Anorexia Nervosa

What is anorexia nervosa?

Anorexia nervosa, commonly referred to simply as anorexia, is one type of eating disorder. More importantly, it is also a psychological disorder. Anorexia is a condition that goes beyond concern about obesity or out-of-control dieting. A person with anorexia often initially begins dieting to lose weight. Over time, the weight loss becomes a sign of mastery and control. The drive to become thinner is actually secondary to concerns about control and/or fears relating to one's body. The individual continues the ongoing cycle of restrictive eating, often accompanied by other behaviors such as excessive exercising or the overuse of diet pills to induce loss of appetite, and/or diuretics, laxatives, or enemas in order to reduce body weight, often to a point close to starvation in order to feel a sense of control over his or her body. This cycle becomes an obsession and, in this way, is similar to an addiction.

Who is at risk for anorexia nervosa?

Approximately 95% of those affected by anorexia are female, most often teenage girls, but males can develop the disorder as well. While anorexia typically begins to manifest itself during early adolescence, it is also seen in young children and adults. In the U.S. and other countries with high economic status, it is estimated that about one out of every 100 adolescent girls has the disorder. Caucasians are more often affected than people of other racial backgrounds, and anorexia is more common in middle and upper socioeconomic groups. According to the U.S. National Institute of Mental Health (NIMH), other statistics about this disorder include the fact that an estimated 0.5%-3.7% of women will suffer from this disorder at some point in their lives. About 0.3% of men are thought to develop anorexia in their lifetimes
Many experts consider people for whom thinness is especially desirable, or a professional requirement (such as athletes, models, dancers, and actors), to be at risk for eating disorders such as anorexia nervosa. Health-care professionals are usually encouraged to present the facts about the dangers of anorexia through education of their patients and of the general public as a means of preventing this and other eating disorders.

What causes anorexia nervosa?

At this time, no definite cause of anorexia nervosa has been determined. However, research within the medical and psychological fields continues to explore possible causes.
Studies suggest that a genetic (inherited) component may play a more significant role in determining a person's susceptibility to anorexia than was previously thought. Researchers are currently attempting to identify the particular gene or genes that might affect a person's tendency to develop this disorder, and preliminary studies suggest that a gene located at chromosome 1p seems to be involved in determining a person's susceptibility to anorexia nervosa.
Other evidence had pinpointed a dysfunction in the part of the brain, the hypothalamus (which regulates certain metabolic processes), as contributing to the development of anorexia. Other studies have suggested that imbalances in neurotransmitter (brain chemicals involved in signaling and regulatory processes) levels in the brain may occur in people suffering from anorexia.
Feeding problems as an infant, a general history of undereating, and maternal depressive symptoms tend to be risk factors for developing anorexia. Other personal characteristics that can predispose an individual to the development of anorexia include a high level of negative feelings and perfectionism. For many individuals with anorexia, the destructive cycle begins with the pressure to be thin and attractive. A poor self-image compounds the problem. People who suffer from any eating disorder are more likely to have been the victim of childhood abuse.
While some professionals remain of the opinion that family discord and high demands from parents can put a person at risk for developing this disorder, the increasing evidence against the idea that families cause anorexia has mounted to such an extent that professional mental-health organizations no longer ascribe to that theory. Possible factors that protect against the development of anorexia include high maternal body mass index (BMI) as well as personal high self-esteem.

How is anorexia nervosa diagnosed?

Anorexia nervosa can be a difficult disorder to diagnose, since individuals with anorexia often attempt to hide the disorder. Denial and secrecy frequently accompany other symptoms. It is unusual for an individual with anorexia to seek professional help because the individual typically does not accept that she or he has a problem (denial). In many cases, the actual diagnosis is not made until medical complications have developed. The individual is often brought to the attention of a professional by family members only after marked weight loss has occurred. When anorexics finally come to the attention of the health-care professional, they often lack insight into their problem despite being severely malnourished and may be unreliable in terms of providing accurate information. Therefore, it is often necessary to obtain information from parents, a spouse, or other family members in order to evaluate the degree of weight loss and extent of the disorder. Health professionals will sometimes administer questionnaires for anorexia as part of screening for the disorder.
Warning signs of developing anorexia or one of the other eating disorders include excessive interest in dieting or thinness. One example of such interest includes a movement called "thinspiration," which promotes extreme thinness as a lifestyle choice rather than as a symptom of illness. There are a variety of web sites that attempt to inspire others toward extreme thinness by featuring information on achieving that goal, photos of famous, extremely thin celebrities, and testimonials, as well as before and after pictures of individuals who ascribe to extreme thinness.
The actual criteria for anorexia nervosa are found in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR).
There are four basic criteria for the diagnosis of anorexia nervosa that are characteristic:

1. The refusal to maintain body weight at or above a minimally normal weight for age and height (maintaining a body weight less than 85% of the expected weight)
2. An intense fear of gaining weight or becoming fat, even though the person is underweight
3. Self-perception that is grossly distorted, excessive emphasis on body weight in self-assessment, and weight loss that is either minimized or not acknowledged completely
4. In women who have already begun their menstrual cycle, at least three consecutive periods are missed (amenorrhea), or menstrual periods occur only after a hormone is administered.

The DSM-IV-TR further identifies two subtypes of anorexia nervosa. In the binge-eating/purging type, the individual regularly engages in binge eating or purging behavior which involves self-induced vomiting or the misuse of laxatives, diuretics, or enemas during the current episode of anorexia. In the restricting type, the individual severely restricts food intake but does not regularly engage in the behaviors seen in the binge-eating type.

What are anorexia symptoms and signs (psychological and behavioral)?

Anorexia can have dangerous psychological and behavioral effects on all aspects of an individual's life and can affect other family members as well.

• The individual can become seriously underweight, which can lead to depression and social withdrawal.
• The individual can become irritable and easily upset and have difficulty interacting with others.
• Sleep can become disrupted and lead to fatigue during the day.
• Attention and concentration can decrease.
• Most individuals with anorexia become obsessed with food and thoughts of food. They think about it constantly and become compulsive about eating rituals. They may collect recipes, cut their food into tiny pieces, prepare elaborate calorie-laden meals for other people, or hoard food. Additionally, they may exhibit other obsessions and/or compulsions related to food, weight, or body shape that meet the diagnostic criteria for an obsessive compulsive disorder.
• Other psychiatric problems are also common in people with anorexia nervosa, including affective (mood) disorders, anxiety disorders, and personality disorders.
• Generally, individuals with anorexia are compliant in every other aspect of their life except for their relationship with food. Sometimes, they are overly compliant, to the extent that they lack adequate self-perception. They are eager to please and strive for perfection. They usually do well in school and may often overextend themselves in a variety of activities. The families of anorexics often appear to be "perfect." Physical appearances are important to the anorexia sufferer. Performance in other areas is stressed as well, and they are often high achievers in many areas.
• While control and perfection are critical issues for individuals with anorexia, aspects of their life other than their eating habits are often found to be out of control as well. Many have, or have had at some point in their lives, addictions to alcohol, drugs, or gambling. Compulsions involving sex, exercising, housework, and shopping are not uncommon. In particular, people with anorexia often exercise compulsively to speed the weight-loss process.
• Symptoms of anorexia in men tend to co-occur with other psychological problems and more commonly follow a period of being overweight than in women. Men with anorexia also tend to be more likely to have a distorted body image.
• Compared to symptoms in men, symptoms of anorexia in women tend to more frequently include a general displeasure with their body and a possibly stronger desire to be thin. Women with anorexia also tend to experience more perfectionism and cooperativeness.

Due to the growth and development inherent during childhood and adolescence, symptoms and signs of anorexia in children and teenagers can include a slowing of the natural increase in height or a slowed increase in development of other body functions.
All of these features can negatively affect one's daily activities. Diminished interest in previously preferred activities can result. Some individuals also have symptoms that meet the diagnostic criteria for a major depressive disorder.

What are anorexia symptoms and signs (physical)?

Most of the medical complications of anorexia nervosa result from starvation. Few organs are spared the progressive deterioration brought about by anorexia.

• Heart and circulatory system: Although not life-threatening, an abnormally slow heart rate (bradycardia) and unusually low blood pressure (hypotension) are frequent manifestations of starvation and are commonly associated with anorexia. Of greater significance are disturbances in the heart rhythm (arrhythmia). A reduction in the work capacity of the heart is associated with severe weight loss and starvation.
• Gastrointestinal complications are also associated with anorexia. Constipation and abdominal pain are the most common symptoms. The rate at which food is absorbed into the body is slowed down. Starvation and overuse of laxatives can seriously disrupt the body's normal functions involved in the elimination process. While liver function is generally found to be normal, there is evidence that some individuals with anorexia develop changes in enzyme levels and overall damage to the liver.
• The glandular (endocrine) system in the body is profoundly affected by anorexia. The complex physical and chemical processes involved in the maintenance of life can be disrupted, with serious consequences. Disturbances in the menstrual cycle are frequent, and secondary amenorrhea (absence of menstrual periods) affects about 90% of adolescent girls with anorexia. Menstrual periods typically return with weight gain and successful treatment. Hormonal imbalances are found in men with anorexia as well. Continual restrictive eating can trick the thyroid into thinking that the body is starving, causing it to slow down in an attempt to preserve calories. When anorexia occurs in a person who also has diabetes mellitus (a tendency toward very high blood sugar levels), the risk of death is higher than in people who have either anorexia or diabetes mellitus alone.
• Kidney (renal) function may appear normal. However, there are significant changes in kidney function in many people with anorexia, resulting in increased or decreased urination or potentially fatal potassium deficiency. Diabetes insipidus, characterized by excessive urination and extreme thirst, has also been seen in anorexia.
• Bone density loss (osteopenia or thinning of the bones) is a significant complication of anorexia, since women acquire 40%-60% of their bone mass during adolescence. Studies have shown that bone loss can occur fairly rapidly in girls with anorexia. While some studies have shown that bone density may be restored if overall health improves and anorexia is successfully treated, other studies suggest that an increased risk for fracture may persist later in life.
• Anorexics who use a large quantity of laxatives or who frequently vomit are in danger of electrolyte imbalance, which can have life-threatening consequences.
• Anemia is frequently found in anorexic patients. In addition to having fewer red blood cells, people with anorexia tend to have lower numbers of white blood cells, which play a major role in protecting the body from developing infections. Suppressed immunity and a high risk for infection are suspected but not clinically proven.
• Contrary to what might be expected, anorexia nervosa is associated with a high total cholesterol levels.
• Physical symptoms, other than the obvious loss of weight, can be seen. Anorexia can cause dry, flaky skin that takes on a yellow tinge. Fine, downy hair grows on the face, back, arms, and legs. Despite this new hair growth, loss of hair on the head is not uncommon. Nails can become brittle. Frequent vomiting can erode dental enamel and eventually lead to tooth loss. People with anorexia might also develop trouble maintaining a consistent body temperature.

What is the treatment for anorexia nervosa?

Anorexia may be treated in an outpatient setting or hospitalization may be necessary. For an individual with severe weight loss that has impaired organ function, hospital treatment must initially focus on correction of malnutrition, and intravenous feeding or tube feeding that goes past the mouth may be required. A gain of between 1 to 3 pounds per week is a safe and attainable goal when malnutrition must be corrected. Sometimes weight gain is achieved using schedules for eating, decreased physical activity, and increased social activity, either on an inpatient or outpatient basis. For individuals who have suffered from anorexia for several years, the goals of treatment may need to be achieved more slowly in order to prevent the anorexia sufferer from relapsing as a result of being overwhelmed by treatment.
The overall treatment of anorexia, however, must focus on more than weight gain. There are a variety of treatment approaches dependent upon the resources available to the individual. Because of increasing insurance restrictions, many patients find that a short hospitalization followed by a day treatment program is an effective alternative to longer inpatient programs. Most individuals, however, initially seek outpatient treatment involving psychological as well as medical intervention. It is common to engage a multidisciplinary treatment team consisting of a medical-care provider, a dietician or nutritionist, and a mental-health-care provider.
Different kinds of psychological therapy have been employed to treat people with anorexia. Individual therapy, cognitive behavior therapy, group therapy, and family therapy have all been successful in the treatment of anorexia. In adolescents, research shows that the Maudsley model of family therapy can be particularly effective in treating this disorder in this population. In contrast to many past approaches to treatment, the Maudsley model approaches the family of the individual with anorexia as part of the solution rather than part of the reason their loved one has the disorder. With ongoing specific guidance from the professional mental-health team, this approach has the family actively help their loved one eat in a more healthy manner.
Any appropriate treatment approach addresses underlying issues of control, perfectionism, and self-perception. Family dynamics are explored. Nutritional education provides a healthy alternative to weight management for the patient. Group counseling or support groups may assist the individual in the recovery process. The ultimate goal of treatment should be for the individual to accept herself/himself and lead a physically and emotionally healthy life.
While no medications have been identified that can definitively reduce the compulsion to starve themselves, olanzapine (Zyprexa, Zydis), risperidone (Risperdal), and quetiapine (Seroquel) are medications that are also used as mood stabilizers and to treat schizophrenia that may be useful in treating anorexia. These medications may also help increase weight and to manage some of the emotional symptoms like anxiety and depression that can accompany anorexia. Some of the selective serotonin reuptake inhibitor (SSRI) antidepressant drugs have been shown to be helpful in weight maintenance after weight has been gained, as well as having beneficial effects on the mood and anxiety symptoms that may be associated with the condition.

Angelman Syndrome

What is Angelman Syndrome?

Angelman syndrome is a genetic disorder that causes developmental delay and neurological problems. The physician Harry Angelman first delineated the syndrome in 1965, when he described several children in his practice as having "flat heads, jerky movements, protruding tongues, and bouts of laughter." Infants with Angelman syndrome appear normal at birth, but often have feeding problems in the first months of life and exhibit noticeable developmental delays by 6 to 12 months. Seizures often begin between 2 and 3 years of age. Speech impairment is pronounced, with little to no use of words. Individuals with this syndrome often display hyperactivity, small head size, sleep disorders, and movement and balance disorders that can cause severe functional deficits. Angelman syndrome results from absence of a functional copy of the UBE3A gene inherited from the mother.

Is there any treatment?

There is no specific therapy for Angelman syndrome. Medical therapy for seizures is usually necessary. Physical and occupational therapies, communication therapy, and behavioral therapies are important in allowing individuals with Angelman syndrome to reach their maximum developmental potential.

What is the prognosis?

Most individuals with Angelman syndrome will have severe developmental delays, speech limitations, and motor difficulties. However, individuals with Angelman syndrome can have normal life spans and generally do not show developmental regression as they age. Early diagnosis and tailored interventions and therapies help improve quality of life.

What research is being done?

The NINDS supports and conducts research on neurogenetic disorders such as Angelman syndrome, to develop techniques to diagnose, treat, prevent, and ultimately cure them.

What is hemoglobin?

Hemoglobin is a red pigment that imparts the familiar red color to red blood cells and to blood. Functionally, hemoglobin is the key chemical compound that combines with oxygen from the lungs and carries the oxygen from the lungs to cells throughout the body. Oxygen is essential for all cells in the body to produce energy.
The blood also transports carbon dioxide, which is the waste product of this energy production process, back to the lungs from which it is exhaled into the air. The transport of the carbon dioxide back to the lung is also achieved by hemoglobin. The carbon dioxide bound to hemoglobin is unloaded in the lungs in exchange for oxygen to be transported to the tissues of the body

What does a low hemoglobin level mean?

Low hemoglobin is called anemia. When there is a low hemoglobin level, there is often a low red blood cell count and a low hematocrit, too. Reference ranges are slightly different from one source to another, but typically hemoglobin of less than 13.5 is abnormal in men less than 12.0 in women.

What is the hematocrit?

The hematocrit is specifically a measure of how much of the blood is made of red cells. The hematocrit is a very convenient way to determine whether the red blood cell count is too high, too low, or normal. The hematocrit is a measure of the proportion of blood that is composed of the red blood cells.

How is hematocrit determined?

The RBCs in the sample of blood are packed down by spinning the tube in a centrifuge under prescribed conditions. The proportion of the tube that consists of RBCs is then measured. Let's say that it is 45%. The hematocrit is 45.

How is anemia treated?

The treatment of the anemia varies greatly. First, the underlying cause of the anemia should be identified and corrected. For example, anemia as a result of blood loss from a stomach ulcer should begin with medications to heal the ulcer. Likewise, surgery is often necessary to remove a colon cancer that is causing chronic blood loss and anemia.
Sometimes iron supplements will also be needed to correct iron deficiency. In severe anemia, blood transfusions may be necessary. Vitamin B12 injections will be necessary for patients suffering from pernicious anemia or other causes of B12 deficiency.
In certain patients with bone marrow disease (or bone marrow damage from chemotherapy) or patients with kidney failure, epoetin alfa (Procrit, Epogen) may be used to stimulate bone marrow red blood cell production.
If a medication is thought to be the culprit, then it should be discontinued under the direction of the prescribing doctor.

What are the complications of anemia?

As mentioned earlier, hemoglobin has the important role of delivering oxygen to all parts of the body for consumption and carries back carbon dioxide back to the lung to exhale it out of the body. If hemoglobin level is too low, this process may be impaired, resulting in body having low oxygen level (hypoxia).

What is the outlook (prognosis) for anemia?

Anemia generally has a very good prognosis and it may be curable in many instances. The overall prognosis depends on the underlying cause of anemia, its severity, and the overall health of the patient.

Anemia

What is anemia?

Anemia is a medical condition in which the red blood cell count or hemoglobin is less than normal. The normal level of hemoglobin is generally different in males and females. For men, anemia is typically defined as hemoglobin level of less than 13.5 gram/100ml and in women as hemoglobin of less than 12.0 gram/100ml. These definitions may vary slightly depending on the source and the laboratory reference used.

What causes anemia?

Any process that can disrupt the normal life span of a red blood cell may cause anemia. Normal life span of a red blood cell is typically around 120 days. Red blood cells are made in the bone marrow.
Anemia is caused essentially through two basic pathways. Anemia is either caused:

1. by a decrease in production of red blood cell or hemoglobin, or
   
2. by a loss or destruction of blood.

As more common classifications of anemia (low hemoglobin) is based on the MCV, or the volume of individual red blood cells.

1. If the MCV is low (less than 80), the anemia is categorized as microcytic anemia (low cell volume).
   
2. If the MCV is in the normal range (80-100), it is called a normocytic anemia (normal cell volume).
   
3. If the MCV is high, then it is called a macrocytic anemia (large cell volume).

Looking at each of the components of a complete blood count (CBC), especially the MCV, a physician can gather clues as what may be the most common reason for anemia.

 

Can not enough iron cause anemia?

Absolutely! This is because iron is major component of hemoglobin and essential for its proper function. Chronic blood loss due to any reason is the main cause of low iron level in the body as it depletes the body's iron stores to compensate for the ongoing loss of iron. Anemia that is due to low iron levels is called iron deficiency anemia. Iron deficiency it is a very common cause of anemia.
Women are more likely than men to have iron deficiency anemia because of the loss of blood each month through normal menstruation. This is generally without any major symptoms as the blood loss is relatively small and temporary.
Iron deficiency anemia can also be due to small repeated l bleeding, for instance from colon cancer or from stomach ulcers. Stomach ulcer bleeding that may or may no be induced by medications even very common over-the-counter drugs as aspirin and ibuprofen (Advil, Motrin). In infants and young children, iron deficiency anemia is most often due to a diet lacking iron.
Interpretation of CBC may lead to clues to suggest this type of anemia. For instance, iron deficiency anemia usually presents with low mean corpuscular volume (microcytic anemia) in addition to low hemoglobin.

What about acute (sudden) blood loss as a cause of anemia?

Acute blood loss from internal bleeding (as from a bleeding ulcer) or external bleeding (as from trauma) can produce anemia in an amazingly short span of time. This type of anemia could result in severe symptoms and consequences if not addressed promptly.

What are other causes of anemia?

Some of the most common causes include:

• Vitamin B12 deficiency may cause pernicious anemia. This type of anemia could happen in people who are unable to absorb vitamin B12 from their intestines due to a number of reasons:
  
  
  • strict vegetarians who may not be taking adequate vitamin supplements, or
    
  • long-term alcoholics.

This typically causes macrocytic (large cell volume) anemia. Vitamin B12, along with folate, is a involved in making the heme molecule that is an integral part of hemoglobin. Folate deficiency can be the culprit of anemia. This may also be caused by inadequate absorption, under-consumption of green, leafy vegetables, and also long-term heavy alcohol use.

• There can be rupture of red blood cells (hemolytic anemia) due to antibodies clinging to the surface of the red cells (for example, hemolytic disease of the newborn and in many other conditions).
  
• A wide assortment of bone marrow diseases can cause anemia.
  
  
  • For example, cancers that spread (metastasize) to the bone marrow, or cancers of the bone marrow (such as leukemia or multiple myeloma) can cause the bone marrow to inadequately produce red blood cells, resulting in anemia.
    
  • Certain chemotherapy for cancers can also cause damage to the bone marrow and decrease red blood cell production, resulting in anemia.
    
  • Certain infections may involve the bone marrow and result in bone marrow impairment and anemia.
    
  • Finally, patients with kidney failure may lack the hormone necessary to stimulate normal red blood cell production by the bone marrow.
    
• Another common cause of anemia is called anemia of chronic disease. This could typically occur in individuals with long-standing chronic diseases.
  
• Some medications can cause anemia in a variety of ways.
  
• Human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) can cause anemia. 

Can anemia be hereditary?

Yes, anemia may be genetic. Hereditary disorders can shorten the life-span of the red blood cell and lead to anemia (for example, sickle cell anemia). Hereditary disorders can also cause anemia by impairing the production of hemoglobin (for example, alpha thalassemia and beta thalassemia).
Depending on the degree of the genetic abnormality, hereditary anemias may cause mild, moderate, or severe anemia. In fact, some may be too severe to be compatible with life and may result in death of the fetus (unborn infant). On the other hand, some of these anemias are so mild that they are not noticeable and are incidentally revealed during a routine blood work.

What are the symptoms of anemia?

Some patients with anemia have no symptoms. Others with anemia may feel:

• tired,
  
• fatigue easily,
  
• appear pale,
  
• develop palpitations (feeling of heart racing), and
  
• become short of breath.

Additional symptoms may include:

• hair loss,
  
• malaise (general sense of feeling unwell), and
  
• worsening of heart problems.

It is worth noting that if anemia is longstanding (chronic anemia), the body may adjust to low oxygen levels and the individual may not feel different unless the anemia becomes severe. On the other hand, if the anemia occurs rapidly (acute anemia), the patient may experience significant symptoms relatively quickly.

Tonsillitis and Adenoid Infection

What are the tonsils and adenoids?

The tonsils and adenoids are composed of tissues that are similar to the lymph nodes or glands found in the neck or other parts of the body. Together, they are part of a ring of glandular tissue (Waldeyer's ring) encircling the back of the throat.
The tonsils are the two masses of tissue on either side of the back of the throat. Normal tonsils are usually about the same size and have the same pink color as the surrounding area. On their surfaces are little depressions, called crypts, which may appear deep and contain pus pockets or stones.
The adenoids are located high in the throat behind the nose and soft palate (the roof of the mouth) and unlike the tonsils, are not easily visible through the mouth. A tonsillectomy and an adenoidectomy (commonly referred to as a T & A) are surgical procedures performed to remove the tonsils and adenoids.

What is the purpose of the tonsils and adenoids?

The tonsils and adenoids are thought to assist the body in its defense against incoming bacteria and viruses by helping the body form antibodies. However, this function may only be important during the first year of life. There is no evidence to support a significant role of the tonsils and adenoids in immunity. Medical studies have shown that children who have their tonsils and adenoids removed suffer no loss whatsoever in their future immunity to disease or ability to ward off infections.

What are common problems affecting the tonsils and adenoids?

The most common problems occurring with the tonsils and adenoids are recurrent or chronic infections and significant enlargement (hypertrophy).
Acute Tonsillitis
Acute tonsillitis is an infection of the tonsils caused by one of several possible types of bacteria or viruses. Acute tonsillitis is characterized by either the sudden or gradual onset of a sore throat which is usually associated with fever. The patient may stop swallowing saliva, start to drool, complain of ear pain with swallowing, and have bad breath. The surface of the tonsil may be bright red or have a grayish-white coating (exudate). The lymph nodes in the neck may be swollen. Fever can be present.
Strep throat (tonsillitis) is a specific type of infection caused by the streptococcus bacteria. Strep tonsillitis can cause secondary damage to the heart valves (rheumatic fever) and kidneys (glomerulonephritis). It can also lead to a skin rash (scarlet fever), sinusitis, pneumonia, and ear infections.
Acute mononucleosis is caused by the Epstein-Barr virus, and can lead to a very severe throat infection which is characterized by the rapid enlargement of the tonsils, adenoids, and lymph nodes of the neck. It also causes extreme malaise and tiredness. The sore throat and gland swelling can last for one week to a month and does not respond to the usually prescribed antibiotics.
Chronic Tonsillitis
Chronic tonsillitis is a persistent infection of the tonsils. Repeated infections may cause the formation of small pockets (crypts) in the tonsils which harbor bacteria. Frequently, small, foul smelling stones are found within these crypts. These stones (tonsilloliths) may contain high quantities of sulfa. When crushed, they give off the characteristic rotten egg smell which causes bad breath. They may also give a patient the sense of something being caught in the back of the throat.
Peritonsillar Abscess
A peritonsillar abscess is a collection of pus behind the tonsils that pushes one of the tonsils toward the uvula (the prominent soft tissue dangling from the back of the upper throat. It is generally very painful and is associated with decreased ability to open the mouth. If left untreated, the infection can spread deep in the neck causing life-threatening complications and airway obstruction.
Enlargement of (Hypertrophic) Tonsils and Adenoids
Obstruction to breathing by enlarged tonsils and adenoids may cause snoring and disturbed sleep patterns that may lead to sleep pauses or sleep apnea. Other features include frequent awakening from sleep, restless sleep, nightmares, bedwetting, mood changes, excessive sleepiness, and even heart problems. Some orthodontists believe that chronic mouth breathing from large tonsils and adenoids causes improper alignment of the teeth (malocclusion). Chronic enlargement and infection of the adenoids may lead to infection of the air passages around the nose (sinusitis) or nasal drainage/obstruction, and/or may affect the eustachian tube of the ear, leading to chronic ear infections.

How is tonsillitis and adenoid infection treated?

Bacterial infections of the tonsils and adenoids are treated with various antibiotics. Tonsillitis caused by the streptococcus bacteria can lead to serious complications, and must be treated. Often the diagnosis of strep throat is confirmed by a throat culture or rapid-strep tests in the doctors office. Once treatment begins, it is important to take the full course of antibiotics as prescribed because premature discontinuance of therapy can lead to adverse consequences and regrowth of the bacteria. Surgical removal is considered in situations resistant to medical therapy or in frequently recurrent infections.
Viral causes of tonsillitis are often treated with only supportive care (hydration and control of fever). Antibiotics are not effective for viral infection of the tonsils.
A peritonsillar abscess should be drained either by removal of fluid with a needle and syringe (needle aspiration), cutting open with a scalpel (incision), or tonsillectomy. Chronic stones in the tonsil can be removed with a clean finger or with a blunt probe. Massive enlargement of the tonsils and adenoids causing airway obstruction may be treated with a long course of antibiotics, or even a brief course of steroids (cortisone-related medications, such as prednisone and prednisolone).

When should the tonsils and/or adenoids be removed?

Tonsillectomy and adenoidectomy are indicated in persons with repeated or persistent infections, particularly if they interfere with everyday activities. In general, repeated infections in children are defined as six to seven episodes in one year, or four to five episodes in each of two years, or three episodes in each of three years.
A significant episode of tonsillitis is defined by one or more of the following criteria: (1) a temperature greater than 101°F; (2) enlarged or tender neck lymph nodes; (3) pus material coating the tonsils; or (4) a positive strep test.
In adults, the severity, frequency, and hardship associated with repeated infections are considered more important than the absolute number. Chronic infections characterized by bad breath and/or tonsillar stones causing significant disability are also indicators for tonsillectomy.
Tonsillectomy and adenoidectomy are strongly considered in those patients who are suffering, or may suffer serious complications of infection. These include peritonsillar abscess, history of streptococcal complications (rheumatic heart disease, glomerulonephritis), or neck abscess. Suspicion of malignancy or tumor is a definite reason for surgery.
Tonsillectomy and adenoidectomy are also warranted in situations where there is enlargement of the tonsils and adenoids to such an extent that it causes severe sleep problems (snoring and breath holding), sleep apnea, dental abnormalities, and difficulty swallowing. Adenoid enlargement alone, or in combination with tonsillar enlargement, can cause nasal obstruction, recurrent ear infections, or sinusitis. If these conditions are resistant to medical therapy, surgery is indicated.
In should be emphasized that all decisions for or against surgery are dependent upon the individual patient's particular situation. Additional factors, such as tolerance of antibiotics, concurrent medical problems, school achievement/progress, and family preferences are also important in the decision process.

Tonsillitis and Adenoid Infection At A Glance

• Tonsils and adenoids are composed of tissues that are similar to the lymph nodes or glands.
  
• Acute tonsillitis is an infection of the tonsils caused by one of several possible types of bacteria or viruses.
  
• Chronic tonsillitis is a persistent infection of the tonsils and can cause tiny stone formation.
  
• Peritonsillar abscess is a collection of pus behind the tonsils.
  
• Obstruction to breathing by enlarged tonsils and adenoids may cause snoring and disturbed sleep patterns.
  
• Bacterial infections of the tonsils and adenoids are treated with appropriate antibiotics. Viral infections are not.
  
• Tonsillectomy and adenoidectomy are indicated as follows: (1) in persons with repeated or persistent infections; (2) when serious complications of infection occur; and (3) when enlargement of the tonsils and adenoids causes breathing, swallowing, or dental problems.

Alcohol and Teens

How much alcohol do teens use?

Alcohol is the most frequently used drug by teenagers in the United States. About half of junior high and senior high school students drink alcohol on a monthly basis, and 14% of teens have been intoxicated at least once in the past year. Nearly 8% of teens who drink say they drink at least five or more alcoholic drinks in a row (binge drink).

What are the dangerous effects of alcohol use in teens?

Just a few of the many dangerous effects of alcohol use in teens include the following:

• Alcohol decreases teens' ability to pay attention.
• Teens who have experienced alcohol withdrawal tend to have difficulties with memory.
• In contrast to adults, teens tend to abuse alcohol with other substances, usually marijuana.
• Male teens who drink heavily tend to complete fewer years of education compared to male teens who do not.
• The younger a person is when they begin drinking, the more likely they are to develop a problem with alcohol.
• Each year, almost 2,000 people under the age of 21 years die in car crashes in which underage drinking is involved. Alcohol is involved in nearly half of all violent deaths involving teens.
• More than three times the number of eighth-grade girls who drink heavily said they have attempted suicide compared to girls in that grade who do not drink.
• Intoxication is associated with suicide attempts using more lethal methods, and positive blood alcohol levels are often found in people who complete suicide.
• Teens who drink are more likely to engage in sexual activity, have unprotected sex, have sex with a stranger, or be the victim or perpetrator of a sexual assault.
• Excess alcohol use can cause or mask other emotional problems, like anxiety or depression.
• Drinking in excess can lead to the use of other drugs, like marijuana, cocaine, or heroin.

How can parents prevent alcohol use?

Clear communication by parents about the negative effects of alcohol, as well as about their expectations regarding drug use, have been found to significantly decrease alcohol use in teens. Adequate parental supervision has also been found to be a deterrent to alcohol use in youth. Alcohol, and other drug use, has been found to occur most often between the hours of 3 p.m. and 6 p.m., immediately after school and prior to parents' arrival at home from work. Teen participation in extracurricular activities has therefore been revealed to be an important measure in preventing use of alcohol in this age group. Parents can also help educate teens about appropriate coping and stress-management strategies. For example, 15- to 16-year-olds who use religion to cope with stress tend to use drugs significantly less often and have less problems as a result of drinking than their peers who do not use religion to cope.

What are the symptoms and signs of alcohol intoxication?

Signs that indicate a person is intoxicated include the smell of alcohol on their breath or skin, glazed or bloodshot eyes, the person being unusually passive or argumentative, and/or deterioration in the person's appearance or hygiene. Other symptoms of intoxication include flushed skin and memory loss.

What is alcoholism?

As defined by the Diagnostic and Statistical Manual of Mental Disorders, alcoholism (alcohol dependence) is a negative pattern of alcohol use leading to a number of problems, which may include needing more alcohol to get intoxicated (tolerance), difficulties that occur when the effects of alcohol wear off (withdrawal), using more alcohol or for longer time than intended, and other life problems because of the use of alcohol.
Five stages of alcohol and drug use have been identified. The first stage is described as access to alcohol rather than use of alcohol, tobacco, inhalants, or other drugs. In that stage, minimizing the risk factors that make a teenager more vulnerable to using alcohol are an issue. The second stage of alcohol and other drug use ranges from experimentation or occasional use to regular weekly use of alcohol, tobacco, inhalants, or other drugs. The third stage is characterized by youths further increasing the frequency of alcohol use and/or using alcohol and other drugs on a regular basis. This stage may also include the teenager either buying drugs or stealing to get drugs. In the fourth stage of alcohol and drug use, adolescents have established regular usage, have become preoccupied with getting intoxicated ("high") and have developed problems in their social, educational, vocational, or family life as a result of using the substance. The final and most serious fifth stage of alcohol or other drug use is defined by the youth only feeling normal when they are using. During this stage, risk-taking behaviors like stealing, engaging in physical fights, or driving while intoxicated increase, and they become most vulnerable to having suicidal thoughts.

What are the causes and risk factors of teen alcoholism?

Family risk factors for teenagers developing drinking problems include low levels of parent supervision or communication, family conflicts, inconsistent or severe parental discipline, and a family history of alcohol or drug abuse. Individual risk factors include problems managing impulses, emotional instability, thrill-seeking behaviors, and perceiving the risk of using alcohol to be low. Girls who drink, as well as teens who begin drinking prior to 14 years of age and those whose mothers have drinking problems, are more likely to develop alcoholism. Teen risk factors for alcoholism differ a bit between the 14- to 16-year-old and 16- to 18-year-old age groups, in that 16- to 18-year-olds tend to be less likely to drink in excess when they have a close relationship with their mothers.

What are the symptoms of alcohol abuse in teens?

Some of the most common symptoms of alcohol abuse in teenagers include lying, making excuses, breaking curfew, staying in their room, becoming verbally or physically abusive toward others, having items in their possession that are connected to alcohol use (paraphernalia), the smell of alcohol on their breath or body, mood swings, stealing, and changes in friends.

What is the treatment for alcohol intoxication?

Replacing fluids that are lost as a result of the increased urination associated with drinking is often used to treat alcohol intoxication. Doctors frequently use fluids that contain sugars for that purpose.

What is alcohol poisoning?

Alcohol poisoning is the potentially fatal result of drinking excessive amounts of alcohol in a short period of time. It is caused by alcohol slowing down the body's functions (for example, breathing, heart rate, and gag reflex), thereby potentially leading to choking, coma, stopped breathing, stopped heart, and death. Treatment involves getting the person to the hospital immediately so he or she can be closely watched by medical professionals, given oxygen and fluids, and so that other measures can be taken in order to prevent choking, as well as stopped breathing or heartbeat.

What is the treatment for alcoholism?

There are few medications that are considered effective in treating alcoholism. Zofran (ondansetron) has been found to be effective in treating alcoholism in people whose problem drinking began before they were 25 years old. Naltrexone (Trexan, ReVia, or Vivitrol) has also been found effective in managing alcoholism. Naltrexone is the most frequently used medication in treating alcoholism. It decreases the alcoholic's cravings for alcohol by blocking the body's euphoric ("high") response to it. Naltrexone is either taken by mouth on a daily basis or through monthly injections. Disulfiram (Antabuse) is prescribed for about 9% of alcoholics. It decreases the alcoholic's craving for the substance by producing a negative reaction to drinking. Acamprosate (Campral) works by decreasing cravings for alcohol in those who have stopped drinking. However, none of these medications have been specifically approved to treat alcoholism in people less than 18 years of age. Some research indicates that psychiatric medications like lithium and sertraline (Zoloft) may be useful in decreasing alcohol use in teens who have another mental-health disorder in addition to alcohol abuse.
There are numerous individual treatments for alcoholism in teens. Relapse prevention uses methods for recognizing and amending problem behaviors. Individualized drug counseling specifically emphasizes short-term behavioral goals in an attempt to help the individual reduce or stop the use of alcohol altogether. Cognitive therapy techniques, like helping the teen recognize what tends to precede and follow their episodes of alcohol use, are often used to address alcohol abuse in teens. Some treatment programs include drug testing. Twelve-step programs like Alcoholics Anonymous are individualized drug-counseling methods. Motivational enhancement therapy encourages the teen to increase their desire to participate in therapy. Stimulus control refers to a treatment method that teaches the person to stay away from situations that are associated with alcohol use and to replace those situations with activities that are contrary to using drugs. Urge control is an approach to changing patterns that lead to drug use. Social control involves family members and other significant others of the alcoholic in treatment.
While group therapy can be helpful in decreasing alcohol use in teens, groups that include a number of teens who also engage in disordered behaviors can actually tend to increase alcohol use in this age group. Family interventions for alcoholism that tend to be effective for teens include multidimensional family therapy (MDFT), group therapy, and multifamily educational intervention (MFE). MDFT has been found to be quite effective. Longer-term residential treatment of three to five months that addresses peer relationships, educational problems, and family issues is often used in treating alcoholism in teens.
For youth in the first stage of alcohol use (having access, but not having yet used alcohol), preventive measures are used. Therefore, limiting access to alcohol or other drugs, addressing any risk factors of the youth or family, as well as optimal parental supervision and expression regarding expectations are often recommended. The approach to those who have experimented with alcohol should not be minimized by mental-health professionals, since infrequent use can progress to the more serious stages of alcohol use if not addressed. Therefore, professionals recommend that the youth be thoroughly educated about the effects and risks of alcohol, that fair but firm limits be set on the use of alcohol, and that the user be referred for brief counseling, a self-help group, and/or family support group. Teens who have progressed to the more advanced stages of alcoholism are typically treated intensively, using a combination of the medical, individual, and familial interventions already described.