Drug use in Pregnancy- FDA Categories

In view of such events as the thalidomide crisis in the 1960’s when in-utero exposure lead to Phocomelia, and the teratogenic effects of diethylstilbestrol in 1979 US Food and Drug Administration developed strict guidelines regarding drug labeling, use of medications in pregnancy with safety parameters before it was marketed.
FDA classifies various drugs used in pregnancy into five categories, categories A, B, C, D and X. Category A is considered the safest while category X is absolutely contraindicated in pregnancy.

Pregnancy Category A
Adequate and well-controlled human studies have failed to demonstrate a risk to the fetus in the first trimester of pregnancy (and there is no evidence of risk in later trimesters).

Pregnancy Category B
Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women OR Animal studies have shown an adverse effect, but adequate and well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus in any trimester.
Pregnancy Category C
Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.
Pregnancy Category D
There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.
Pregnancy Category X
Studies in animals or humans have demonstrated fetal abnormalities and/or there is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience, and the risks involved in use of the drug in pregnant women clearly outweigh potential benefits.
Source

Journal Impact Factor

The best evaluation system for the quality of a Journal would involve actually reading all its articles but then the amount of information available is too much, and expanding for this sort of evaluation to carry on.


Here comes the role of Journal Impact Factor.

The Impact factor was devised by Eugene Garfield, the founder of the Institute for Scientific Information, now part of Thomson, a large worldwide US-based publisher.

It is not a perfect tool but is generally considered a good technique for scientific evaluation. For those who have some experience in research publications will know that it is difficult to get an article published in the best of journals, which incidentally also have the highest impact factors.

CALCULATION

The impact factor for a journal is calculated based on a three-year period. It can be viewed as an approximation of the average number of citations in a year, given to those papers in a journal that were published during the two preceding years. For example, the 2003 impact factor for a journal would be calculated as follows:

A = the number of times articles published in 2001-2 were cited in indexed journals during 2003

B = the number of "citable items" (usually articles, reviews, proceedings or notes; not editorials and letters-to-the-Editor) published in 2001-2

2003 impact factor = A/B

(note that the 2003 impact factor was actually published in 2004, because it could not be calculated until all of the 2003 publications had been received.)

A convenient way of thinking about it is that if a journal is cited once for each article published it will have an Impact Factor(IF) of ‘1’ in the expression above.

In the field of psychiatry... Archives of General Psychiatry is the Highest rated in terms of IF. The impact factor of Indian Journal of Psychiatry cannot be calculated as of now as it has been indexed for less than an year.

Sci-Bytes provides ranking and impact factor for selective journals. The list is located here:

http://www.sciencegateway.org/rank/index.html

COGNITIVE BEHAVIOURAL THERAPY

 


Even if you take a pill for every ill, medications can't do everything.

 So the next step is COGNITIVE BEHAVIOURAL THERAPY. Few facts below.

IS IT USEFUL?
CBT is one of the established methods of treatment of mental health problems.
It is one of the most effective treatments for conditions where anxiety or depression is the main problem
It is the most effective psychological treatment for moderate and severe depression
It is as effective as antidepressants for many types of depression


WHERE DOES IT HELP?
It can help people suffering from Anxiety, depression, panic, phobias (including agoraphobia and social phobia), poor stress coping, eating disorders, obsessive compulsive disorder, post-traumatic stress disorder.
Those with anger outbursts, or with a low opinion of self or chronic physical health problems, like pain or fatigue, can also benefit a lot.

HOW DOES IT WORK?

It is a way of talking about:
      How you think about yourself, the world and other people?
      How what you do affects your thoughts and feelings?
CBT can help you to change how you think ("Cognitive") and what you do ("Behaviour)".
These changes can help you to feel better.
There is focus on the "here and now" problems and difficulties instead of focussing on the causes of distress in the past.

Problems can be overwhelming... but by breaking them down into smaller parts... makes it easier to see how they are connected and how they affect you.

In a test situation (e.g.a problem, event or difficult situation), there can follow: Thoughts + Emotions + Physical feelings + Action.

Each of these areas can affect the others.

The key point is How you think about a problem... it can affect how you feel physically and emotionally. It can also alter what you do about it.

AN EXAMPLE
Situation: After a bad day in office, feeling tired, you drag yourself for shopping and while coming back, your neighbour walks by you, apparently, ignores you.
REACTION 1: Unhelpful

• Thoughts: He/she ignored me – it means they don't like me  
• Emotional Feelings: Low, sad and rejected
• Physical: Stomach cramps, low energy, feel sick  
• Action: $##@*@#$, Go home and avoid them

REACTION 2: Helpful

• Thoughts He/she looks a bit wrapped up in themselves - I wonder if there's something wrong?
• Emotional Feelings: Concerned for the other person
• Physical: None - feel comfortable
• Action: Get in touch to make sure they're OK

There are helpful and unhelpful ways of reacting to most situations, depending on how you think about them.
When we are distressed, we are more likely to jump to conclusions and to interpret things in extreme and unhelpful ways.
CBT can help you to break this vicious circle of altered thinking, feelings and behaviour.

When you see the parts of the sequence clearly, you can change them - and so change the way you feel.

CBT aims to get you to a point where you can "do it yourself", and work out your own ways of tackling these problems.

DIFFICULTIES WITH CBT
CBT is not a quick fix. It takes time and effort both from the patient and the therapist.
The therapist advises and encourages - but cannot 'do' it for the patient. If someone is feeling low, it can be difficult to concentrate and get motivated.
To overcome anxiety, it has to be confronted. This may lead you to feel more anxious for a short time.


Smile, it's free therapy

  

Anxiety: Normal to Disorder

What is anxiety? 

• It’s a vague unpleasant emotion that is experienced in anticipation of some future misfortune
• A state of apprehension, uncertainty or fear, resulting from the anticipation of a realistic or imaginary threatening event or situation
• May have emotional, behavioural, cognitive and physical components

Anxiety is commonly experienced by virtually all living beings including humans. It is an alerting signal and warns of threat, both internal and external, and is the first line of defense.
When the body prepares to deal with a threat: blood pressure and heart rate are increased, sweating is increased, blood flow to the muscles is increased, and other functions are inhibited (the fight or flight response) causing what we call the manifestations of anxiety.
It prepares us for the situations, and its consequences. It is beneficial to an individual and is NORMAL.

Anxiety and Performance
An increase in the anxiety to some extent helps a person grow and improve his performance.
In very low level of anxiety, performance is very low, as the anxiety increases the performance increases. A phase comes when performance is at its peak any increase in anxiety does not increase performance. At this stage any anxiety leads to discomfort. Now the anxiety symptoms will appear and any increase will reduce the performance and may lead to deterioration.
The complete absence of anxiety is as pathological as excessive anxiety.

Anxiety Disorders
  When anxiety becomes excessive, and being detrimental rather than adaptive, then it fall's under the classification of an anxiety disorder. There are several specific forms of the disorder as per the current classificatory systems. Some of these are: Agoraphobia, Social phobias, Specific (isolated) phobias, Panic disorder, Generalized anxiety disorder, Mixed anxiety and depressive disorder, Anxiety disorder- unspecified.

Anxiety can also be a symptom of any other underlying medical condition such as mitral valve prolapse, hypoglycemia, pheochomcytoma, hyperthyroidism, hyper parathyroid, cardiac arrhythmias, seizures, chronic obstructive pulmonary disease (COPD), heart failure; or as a part of drug abuse and withdrawls.

Identify the Anxiety Symptoms
  1- Physiological

• Palpitations or thumping of heart.
• Tremors
• Tightness of chest and choking sensation
• Difficulty in breathing
• Hyperventilation
• Sweating
• Dizziness
• Tingling
• Urinary frequency
• Increased motility of GI tract
• Restlessness
• Insomnia
• Pupillary dilatation
• Light headedness

2-Psychological

• Diffuse,vague, unpleasant sense of apprehension, fearfulness,
• Nervousness, irritability
• Inability to relax,
• Poor concentration
• Inability to think clearly
• Derealisation, depersonalization
• Feeling of impending doom / disaster, the perception of danger is very real, as if he or she is about to die or pass out.

“There are more things to alarm us than to harm us, and we suffer more often in apprehension than reality.”

International Day against Drug Abuse and Illicit Trafficking (26 June, 2010)

Health is the theme of this year's world drug campaign, to be launched on International Day against Drug Abuse and Illicit Trafficking (26 June, 2010).

The United Nations Office on Drugs and Crime (UNODC) is leading the international campaign to raise awareness about the major challenge that illicit drugs represent to society as a whole, and especially to the young.

The goal of the campaign "Think health - not drugs" is to mobilize support and to inspire people to act against drug abuse. The campaign encourages young people to put their health first and not to take drugs.

Drugs have the power both to improve and to damage health, depending on the type of drugs used, the quantity consumed and the purpose for which they are taken. For example, while morphine can relieve pain, heroin can be highly addictive. Such examples illustrate the need to control drugs.

Drugs under international control include amphetamine-type stimulants, cannabis, coca/cocaine, hallucinogens, opiates and hypnotic sedatives, all of which have immediate physical effects. While some of the physical effects might sound pleasant, they do not last long. Drugs can also severely hinder psychological and emotional development, particularly in young people. In addition, some users risk addiction.

Drug use is preventable. UNODC has developed prevention activities that provide the public, particularly young people, with the information, skills and opportunities they need to make healthy choices, including the choice to avoid using harmful drugs.

The world drug campaign calls on young people, who are twice as likely as adults to take drugs, to protect their health.

Parents, teachers and other interested individuals can also join the campaign. There are a number of ways to get involved, including providing information, by spreading the word about the campaign and organizing outreach or institutional events to mark International Day against Drug Abuse and Illicit Trafficking on 26 June.

We can all play a role in promoting health in our communities.

Signs of drug use

Although there are certain emotional and physical symptoms of substance use, do not immediately assume that the person is on drugs. There could be other reasons why he or she behaves unusually.

Emotional and social signs
• Moodiness, excitement, anger, hostility, depression
• Constant lying and stealing
• Refusing to admit to the harmful effects of drugs
• Avoiding old friends or people who could confront them about behaviour changes
• Being secretive about phone calls
• Having friends they do not want you to meet or talk about
• Being evasive about their whereabouts
• Loss of motivation
• No interest in everyday life
• Playing truant from school

Physical signs
• Drowsiness
• Trembling
• Red eyes, dilated pupils
• Lack of interest in personal hygiene and appearance
• Slurred speech
• Loss of, or increase in appetite
• Uncoordinated movements
• Circles under the eyes
• Irregular sleeping habits
• Frequent colds and coughs
• Weight loss

(source: www.unodc.org)

The Human Clock: CHRONOBIOLOGY

It seems natural but why in a 24 hours day do we sleep at night and work in day, and why does ‘shit happens’ mostly in the mornings? Our biological routines are mostly time bound…and that too round the clock.
A clock can be defined as an instrument used to indicate, keep, and co-ordinate time. Clocks have advanced from being the sun dials of ancient times to the ultra modern atomic clocks.

But there is another clock, besides the one hanging on the wall… inside our body. It is fitted in our brain. It determines the rhythmicity of our biological routines like being alert in day, sleepy at night. And the study of “biological time” or biological rhythmicity is called Chronobiology.

Among biological rhythms, circadian (in Latin: circa= about; dies= day) rhythms are the most extensively studied. The activity–rest (i.e. wake-sleep) cycle is the most apparent of all circadian rhythms.

There are various less overt phenomena going on inside our body which depend on this clock, such as many hormones are released in a pulasatile manner, heart attacks are more common in early mornings, the blood pressure varies at different times of day- being maximum in evenings, the normal body temperature is maximum in the evenings and lowest in early morning before dawn. The fever of tuberculosis also has an evening rise; the alertness in daytime also varies in between the day, being most alert in the forenoon. Although there can be exceptions… these processes are more or less time bound.

This human ‘clock’ resides in an area of brain- the anterior hypothalamus and is called suprachiasmatic nucleus (SCN) by the scholars. And it does not agree with the wall clock.

The mean circadian period generated by the human clock (or SCN) is approximately 24.18 hours. The wall clock completes an astronomical day/cycle in 24 hrs. So the human watch ticks 10 minutes and 48 seconds too slowly per day. Therefore, a circadian/human clock must be reset on a regular basis to be effective at maintaining the proper phase relationships of behavioral and physiological processes within the context of the 24-hour day. If not done, an individual will gradually come out of synchrony with the astronomical day. In slightly more than 3 months, a normally diurnal human would be in opposite phase to the day–night cycle and thus would become transiently nocturnal i.e. wakeful at night and sleeping in day.
Best wishes for your Time Check.

New Year Resolutions: A Blank Board?

Good resolutions are simply checks that men draw on a bank where they have no account...Oscar Wilde

New Year's is a harmless annual institution, of no particular use to anybody. Along with the provision of nice parties, it has become customary to make a nice wish list also called NEW YEARS RESOLUTIONS. These range from promising to exercise regularly and loose weight, to being honest, be good to others, quit smoking/drinking, work harder, relax more etc. Many will vouch for change in the arriving year but how many of them do actually keep their promise?

The responsibility and capability for change lie within the person. The fact of the matter is that reward/hope of a positive outcome should be ingrained within the act that one is trying to achieve, i.e. the changed state brings pleasure or makes one feel significant. The motive for change should come from within. If external factors are the driving force, it doesnt last too long. The promise for change should be to ourselves and not to the new years! This is simply a slippery seduction. The key element of transformation is a clear and firm decision to change.There is truth to the saying that we can "talk ourselves into" a change. If I say it, and no one has forced me to say it, then I must believe it! And the way to get started is to quit claiming and begin doing.

May all your troubles last as long as your New Year's resolutions!