Dissociative Disorders
In dissociative disorders, one aspect of a person’s psychological makeup is dissociated (separated) from others. A commonality among most people diagnosed with these disorders is their susceptibility to trance states, hypnosis, and suggestibility. Hans Eysenck's research suggests as well that these are more likely to be nervous extraverts.
Dissocative amnesia is the “inability to recall important personal information, usually of a traumatic or stressful nature,” (DSM IV) but more than what we would characterize as ordinary forgetfulness. It is not due, of course, to a physical trauma, drug use, or a medical condition. Instead, it is due to the ability that these people have to focus away from certain memories that disturb them.
It has been increasingly common for people to report having forgotten childhood traumas, especially sexual abuse, while in the care of certain therapists. Recent researchers now believe that the “recovered memories” that these patients report are actually implanted in the minds of these very suggestable people by their over-enthusiastic therapists. It is still not known whether all recovered memories should be suspect or not, although memory research suggests that trauma is more typically remembered well, not poorly.
Fugue is amnesia accompanied by sudden travel away from a person’s usual haunts. Time away can range from a few hours to months. When these people return to normal, they often don’t remember what happened while they were away. A few adopt an entirely new identity while “on the road.”
Dissociative identity disorder -- formerly known as multiple personality -- involves someone developing two or more seperate “identities” that take over the person’s behavior from time to time. The "usual" personality doesn't remember what happens when an alternate personality takes over. Dissociative identity disorder is not the same as schizophrenia, but does have some similarities. In schizophrenia, voices and impulses are seen as coming from outside oneself, while in dissociative identity disorder, they are seen as coming from within, in the form of these alternate personalities.
One of the first cases to reach the public was the story of Eve White. Eve White (a pseudonym, of course), was a mild mannered woman with a domineering husband. She found herself waking up with garish makeup, hangovers, and other signs that she had been out carousing during the night. This alternate personality that took over occasionally was called Eve Black. Eventually, the two personalities were brought together, and Eve's story was made into a movie with actress Joanne Woodward called "The Three Faces of Eve." A second movie was much more popular: "Sybil." This was the true story of a woman who had been severely abused by her schizophrenic mother, and developed (supposedly) 26 personalities.
People with multiple personalities are usually easily hypnotized, making it likely that this disorder may be caused or at least aggravated by therapists, intentionally or unintentionally, much like recovered memories. It is looked upon with skepticism by many psychologists.
On the other hand, it may also be understood as a modern version of a fairly common occurance in the nonwestern, premodern world:
Spirit possession. In cultures where the powers of gods, ghosts, and demons are taken for granted, people sometimes feel possessed by these outside personalities. In more modern societies, lacking the possession explanation, people assume that the alternate personality is internal.
Depersonalization is the “persistent or recurrent feeling of being detached from one’s mental processes or body....” (DSM IV) Often the world seems odd as well, which is called derealization. Physical objects may seem distorted and other people may seem mechanical. Again, these people may be particularly easy to hypnotize, and the feeling can be induced even in normal people under hypnosis. Half of all adults may have experienced a brief episode of depersonalization or derealization in their lifetime, but it is most common in people who have suffered from abuse, the loss of a loved one, or have seen combat. It is also common under the influence of hallucinogens like LSD.
Dissociative trance disorder is an unofficial category often referred to by psychologists and psychiatrists working in premodern, nonwestern societies. Trance is a narrowing of one's attention so that some things (such as sight, movement, or even outer reality) are placed outside awareness. Cross-cultural therapist Richard Castillo, in his book Culture and Mental Illness, says that trance is "an adaptation with great individual and species survival value." It is not far from such non-pathological states as hypnosis and meditation.
Castillo gives numerous examples:
Amok is found in Malaysia and Indonesia. The word comes from the Sanskrit for "no freedom." It involves a person losing their sense of self, grabbing a weapon such as a machete, and running through the village slashing at people. Afterwards, they have no memory of what they have done and are typically excused from any damage, even if their actions resulted in someone's death!
Grisi siknis is found among teenage girls and yound women of the Miskito indians in Nicaragua. They also run wild with machetes, occasionally assaulting people or mutilating themselves. They have no memory of their actions.
Pibloktoq or arctic hysteria is found among polar eskimos. For anywhere from a few minutes to an hour, a person takes off their clothing and runs screaming through the snow and ice, as a response to a sudden fright.
Latah (in Malaysia) involves violent body movements, taking unusual postures, trance dancing, mimicking other people, throwing things, and so on.
"Falling out" (in the Bahamas) involves falling to the ground, apparently comatose, but hearing and understanding what is going on around you.
"Indisposition" (in Haiti) is a possession trance understood as a response to fear.
"Fits" (in India) is a seizure-like response by some women to family stress, curable by exorcism or by simply telling her husband to protect her from her inlaws!
In the west, these kinds of behaviors are often classified as impulse control disorders, along with trichotillomania, compulsive gambling, pyromania, and kleptomania (discussed with anxiety disorders). One of these - intermittent explosive disorder - is basically the same as running amok, and is commonly known as "going postal
Kaposi Sarcoma : Horror of AIDS
Definition of Kaposi's Sarcoma
Kaposi's sarcoma (KS) is a disease in which cancer cells are found in the tissues under the skin or mucous membranes that line the mouth, nose, and anus.
KS causes red or purple patches (lesions) on the skin and/or mucous membranes and spreads to other organs in the body, such as the lungs, liver, or intestinal tract.
KS causes red or purple patches (lesions) on the skin and/or mucous membranes and spreads to other organs in the body, such as the lungs, liver, or intestinal tract.
consists of characteristic skin lesions that range from flat to raised purple plaques. These tumors have a rich network of small blood vessels, and red blood cells moving slowly through these channels lose their oxygen, changing from red to blue. The mixture of red and blue cells gives the KS lesion a characteristic purple color.
There are several forms of KS, based on cause rather than appearance. The "classic" Kaposi's sarcoma, found mainly in Mediterranean males and mid-European Jews, has always been rare. In the 1950s a large number of cases were found in Africa, and the incidence has dramatically increased since then. KS was later found to be a common result of an alteration of body immunity.
There are several forms of KS, based on cause rather than appearance. The "classic" Kaposi's sarcoma, found mainly in Mediterranean males and mid-European Jews, has always been rare. In the 1950s a large number of cases were found in Africa, and the incidence has dramatically increased since then. KS was later found to be a common result of an alteration of body immunity.
There are two circumstances under which this alteration takes place.
The first is when depression of the immune system is part of some treatment, for example in kidney or other organ transplants. To prevent the foreign organ from being rejected, powerful drugs are given to shut down the immune system.
The second circumstance is associated with Acquired Immune Deficiency Syndrome (AIDS).
Types Of Tumors
KS tumors are divided into three groups, based on appearance, with much overlap.
Nodular lesions are of varying size and thickness. They are purple and will at times have a halo of brown or yellow pigment around them.
Infiltrating lesions may be quite large, may be raised, or grow downward beneath the skin.
Lymphatic lesions can mimic other causes of swollen lymph nodes and may require a biopsy to rule out infection.
Under the microscope, all three types of KS appear similar. But three sub-types have been identified, all of which are treated much the same. The spindle cell variety is the slowest growing, the anaplastic is the most aggressive, and the mixed cell has a somewhat intermediate growth rate.
The second circumstance is associated with Acquired Immune Deficiency Syndrome (AIDS).
Types Of Tumors
KS tumors are divided into three groups, based on appearance, with much overlap.
Nodular lesions are of varying size and thickness. They are purple and will at times have a halo of brown or yellow pigment around them.
Infiltrating lesions may be quite large, may be raised, or grow downward beneath the skin.
Lymphatic lesions can mimic other causes of swollen lymph nodes and may require a biopsy to rule out infection.
Under the microscope, all three types of KS appear similar. But three sub-types have been identified, all of which are treated much the same. The spindle cell variety is the slowest growing, the anaplastic is the most aggressive, and the mixed cell has a somewhat intermediate growth rate.
Causes and Risk Factors of Kaposi's Sarcoma
The epidemic KS, occurring as a disease that accompanies AIDS, is thought to have a cause - the virus named HIV (Human Immunodeficiency Virus). If given a blood test for HIV, nearly all patients with epidemic KS will show evidence of being infected.
Various ideas have been advanced to explain how this virus causes KS. One theory is that it causes a normal cell to become malignant either directly or by initiating a chain of events. Various agents that may be involved in such a change have been identified.
Yet another idea has to do with the body's T cells, some of which hunt for malignant cells that have developed spontaneously and kill them off before they can become cancers. The T cell is known to be infected with the virus and cannot kill the malignant cells.
Symptoms of Kaposi's Sarcoma
Various ideas have been advanced to explain how this virus causes KS. One theory is that it causes a normal cell to become malignant either directly or by initiating a chain of events. Various agents that may be involved in such a change have been identified.
Yet another idea has to do with the body's T cells, some of which hunt for malignant cells that have developed spontaneously and kill them off before they can become cancers. The T cell is known to be infected with the virus and cannot kill the malignant cells.
Symptoms of Kaposi's Sarcoma
There are no general symptoms of early KS. In the epidemic form, KS may be the first sign of AIDS, or, the first lesion may follow an illness of months or years. During this time, the patient may have had non-specific symptoms such as fever, weight loss and sweating. Possibly there were other illnesses, such as lymphoma or tuberculosis, before the first KS lesion developed.
Once the disease occurs, symptoms relate to the site of involvement. Early and more advanced skin lesions are usually only mildly uncomfortable, although painful ulcers may occur.
Lesions in the gastrointestinal tract are very common but rarely cause significant symptoms. Early lesions in the lung have no symptoms either, but severe lung involvement produces a profound air hunger.
Treatment of Kaposi's Sarcoma
Once the disease occurs, symptoms relate to the site of involvement. Early and more advanced skin lesions are usually only mildly uncomfortable, although painful ulcers may occur.
Lesions in the gastrointestinal tract are very common but rarely cause significant symptoms. Early lesions in the lung have no symptoms either, but severe lung involvement produces a profound air hunger.
Treatment of Kaposi's Sarcoma
KS is not considered curable. Neither surgical removal of the first-detected lesion nor obtaining a complete remission of multiple sites with chemotherapy or other techniques results in cure. Long-term survival does occur both with or without treatment, however.
Survival in classic KS is usually years and sometimes decades. Some patients with AIDS-related KS are still alive after 10 years, though most survive only a few years and treatment decisions are usually aimed at palliation.
All forms of KS are sensitive to radiation therapy. Radiation is especially useful for lesions that are cosmetically disturbing, painful, involve the mouth extensively, block lymphatics, bleed, or protrude from the skin. Response rates are quite high and treatment is well tolerated.
Chemotherapy can be used in treatment but there is concern that aggressive treatment might further depress the immune system. The disease does respond to chemotherapy, both with single agents and combinations of drugs.
KS is one of the few tumors that responds to local injections of chemotherapy. Many anticancer drugs cause intense local damage if they are accidentally injected into tissue. This undesirable effect has been used in a positive way to treat skin lesions.
Biological therapy involves immunologic treatment of KS primarily with the interferons, mainly alpha. Other agents, especially interleukin-2 are being studied.
Survival in classic KS is usually years and sometimes decades. Some patients with AIDS-related KS are still alive after 10 years, though most survive only a few years and treatment decisions are usually aimed at palliation.
All forms of KS are sensitive to radiation therapy. Radiation is especially useful for lesions that are cosmetically disturbing, painful, involve the mouth extensively, block lymphatics, bleed, or protrude from the skin. Response rates are quite high and treatment is well tolerated.
Chemotherapy can be used in treatment but there is concern that aggressive treatment might further depress the immune system. The disease does respond to chemotherapy, both with single agents and combinations of drugs.
KS is one of the few tumors that responds to local injections of chemotherapy. Many anticancer drugs cause intense local damage if they are accidentally injected into tissue. This undesirable effect has been used in a positive way to treat skin lesions.
Biological therapy involves immunologic treatment of KS primarily with the interferons, mainly alpha. Other agents, especially interleukin-2 are being studied.
Insurance : Need of health insurance for life
A Health insurance policy
is a contract between an insurance company and an individual. The
contract can be renewable annually or monthly. The type and amount of health care costs that will
be covered by the health plan are specified in advance, in the member contract or Evidence of
Coverage booklet. The individual policy-holder's payment obligations may take several forms[4]:
Premium: The amount the policy-holder pays to the health plan each month to purchase health
coverage.
Deductible: The amount that the policy-holder must pay out-of-pocket before the health plan pays
its share. For example, a policy-holder might have to pay a $500 deductible per year, before any of
their health care is covered by the health plan. It may take several doctor's visits or prescription
refills before the policy-holder reaches the deductible and the health plan starts to pay for care.
Copayment: The amount that the policy-holder must pay out of pocket before the health plan pays
for a particular visit or service. For example, a policy-holder might pay a $45 copayment for a
doctor's visit, or to obtain a prescription. A copayment must be paid each time a particular service
is obtained.
Coinsurance: Instead of paying a fixed amount up front (a copayment), the policy-holder must pay a percentage of the total cost. For example, the member might have to pay 20% of the cost of a
surgery, while the health plan pays the other %80. Because there is no upper limit on
coinsurance, the policy-holder can end up owing very little, or a significant amount, depending on
the actual costs of the services they obtain.
Exclusions: Not all services are covered. The policy-holder is generally expected to pay the full cost of non-covered services out of their own pocket. Coverage limits: Some health plans only pay for health care up to a certain dollar amount. The
policy-holder may be expected to pay any charges in excess of the health plan's maximum
payment for a specific service. In addition, some plans have annual or lifetime coverage
maximums. In these cases, the health plan will stop payment when they reach the benefit
maximum, and the policy-holder must pay all remaining costs. Out-of-pocket maximums: Similar to coverage limits, except that in this case, the member's payment obligation ends when they reach the out-of-pocket maximum, and the health plan pays all further covered costs. Out-of-pocket maximums can be limited to a specific benefit category (such as prescription drugs) or can apply to all coverage provided during a specific benefit year.
Prescription drug plans are a form of insurance offered through many employer benefit plans in
the U.S., where the patient pays a copayment and the prescription drug insurance pays the rest.
Some health care providers will agree to bill the insurance company if patients are willing to sign
an agreement that they will be responsible for the amount that the insurance company doesn't
pay, as the insurance company pays according to "reasonable" or "customary" charges, which
may be less than the provider's usual fee.
Health insurance companies also often have a network of providers who agree to accept the
reasonable and customary fee and waive the remainder. It will generally cost the patient less to
use an in-network provider.
Health Insurance companies are now offering Health Incentive accounts (HIA)[5], to reward users
for living healthy and making healthy choices, like stop smoking and/or losing weight, may get you
funds added into your Health Incentive Account, which may lower your out of pocket costs. The
health incentive accounts also carry over from year to year but once you leave the program you
lose those benefits in the HIA.
[edit]
Private: individually purchasedPolicies of health insurance obtained by individuals not otherwise covered under policies or programs elsewhere classified. Generally major medical, short term medical, and student policies. According to the U.S. Census Bureau, about 9% of Americans are covered under health insurance purchased directly.[14] The range of products available is similar to those provided through employers. Average premiums are generally somewhat lower than those for employer-sponsored coverage, but vary by age. Deductibles and other cost-sharing are also higher, on average, and the individual consumer pays the entire premium without benefit of an employer contribution.[21] Many states allow medical underwriting of applicants for individually purchased health insurance by insurance companies.
[edit] Private: long-term care insuranceLong-term care (LTC) insurance is growing in popularity in the U.S. Premiums have remained relatively stable in recent years. However, the coverage is quite expensive, especially when consumers wait until retirement age to purchase it. The average age of new purchasers was 61 in 2005, and has been dropping.
New types of medical plans in the U.S.One approach to addressing increasing premiums, dubbed "consumer driven health care," received a boost in 2003, when President George W. Bush signed into law the Medicare Prescription Drug, Improvement, and Modernization Act. The law created tax-deductible Health Savings Accounts (HSAs). An HSA is a private bank account which is un-taxed and only penalized if spent on non-medical items or services. It must be paired with a high-deductible insurance plan. HSAs enable mostly healthy people to pay less for insurance and bank money for their own health care expenses.[23] HSAs are one form of tax-preferrenced health care spending account. Others include Archer Medical Savings Accounts (MSAs), which have been superseded by the new HSAs (although existing MSAs are grandfathered), Flexible Spending Arrangments (FSAs) and Health Reimbursement Accounts (HRAs). FSAs and HRAs are typically used as part of an employee-benefit plan.[24]
Limited Medical Benefit Plans pay for routine care and do not pay for catastrophic care. As such, they do not provide equivalent financial security to a major medical plan. Annual benefit limits can be as low as $2,000. Lifetime maximums can be very low as well.
is a contract between an insurance company and an individual. The
contract can be renewable annually or monthly. The type and amount of health care costs that will
be covered by the health plan are specified in advance, in the member contract or Evidence of
Coverage booklet. The individual policy-holder's payment obligations may take several forms[4]:
Premium: The amount the policy-holder pays to the health plan each month to purchase health
coverage.
Deductible: The amount that the policy-holder must pay out-of-pocket before the health plan pays
its share. For example, a policy-holder might have to pay a $500 deductible per year, before any of
their health care is covered by the health plan. It may take several doctor's visits or prescription
refills before the policy-holder reaches the deductible and the health plan starts to pay for care.
Copayment: The amount that the policy-holder must pay out of pocket before the health plan pays
for a particular visit or service. For example, a policy-holder might pay a $45 copayment for a
doctor's visit, or to obtain a prescription. A copayment must be paid each time a particular service
is obtained.
Coinsurance: Instead of paying a fixed amount up front (a copayment), the policy-holder must pay a percentage of the total cost. For example, the member might have to pay 20% of the cost of a
surgery, while the health plan pays the other %80. Because there is no upper limit on
coinsurance, the policy-holder can end up owing very little, or a significant amount, depending on
the actual costs of the services they obtain.
Exclusions: Not all services are covered. The policy-holder is generally expected to pay the full cost of non-covered services out of their own pocket. Coverage limits: Some health plans only pay for health care up to a certain dollar amount. The
policy-holder may be expected to pay any charges in excess of the health plan's maximum
payment for a specific service. In addition, some plans have annual or lifetime coverage
maximums. In these cases, the health plan will stop payment when they reach the benefit
maximum, and the policy-holder must pay all remaining costs. Out-of-pocket maximums: Similar to coverage limits, except that in this case, the member's payment obligation ends when they reach the out-of-pocket maximum, and the health plan pays all further covered costs. Out-of-pocket maximums can be limited to a specific benefit category (such as prescription drugs) or can apply to all coverage provided during a specific benefit year.
Prescription drug plans are a form of insurance offered through many employer benefit plans in
the U.S., where the patient pays a copayment and the prescription drug insurance pays the rest.
Some health care providers will agree to bill the insurance company if patients are willing to sign
an agreement that they will be responsible for the amount that the insurance company doesn't
pay, as the insurance company pays according to "reasonable" or "customary" charges, which
may be less than the provider's usual fee.
Health insurance companies also often have a network of providers who agree to accept the
reasonable and customary fee and waive the remainder. It will generally cost the patient less to
use an in-network provider.
Health Insurance companies are now offering Health Incentive accounts (HIA)[5], to reward users
for living healthy and making healthy choices, like stop smoking and/or losing weight, may get you
funds added into your Health Incentive Account, which may lower your out of pocket costs. The
health incentive accounts also carry over from year to year but once you leave the program you
lose those benefits in the HIA.
[edit]
Private: individually purchasedPolicies of health insurance obtained by individuals not otherwise covered under policies or programs elsewhere classified. Generally major medical, short term medical, and student policies. According to the U.S. Census Bureau, about 9% of Americans are covered under health insurance purchased directly.[14] The range of products available is similar to those provided through employers. Average premiums are generally somewhat lower than those for employer-sponsored coverage, but vary by age. Deductibles and other cost-sharing are also higher, on average, and the individual consumer pays the entire premium without benefit of an employer contribution.[21] Many states allow medical underwriting of applicants for individually purchased health insurance by insurance companies.
[edit] Private: long-term care insuranceLong-term care (LTC) insurance is growing in popularity in the U.S. Premiums have remained relatively stable in recent years. However, the coverage is quite expensive, especially when consumers wait until retirement age to purchase it. The average age of new purchasers was 61 in 2005, and has been dropping.
New types of medical plans in the U.S.One approach to addressing increasing premiums, dubbed "consumer driven health care," received a boost in 2003, when President George W. Bush signed into law the Medicare Prescription Drug, Improvement, and Modernization Act. The law created tax-deductible Health Savings Accounts (HSAs). An HSA is a private bank account which is un-taxed and only penalized if spent on non-medical items or services. It must be paired with a high-deductible insurance plan. HSAs enable mostly healthy people to pay less for insurance and bank money for their own health care expenses.[23] HSAs are one form of tax-preferrenced health care spending account. Others include Archer Medical Savings Accounts (MSAs), which have been superseded by the new HSAs (although existing MSAs are grandfathered), Flexible Spending Arrangments (FSAs) and Health Reimbursement Accounts (HRAs). FSAs and HRAs are typically used as part of an employee-benefit plan.[24]
Limited Medical Benefit Plans pay for routine care and do not pay for catastrophic care. As such, they do not provide equivalent financial security to a major medical plan. Annual benefit limits can be as low as $2,000. Lifetime maximums can be very low as well.
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