the clinical and therapeutic possibilities. Also, an authentic knowledge of the person presents the process of the structure of psychism or, capable of conditioning all the components of the disease, from ethiopathogenic ones to the clinical-therapeutic and prognostic evolution, is desired to enroll in the full knowledge, comprehensive, total.

The increasingly important contribution of the clinical psychologist has opened the question of relations between the two industries, the medical and psychological. Analyzing the relationships between medical profession and that of the psychologist, the activities were both contributory , illustrated especially by seeking investigative and competitive nature, illustrated by therapeutic area by assuming the role of a psychotherapist by the psychologist. One of the particular activity of the psychologist is that unlike the physicians relationships with other professionals involved in investigative work, relationships mediated by machines, the products harvested or results, working with psychologist involve direct relationships, determined by specific approaches, which are direct and interpersonal.

Analyzing the content of psycho-medical activities are noted as specific medical collaboration with the psychologist is that he takes part in more closely, the doctor-patient relationship. This work extends from the establishing of a biographical case history of personality diagnosis, to the diagnosis of nevrotico-depressive states and making certain psychotherapeutic measures. The opportunity of the psychological approach work in close liaison with neurology clinician is fully justified if patients with MS, on which are present in the cognitive impairment symptoms, psychiatric manifestations. Psychiatric disorders in MS are not exceptions, during he disease they are frequently met. Most symptoms indicate an alteration of the emotional state in these patients. Depression states varied in intensity are pregnantly observed (55% of cases), by numerous studies see a more favorable prognosis in cases in which depression occurs with neurological phenomena. There has been noted the presence of depression and emotional disorders especially in periods of flares.

The widest and general definition considers depression as a collapse of basal mood with the update of the unpleasant feelings, sad and threatening. Strong emotional involvement, the deep living of this state, consensual involvement are all arguments for considering depression a negative hipertimie. As defined above, depression is related to depression symptom and the definition is scholastic because in practical reality, depression is the syndrome or nosologic entity. In the following, we refer to this second aspect (syndrome), which we will define, as do other authors, operational, it's parts are the ideational echo, behavioral and somatic of affective disorder. Depressive syndrome has as defining components depressed mood, psychomotor slowing and slow thought processes, in addition with a series of auxiliary symptoms of somatic expression. Depressed mood is experienced as vital sadness, loss of feeling, emptying and inner restlessness, perceptual content gray.

Combining the etiologic criteria with te nosologic are described: somatogene depression (organic, symptomatic), endogenous depression (schizoafective, bipolar, unipolar, involutional), psychogenic depression (neurotic, depression, exhaustion, reactive). After the degree of intensity,there can be described a neurotic depression and psychotic depression. Depression of neurotic intensity is triggered psychogenic and is manifested in terms of prolonged sadness, lack of initiative, intolerance to frustration, decreased or exacerbation of appetite, insomnia, sexual disorders, irritability, anxiety. Neurotic depression occurs in neurotic intensity relationships, neurasthenia, depressive neurosis in decompensation intensity paleastenic personalities, hysterical, emotional, in weakly symptomatic depression.

In psychotic depression, each of the elements of depressive syndrome reach maximum intensity, changing the personality and behavior in psychotic effect. Masked depression was defined as a depressive illness which occupy the foreground of somatic symptoms or psychological symptoms that are on the second plane (as substrate). This type of depression is most common in case patients with MS. Correct attitude in the treatment plan of somatic disease involves the collaboration of the neurologist, psychiatrist and psychologist for depression treatment and current investigation, which may enhance the somatic symptoms.

When a depressive disorder appears along with a somatic distress there are several possible explanations:

•  General medical suffering biologicaly cause depression;
•  Somatic pain trigger depression of genetically vulnerable persons ;
•  Somatic pain psychologicaly produces depression in response to prognosis, pain and disability;
•  Somatic pain and depression are not related, are independent;  

 Evaluative approach of the psychologist has a special importance in assessing the type and degree of intensity of depression in order to establish an appropriate psychotherapeutic plan. In the neurological clinic of Targu-Mures, in the psychological analysis of patients with MS are used complex evaluation methods, starting from the interview and to the administration of specific tests. Psychological examination begins, usually by interviewing the individual and his family. If possible, are collected information from collateral sources (jobs, medical unit). After this first phase following the administration of selected tests that respond to the problem of reference (depression). There is not recommended to use a single test.

The tests commonly used in neurological clinic in Targu-Mures, in order to assess the correct type and level of intensity of depression are: Hamilton depression scale, Beck depression questionnaire, the questionnaire Woodworth multiphase, multiphase personality inventory Minesota (MMPI), pronounced personalities of Karl Leonhard, test anxiety: STAI, S.T.A.X.I. Conclusions reached on the interpretation offered by the interview and the listing of administered tests offers a concrete picture of the physical state of the subject. The psychologist establishes a psychological diagnose,elaborates an psychotherapeutic and appropriate plan, elements of prognosis and recommendations to the problem of reference. In MS patients it is find that the mind deteriorates along with physical and drug treatment and motor education without a physical rehabilitation does not give satisfactory results. Most times, the psychological study of these patients gain an important psychological education of their outstanding and are even more difficult.

Neurological clinic in Targu-Mures is using a physical rehabilitation plan which includes: patient and family counseling, supportive psychotherapy, relaxation psychotherapy, existential psychotherapy and occupational, with good results. Psychotherapeutic treatment succeeded in improving depressive symptoms in these patients and ensure the maintenance of a satisfactory tone psychological, familial and social reintegration of a better adaptability to conditions of the disease.

Disorders of deglutition (swallowing) in multiple sclerosis

Dysphagia or swallowing disorders can be very disturbing to patients with multiple sclerosis (MS). Swallowing refers to the passage of food through the esophagus into the stomach. Food can remain in the oral cavity, can cause coughing, etc..

Swallowing disorders include:

•  Cough after meal
•  Inability of swallowing solid food
•  Refluation of liquids through the nose
•  Weight loss
•  Dehydration
•  Malnutrition
•  Pneumonia 

Drowning An evaluation of swallowing includes neurological and radiological examination with barium. The aim of recovery of deglutition disorders follows the nutritional improvement and ensurance of safety in the upper airway during feeding.

Recovery or improvement of swallowing can be done by:

1. Change the texture of food because some food can be swallowed more easily than others. For example, adding an agent fattening food (eg gelatin) may lead to eating easier. Sometimes the administration of milk products should be reduced because they can stick to the pharynx and may become irritating.
2. Soaking the food with sauces, juices, oil, can lead to an easy and safe passage to the stomach.
3. Heating or cooling food (as applicable) may improve the swallowing reflex.
4. Change head position during feeding is often necessary. Printing a passive movements in lower jaw allows easy entry of food into mouth and then tilt your head back allows triggering swallowing reflex.
5. During meals is recommended to alternate solid food with liquid.
6. Reduce the size of food and the amount of food from a table, the establishment of small quantity but more frequent meals.
7. Decrease in bite size significantly improves swallowing food.
8. Swallowing will be done during an apnea to prevent food reaching in the upper airways.
9. Before starting food are rccomended some motor exercises with the tongue, lips.
10. It is important that dinner time to be the same.

Fatigue

I feel I get tired very quickly, even if I do not do a big deal of a work. Is this situation related to MS?

Contents:

• Fatigue in multiple sclerosis
• Management of fatigue in MS Fatigue in multiple sclerosis

Fatigue is a universal feeling, felt by most people with MS. In general, fatigue is a direct proportion to one particular case, for example in case of a sustained effort or lack of sleep. In any disease of the nervous system the affected person notices that gets tired quickly. Fatigue in multiple sclerosis is not directly proportional to the effort. Fatigue is one of the most common MS-related distress, as experienced by over 75% of people with MS. It is one of the most difficult symptoms to understand and treat because it is invisible and its appearance can producer disputes especially among friends, family and employers. Family members may think that a person with MS is not working hard; sexual problems may occur between partners, an employer can say about the person that it is lazy. Fatigue can have a powerful impact on daily activities, welfare activities in general and from work.

The fatigue caused by MS is not fully understood. Fatigue in MS can be divided into four different types:

• Normal fatigue - that appears usually. Not all fatigue is caused by MS;
• Neuro-muscular fatigue - is caused by inefficient transmission of nerve impulses. The solution for this fatigue - short-circuit - is a rest period;
• Depression - is a common element in MS and is usually accompanied by little sleep, loss of appetite, depression and fatigue affecting.
• Drowsiness - is an overwhelming fatigue that occurs without a reason. Because neuro-chemical medications are effective tools in managing MS is believed that drowsiness is a direct effect of biochemical imbalance in the brain.

Periods of fatigue, in addition to the harmful effects it has in everyday life, can create anxiety when MS symptoms reoccur. This phenomenon occurs after an effort or when a task or the environment causes an increase body temperature. Should be noted that fatigue has nothing to do with flares and will not cause a worsening of the disease or an acceleration of the disability. It is also possible that the impact of fatigue and seizures to be exacerbated by psychological factors such as sense of situation control (eg an important factor in MS fatigue is the inability to manipulate, control and change the environment to suit personal psychological needs).

Management of MS fatigue

 When fatigue becomes a major problem of the person with MS is recommended a full medical examination to eliminate other possible causes of fatigue (eg an infection). One of the causes of MS fatigue is fatigue that causes restless sleep during the day. If the only cause of fatigue is a disease of the nervous system (in this case MS), lifestyle, environment and daily occupations must be adjusted to include this symptom. As may be necessary to change your role at work and the family in order to avoid fatigue. To control fatigue there are a number of techniques such as time management, adjusting the pace of work, energy conservation, simpler and relaxing break.

Practical tips

• Avoid hot baths, very high temperatures, excessive exercise, large amounts of food, smoking;
• Plan your life so that you control requirements at work, social events and late nights spent;
• Follow a rational diet and try to lose weight if you are obese;
• Yoga exercises can be helpful, it combines exercise with meditation;
• Try to keep In good physical condition through an exercise program tailored to your possibilities.

 These exercises should not be exhausting and must be followed by proper rest periods. Stress management and counseling should not be excluded of the methods to combat the fatigue. Psycho-social factors and concerns related to quality of life directly influences the ability of people with MS cope with their lives and can cause the appearance of fatigue and a determinant of the extent to which it influences everyday life.

Friends, families of people with MS, health professionals and employers should be informed about this aspect of MS. Fatigue is one of MS symptoms, but one that can be treated if it is understood and accepted. Read Exercise and MS by Dr R Schapiro. MS MANAGEMENT Vol 2 No 2 September 1995.

Bladder problems

 It seems that I have bladder problems. I have to go to the toilet more frequently than usual. Sometimes reaching almost the last minute. Does this have to do with MS?

For people with MS bladder control is a common problem. The deterioration of bladder function affects up to 90% of people with MS at some time in the course of the disease. Urinary symptoms are unpleasant and can cause medical problems, emotional and hygiene affect critical areas of life such as social, vocational and sexual. Most symptoms can be controlled and the bladder and urinary complications are preventable. Bladder problems is due to problems along the spine disease.

 Symptoms are varied and covers the following:

•  Emergency - need to go to the bathroom as soon as possible
•  Frequency - urination for more than five or six times a day
•  Hesitation - problems in starting urination
•  Nocturia - waking from sleep to urinate
•  Incontinence - urine leakage and loss of urinary control
•  Retention - the bladder is not emptied completely.

To solve bladder problems you will have to go to the doctor several times, and to be consulted by a specialist in urological problems. If you see the need to urinate frequently or have trouble passing urine you should contact your doctor as soon as possible.

There are treatments that soothes a slightly irritable bladder or bladder emptying help when needed. On receipt of aid, such drawbacks of many people are at a minimum. Inform your doctor on a regular basis with your urinary habits and associated problems.

Some people have urinary tract infections characterized by frequent urination, strong odor or discoloration of urine and abdominal or back pain sometimes accompanied by fever. This slows MS urinary system functions without specific medication, so do not try to treat it by yourself. There are ways to eliminate entirely the urine waste - which is often due to infection. Your doctor or a member of a team of specialists can give advice on the matter depending on your specific problems.

 You can also make a number of practical steps. If you have problems with frequent urination or lack of control over it, when out of the house is good to know exactly where there are toilets in public places like theaters, restaurants and shops. Note that if you are permanently in search of a toilet is recommended that you consult the doctor to establish a program to control bladder activity. Part of the problem can be solved by coordinating timing of ingestion of liquids. When some people have problems with bladder  control, they tend not to drink fluids. This approach to the problem may have serious repercussions for the kidneys that requires about 2 liters of fluid a day to remove toxins from the body effectively.

The solution to this problem lies in planning consuming liquids. Do not eat large amounts before leaving home or before going to bed. Same amount of liquid can be consumed on a longer period of time. Common sense has no substitute.

There are special clothes and diapers for incontinence at affordable prices, they are very helpful for people with these problems. These products are available in pharmacies and stores with medical products.

Not all symptoms are related to MS: men can have prostate problems and women vaginal infections. It is best to let your doctor to establish the cause and necessary treatment. Urinary problems occur frequently in cases of MS and can be embarrassing in terms of social interaction. However they respond well to treatment and can be controlled to allow resumption of normal activities.