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Friday, March 26, 2010

What Does Pityriasis Rosea Look Like

neurological consequences of PTSD (Post Traumatic Stress Disorder)


PTSD DIAGNOSIS PROTOCOL
By Dr. D ª. Maria Antonia Mengual Azcárate

PART I
BIOLOGICAL TESTS
MARKERS OF FEAR

1. LABORATORY TESTS
2. Neuroimaging
3. ASSESSMENT OF COGNITIVE LOSS (memory and learning)
4. MEASURING THE INCREASE IN SYMPATHETIC ACTIVITY

1. LABORATORY TESTS

A) THYROID TESTS: euthyroid sick syndrome.

B) ASSESSMENT TESTS hypothalamic-pituitary-adrenal

· lability of cortisol: baseline measurement in blood, determination in saliva and / or determination of cortisol in urine for 24 hours. May be low, normal or high in stress or anticipation.

· Test of DXM:
consists of making a baseline measurement of cortisol in the blood. The same day, at 11 pm, take a dose of 0.5 mg. Dexamethasone, and no later than 12 hours, repeat the extraction of blood for cortisol measured again. In PTSD occurs hipersupresión typical of cortisol after DXM (75-80% control).

This test allows for Differential Diagnosis of Depression, in which cortisol levels are always high and not be deleted or HPA axis suppression is minimal.

- normal or increased ACTH
blood - the ACTH response to cortisol injection. After obtaining a baseline measurement of blood cortisol is injected 17.5 mg. cortisol and extraction is repeated at 8, 40, and 95 minutes. PTSD occurs in a large decrease in ACTH after administration of cortisol.
- Catecholamines in blood and / or urine for 24 hours. (Epinephrine, norepinephrine). Are mainly increased noradrenaline.
- Increased DHEA-S in PTSD symptoms, non-depressed subjects and Florida.
- normal or low testosterone.

C) COAGULATION TESTS: Usually

a hypercoagulable state: increased protrombima activity and increased fibrinogen, factor VII, and PAI-1 PCR

D) Laboratory of Immunology:

- Autoantibodies: Thyroid , antiphospholipid (lupus, anticardiolipin), anti-insulin, ANA, ANCA
- Increased inflammatory cytokines: IL-1, IL-6, TNF (tumor necrosis factor)
- Alteration of lymphocyte subsets.

E) OTHER EVENTS:

- Increase in plasma sodium increased reabsorption in the kidney
- Detection of metabolic syndrome: insulin resistance. Elevated triglycerides, increased LDL-cholesterol, low HDL-cholesterol, decreased SHBG ...
- Changes in serum protein.

2.
neuroimaging
- Magnetic Resonance Spectroscopy spectroscopic or: a study of brain metabolites in the areas concerned are: right hippocampus, right lateral amygdala, left prefrontal cortex. (N acetylaspartate, choline, creatine, myo-inositol).

- NAA (N-acetylaspartate): the decline is a sign of neuronal death (Normally irreversible) or axonal injury (often recoverable)
- Hill: increased in cell proliferation (tumors)
- Creatine stable and reliable marker in time, cerebral energy metabolism
- Mio-Inositol: increase in cases of gliosis and reactive astrocytosis.

- Nuclear Magnetic Resonance: morphological and volumetric study of structures involved. Volumetric study of hippocampus (decreased right hippocampus head and body). Right side tonsil hypertrophy and indirect signs such as increased right temporal horn

- SPECT (cerebral blood flow determined by tracing the injected Tc 99. Decrease cerebral flow in the hippocampus and prefrontal cortex left), PET (colored 3D image as gamma radiation intensities emitted by different substances indicating hyper-or hypometabolism), functional studies placing the victim's recollection of the trauma. These techniques, at present, do not seem available in our country, for the study of PTSD.

3. COGNITIVE ASSESSMENT OF LOSS.

memory is lost and limited ability to learn in care, lack of concentration, distracting stimuli minor (cuts of thought).

test can be measured or it can be seen with neuroimaging (Decreased hippocampal volume, hyperactivation of the amygdala, decreased activity of the frontal cortex. All these alterations of the limbic system, which regulates emotions, memory, learning and e).

4. MEASUREMENT OF SYMPATHETIC ACTIVITY INCREASE.

- TA pulse.
- Temperature: hypothermia.
- pupillary dilation (mydriasis). The patient may complain of blurred vision, glare.
- Reaction startle (startle response). Can be measured by electromyographic recording of the muscles of the face to certain stimuli.
- Piloerection.
- frequent appearance muscle spasms, myoclonus. Increased muscle tension.
- Crisis sweating: if there are any in our presence, we see that is not accompanied by facial flushing (vasodilatation) and causes a cooling and pale skin.
- increased muscle development (hyperproteinemia rating.)
- Assessment of skin lesions, due to cutaneous vasoconstriction and / or alt. coagulation. Vasodilation signs of muscle and body fat.
- abdominal distention and decreased bowel peristalsis.
- Increased mental activity.


PART II DISORDER POST-TRAUMATIC STRESS

ME WHAT'S GOING ON?


sagittal Comparison 2004 and 2006 study of right hippocampus

While accepting that the lack of identity in the cutting plane of the two studies, 2004 and 2006, may explain the differences, it seems more than reasonable admit an obvious asymmetry between the two studies (before and after the diagnosis of PTSD).

2006
Axial
striking hypertrophy of the right amygdala on the left (also described as a radiological sign of PTSD). Enlarged right temporal horn and apparent reduction in right hippocampal head and body.

previous Coronal hippocampal head
2006

Coronal level 2006
fingerings
Show thinning right hippocampus on the left.


CONCLUSIONS

• Violence sustained psychological causes brain damage.
• The PTSD is a multisystemic disease that affects the limbic system, the endocrine system, the NSS and the immune system.
· Brain damage is the effect of this violence and does not cause a favor.
• It is possible by biological tests to diagnose PTSD secondary to psychological violence.
• It is possible by biological tests to differentiate PTSD from other disorders (depression, anxiety) and even in the absence of pathology (simulation).
· We need studies to determine whether the changes induced are reversible or not.
• The PTSD secondary to psychological abuse in the workplace should be considered an occupational disease.
· The traumatic life experiences alter brain chemistry. Violence kept causes neurological damage, but the absence of violence, healthy environment, we can help make people smarter and happier.
• There is a lack of knowledge of this disease by society and their health. Is urgently needed updating to avoid re-victimized.
· We should establish multidisciplinary teams for treatment and monitoring of the victims, made up of doctors, psychiatrists, psychologists, lawyers, neurologists, endocrinologists, unions, occupational health, mutual, risk prevention services, psychosocial ...
· ES URGENTE PREVENT VIOLENCE. SUMMARY



The purpose of this paper is to help victims of psychological violence to understand what is happening, their caregivers to deepen the study of the damage it causes and the need for a multidisciplinary approach, to society, to measure the real magnitude of the consequences of this violence, the illusion that if we know the seriousness, maybe try not to look away. A venture researchers in brain chemistry and neuroscience because knowing the effects of violence, we can help prevent and avoid such pain.

Source: http://www.anamib.com/AZCARATE/dcerebral.htm