1. szöveg
Hoarding disorder
The Clinical Problem
Hoarding disorder is a mental disorder that has been newly included in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). The cardinal feature of hoarding disorder is persistent difficulty in discarding or parting with possessions. The diagnosis does not require that the saved items be worthless; valuable items are frequently saved also. Persons with hoarding disorder attribute their difficulties in discarding items to the perceived usefulness or aesthetic value of the items, a strong sentimental attachment to the possessions, the wish to avoid creating waste, or a combination of these factors. A criterion for establishing the diagnosis is that the prospect of discarding or parting with possessions causes substantial distress to the person. In addition, these difficulties result in the disorganized accumulation of possessions that clutter active living areas, substantially compromising their intended use, and cause clinically significant distress or impairment in social, occupational, or other important areas of functioning, including maintaining a safe environment for oneself and others.
Persons with hoarding disorder may not be able to sleep in their bed, sit in their living room, or cook in their kitchen. In severe cases, hoarding can pose a range of health risks, including fire, falling, and poor sanitation. Hoarding can also increase the risk of death from a house fire or from being trapped under a “clutter avalanche.” Quality of life is substantially affected, and family relationships are often considerably strained. Sometimes threats to health and safety extend to neighbors and others living nearby.
Coexisting Conditions
In clinical samples, approximately 75% of persons with hoarding disorder have a concurrent mood or anxiety disorder. Symptoms of attention deficit–hyperactivity disorder, particularly inattention, are also common. These coexisting conditions, rather than the hoarding, are often the main reason for consultation and may contribute to the overall impairment and disability of a person with hoarding disorder, but the symptoms of hoarding disorder are impairing in their own right. Persons with hoarding disorder, particularly older persons, also have worse general health and more medical problems than age-matched controls.
Prevalence and Natural History
Community surveys have estimated the point prevalence of clinically significant hoarding to be approximately 2 to 6% among adults and 2% among adolescents. The course of hoarding is often chronic and progressive, with few persons reporting a waxing and waning course. Hoarding difficulties typically begin early in life (often in the early teenage years) and tend to increase in severity as the person ages. Symptoms often start interfering with the person's everyday functioning by the mid-20s and cause clinically significant impairment by the mid-30s.
Risk Factors
The causes of hoarding disorder are unknown, but it appears to run in families. Studies involving twins suggest that, in adults, approximately 50% of the variance in hoarding behaviors is attributable to genetic factors, with the remaining variation being attributable to nonshared environmental influences. Reports of specific genes predisposing people to hoarding disorder have not been replicated consistently. Persons with hoarding disorder often retrospectively report stressful and traumatic life events preceding the onset or exacerbations of the disorder, but it is uncertain whether these factors are causally related.
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Forrás: http://content.nejm.org/
2. szöveg
- Perhaps the most frightening part of Barrett's esophagus, first of all, is that up to about 25 percent of our patients don't have any symptoms at all. But leading into your question, the most common symptom that we see and what we call, or underlies our constellation of gastroesophageal reflux, or GERD, is heartburn. Interestingly, beyond that there are lots of other symptoms that can manifest solely in GERD, and specifically other GI tract symptoms like nausea, stomach pain, things that we think of as almost being kind of day-to-day nuisances that don't necessarily mean much but can actually mean significant disease. Secondly, we can have lots of symptoms associated with the lungs and the throat, for example, like hoarseness, chronic cough and even asthma-type symptoms that can be the only symptoms associated with GERD and ultimately giving you this Barrett's esophagus.
- So our stomachs are built for acid, right. It's kind of like the car battery is built for acid, and I take it that when the acid comes out the top and gets to the esophagus the lining was not built for acid, is that right?
- Yes, that's correct. The stomach is normally the reservoir where acid is stored, and between the stomach and the esophagus there is a valve which is called the lower sphincter. It's like any other sphincter that we have in the body that normally prevents and it functions to prevent reflux of acid into that area precisely because of what you said. Acid can cause changes in the lining anywhere from inflammation locally to this Barrett's esophagus.
- All right. Let's talk about what affects that sphincter. So I know there's an obesity problem. and I always think that it's the food that is acidic somehow, and that just somehow escapes. But there are foods, chocolate, coffee, is it acid that's at work, or is it doing something to the way our body holds things in the stomach? Help us understand the difference.
We call a lot of these things in the one group called triggers, so things that trigger gastroesophageal reflux disease in general. The first thing we all hear about is the different types of foods, like you said, like the chocolates, the caffeinated beverage, the alcohol, the pasta sauce that we all love. All these things don't directly cause increased acidity by the nature of the food, but instead they each have different chemicals which cause relaxation, inappropriate relaxation of that sphincter we were talking about. So when you have inappropriate relaxation there is at that time reflux per se or acid coming right up into the esophagus when it's not supposed to. The only time we consider relaxation of that sphincter normal, obviously, is when you eat something and we need the sphincter to relax to let the food go through into the stomach. That's the normal physiology. But any of these foods that are at high risk for reflux or heartburn are technically not acidic by nature per se, although some of them may be. They really are working on that sphincter and causing it to inappropriately relax and let the normal acid that's in the stomach come up into the esophagus. To your second point, body habitus or obesity, another aspect to these types of symptoms is anything that would increase the pressure on the abdomen, or the intraabdominal pressure as we call it, which would then cause reflux of acid getting pushed, essentially compressing the stomach and pushing acid back up into the esophagus. We see this with obesity and actually have found a link between obesity and increased reflux and Barrett's esophagus. This is also mimicked, for example, in pregnancy, and that's why a lot of pregnant women experience heartburn.
Forrás: http://www.nmh.org/nm/podcast-heartburn-to-esophageal-cancer