Adult ADHD (attention-deficit/hyperactivity disorder)

Adult ADHD (attention-deficit/hyperactivity disorder)

Definition:

Adult attention-deficit/hyperactivity disorder (adult ADHD) is a mental health condition that causes inattention, hyperactivity and impulsive behavior. Adult ADHD symptoms can lead to a number of problems, including unstable relationships, poor work or school performance, and low self-esteem.

ADHD always starts in early childhood, but in some cases it's not diagnosed until later in life. It was once thought that ADHD was limited to childhood. But symptoms can persist into adulthood. For some people, adult ADHD causes significant problems that improve with treatment.
Treatment for adult ADHD is similar to treatment for childhood ADHD, and includes stimulant drugs or other medications, psychological counseling (psychotherapy) and treatment for any mental health conditions that occur along with adult ADHD.

Symptoms:

ADHD has been called attention-deficit disorder (ADD) and hyperactivity. But attention-deficit/hyperactivity disorder is the preferred term because it describes both primary aspects of the condition: inattention and hyperactive-impulsive behavior.
Adult ADHD symptoms can include:

• Trouble focusing or concentrating
• Restlessness
• Impulsivity
• Difficulty completing tasks
• Disorganization
• Frequent mood swings
• Hot temper
• Trouble coping with stress
• Unstable relationships

Many adults with ADHD aren't aware they have the disorder — they just know that everyday tasks can be a real challenge. Many adults with ADHD find it difficult to focus and prioritize, leading to missed deadlines and forgotten meetings or social engagements. The inability to control impulses can range from impatience waiting in line or driving in traffic to mood swings, outbursts of anger and troubled relationships. Many adults with ADHD have a history of problems at school and at work.
All adults with ADHD had ADHD as children, even if it was never diagnosed. About 1 in 3 people with ADHD grows out of symptoms; about 1 in 3 continues to have symptoms that are less severe as adults; and about 1 in 3 continues to have significant symptoms as adults.

What's normal, and what's ADHD?
At some point in life, virtually everyone has some or all of the symptoms for ADHD. Some people simply have personalities with certain characteristics common with ADHD. But ADHD is diagnosed only when symptoms are severe enough to cause ongoing problems in multiple areas of your life. In adults with ADHD, these persistent and disruptive symptoms can be traced back to early childhood. If your difficulties are recent or occurred only occasionally in the past, you're not considered to have ADHD.
Diagnosis of ADHD in adults can be difficult because certain ADHD symptoms are similar to those caused by other conditions, such as anxiety or mood disorders. To make it even more challenging, half of adults who have ADHD also have at least one other diagnosable mental health condition, such as depression or anxiety.

When to see a doctor
If inattention, hyperactivity or impulsive behavior continually disrupts your life, talk to your doctor about whether you might have ADHD. Because signs of ADHD are similar to those of a number of other mental health conditions, you may not have ADHD — but you may have another condition that needs treatment.

Causes:

While the exact cause of ADHD remains a mystery, it increasingly appears that structural changes in the brain are linked to the disorder. Here are several factors that may play a role in developing ADHD:

• Altered brain function and anatomy. Brain scans have revealed important differences in the structure and brain activity of people with ADHD. For example, people with ADHD appear to have less activity in the area of the brain that controls attention than people who don't have ADHD.
• Inherited traits. ADHD can run in families.
• Maternal smoking, drug use and exposure to toxins. Pregnant women who smoke, drink alcohol or use drugs are at increased risk of having children with ADHD. Likewise, women exposed to environmental poisons during pregnancy — such as polychlorinated biphenyls (PCBs) — may be more likely to have children with symptoms of ADHD.
• Childhood exposure to environmental toxins. Preschool children exposed to certain toxins are at increased risk of developmental and behavioral problems. Exposure to lead, which is found mainly in paint and pipes in older buildings, has been linked to disruptive and even violent behavior and to a short attention span.

Complications:

ADHD has been linked to:

• Poor school performance
• Trouble with the law
• Problems at work
• Alcohol or drug abuse
• Frequent car accidents or other accidents
• Unstable relationships

Although ADHD doesn't cause other psychological or developmental conditions, a number of other disorders frequently occur along with ADHD. These include:

• Mood disorders. Many adults with ADHD also have depression, bipolar disorder or another other mood disorder. While mood problems aren't necessarily due directly to ADHD, a repeated pattern of failures and frustrations due to ADHD can worsen depression.
• Anxiety disorders. Anxiety disorders occur fairly often in adults with ADHD. Anxiety disorder may cause overwhelming worry, nervousness and other symptoms. Anxiety can be made worse by the challenges and setbacks caused by ADHD.
• Personality disorders. Adults with ADHD are at increased risk of personality disorders, such as borderline personality disorder or antisocial personality disorder.

Treatments and drugs:

The best treatment for ADHD is still a matter of debate. Current treatments typically involve medication, psychological counseling or both. A combination of therapy and medication is often the most effective treatment.
Medications
Stimulants (psychostimulants) are the most commonly prescribed medications for ADHD. Stimulants appear to boost and balance levels of brain chemicals called neurotransmitters.
These ADHD medications help treat the core signs and symptoms of inattention and hyperactivity — sometimes dramatically. However, effects of the drugs can wear off quickly, especially if you take a short-acting type rather than a long-acting type of stimulant. The right dose varies between individuals, so it may take some time in the beginning to find the dose that's right for you. Stimulants used to treat ADHD include:

• Methylphenidate (Ritalin, Concerta, Daytrana, Metadate)
• Dextroamphetamine-amphetamine (Adderall)
• Dextroamphetamine (Dexedrine)
• Lisdexamfetamine (Vyvanse)

Stimulant drugs are available in short-acting and long-acting forms.

• The short-acting forms last about four hours, while the long-acting preparations last between six and 12 hours.
• Methylphenidate is available in a long-acting patch that can be worn on the hip (Daytrana). It delivers medication for about nine hours. While the long-lasting effects mean you won't need to take medication as often, it can take up to three hours to start working.

Side effects of stimulants can include insomnia, anorexia, nausea, decreased appetite, weight loss, headache, increased blood pressure, faster pulse, abdominal pain and shifting moods. In some people, stimulants may cause involuntary muscle movements of the face or body (tics). Rarely, they cause seizures, high blood pressure (hypertension), delusions (psychosis) or liver problems. For most people, these medications are considered a safe long-term treatment for adult ADHD. If you have certain conditions, including high blood pressure, heart disease, or problems with alcohol or drug use, your doctor may start your treatment with a nonstimulant medication.
Other medications sometimes used to treat ADHD include:

• Atomoxetine (Strattera)
• Antidepressants such as bupropion (Wellbutrin) and venlafaxine (Effexor)

Atomoxetine and antidepressants work more slowly than stimulants and may take several weeks before they take full effect. These medications may be a good option if you can't take stimulants because of health problems, have a history of substance abuse or have a tic disorder or if stimulants cause severe side effects. Bupropion or venlafaxine may be a good choice if you have a mood disorder along with ADHD.

• Side effects of atomoxetine can include nausea, decreased appetite, insomnia, slightly increased blood pressure and heart rate, decreased sex drive (libido), sweating, and painful urination.
• Side effects of bupropion can include headache, nausea, dry mouth, insomnia, sweating, anxiety and constipation. These side effects may improve as your body adjusts to the medication. In rare cases, bupropion can cause seizures. Bupropion causes fewer sexual side effects than atomoxetine and most other antidepressants. Higher doses of bupropion have been associated with seizures.
• Side effects of venlafaxine and other commonly prescribed antidepressants can include nausea, loose bowel movements, headache and insomnia. These will likely improve as your body adjusts to the medication. For many people the most bothersome side effect is a decrease in sexual desire or ability, which may not improve. High doses of venlafaxine can increase blood pressure.

Psychological counseling
Adults with ADHD often benefit from counseling. Counseling for adult ADHD also generally includes psychological counseling (psychotherapy) and education about the disorder (psychoeducation). Counseling can help you and your family members understand why ADHD occurs, how it affects your life and relationships, and how treatment works.
Psychotherapy for adults with ADHD is often focused on helping develop skills to resolve specific issues. It can help you:

• Improve your time management and organizational skills
• Learn how to reduce your impulsive behavior
• Develop better problem-solving skills
• Cope with past academic and social failures
• Improve your self-esteem
• Learn ways to have better relationships with your family, co-workers and friends
• Develop strategies for controlling your temper

Common types of psychotherapy for ADHD include:

• Cognitive behavioral therapy. This is a structured type of counseling that teaches specific skills to control your behavior and change negative thinking patterns into positive ones. It can be helpful in dealing with specific life challenges, such as school, work or relationship problems, and is also helpful in addressing other mental health conditions such as depression or substance abuse. This type of therapy can be done one-on-one or in a group setting.
• Marital counseling and family therapy. This type of therapy can help loved ones cope with the stress of living with someone who has ADHD and learn what they can do to help. Problems linked to ADHD can put a lot of stress on your relationships. Your spouse or other family members may feel like you're unreliable, messy, a poor listener or not contributing equally to family responsibilities. Understanding that your faults aren't due to not making an effort to change your behavior can relieve tension and help you avoid blaming one another.

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Adjustment disorders

Adjustment disorders

Definition:

Work problems, going away to school, an illness — any number of life changes can cause stress. Most of the time, people adjust to such changes within a few months. But if you continue to feel down or self-destructive, you may have an adjustment disorder.
An adjustment disorder is a type of stress-related mental illness. You may feel anxious or depressed, or even have thoughts of suicide. Your normal daily routines may feel overwhelming. Or you may make reckless decisions. In essence, you have a hard time adjusting to change in your life, and it has serious consequences.
You don't have to tough it out on your own, though. Adjustment disorder treatment — usually brief — is likely to help you regain your emotional footing.

Symptoms:

Adjustment disorders symptoms vary from person to person. The symptoms you have may be very different from those of someone else with an adjustment disorder. But for everyone, symptoms of an adjustment disorder begin within three months of a stressful event in your life.
Emotional symptoms of adjustment disorders
Signs and symptoms of adjustment disorder may affect how you feel and think about yourself or life, including:

• Sadness
• Hopelessness
• Lack of enjoyment
• Crying spells
• Nervousness
• Thoughts of suicide
• Anxiety
• Worry
• Desperation
• Trouble sleeping
• Difficulty concentrating
• Feeling overwhelmed

Behavioral symptoms of adjustment disorders
Signs and symptoms of adjustment disorder may affect your actions or behavior, such as:

• Fighting
• Reckless driving
• Ignoring bills
• Avoiding family or friends
• Performing poorly in school or at work
• Skipping school
• Vandalizing property

Length of symptoms
How long you have symptoms of an adjustment disorder also can vary:

• 6 months or less (acute). In these cases, symptoms may go away on their own, especially if you actively follow self-care measures.
• More than 6 months (chronic). In these cases, symptoms continue to bother you and disrupt your life. Professional treatment can help symptoms improve and prevent the condition from continuing to get worse.

When to see a doctor
Sometimes the stressful change in your life goes away, and your symptoms of adjustment disorder get better on their own. But often, the stressful event remains a part of your life. Or a new stressful situation comes up, and you face the same emotional struggles all over again.
You may think that an adjustment disorder is less serious than other mental health problems because it involves stress, but that's not necessarily true. Adjustment disorders can affect your whole life. You may feel so overwhelmed, stressed and hopeless that you can't go about your normal daily activities. You may skip work or school, for instance, or not pay your bills. You may drive dangerously or pick fights.
Talk to your doctor if you're having trouble getting through each day. You can get treatment to help you cope better with stressful events and feel better about life again.
If you or someone you love has suicidal thoughts, seek help immediately.

Causes:

 People of all ages are affected by adjustment disorders. Among children and teenagers, both boys and girls have about the same chance of having adjustment disorders. Among adults, women are twice as likely to have adjustment disorders. But researchers are still trying to figure out what causes adjustment disorders. As with other mental disorders, the cause is likely complex and may involve genetics, your life experiences, your temperament and even changes in the natural chemicals in the brain.

Complications:

Most adults with adjustment disorder get better within six months and don't have long-term complications. However, people who also have another mental health disorder, a substance abuse problem or a chronic adjustment disorder are more likely to have long-term mental health problems, which may include:

• Depression
• Alcohol and drug addiction
• Suicidal thoughts and behavior

Compared with adults, teenagers with adjustment disorder — especially chronic adjustment disorder marked by behavioral problems — are at significantly increased risk of long-term problems. In addition to depression, substance abuse and suicidal behavior, teenagers with adjustment disorder are at risk of developing psychiatric illnesses such as:

• Schizophrenia
• Bipolar disorder
• Antisocial personality disorder

Treatments and drugs:

 Most people find treatment of adjustment disorder helpful, and they often require treatment only briefly. Others may benefit from longer treatment, though. There are two main types of treatment for adjustment disorder — psychotherapy and medications.

Psychotherapy
The main treatment for adjustment disorders is psychotherapy, also called counseling or talk therapy. You may attend individual therapy, group therapy or family therapy. Therapy can provide emotional support and help you get back to your normal routine. It can also help you learn why the stressful event affected you so much. As you understand more about this connection, you can also learn healthy coping skills. These skills can help you deal with other stressful events that may arise in your life.

Medications
In some cases, medications may help, too. Medications can help with such symptoms as depression, anxiety and suicidal thoughts. Antidepressants and anti-anxiety medications are the medications most often used to treat adjustment disorders. As with therapy, you may need medications only for a few months.

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Attention-deficit/hyperactivity disorder (ADHD) in children

Attention-deficit/hyperactivity disorder (ADHD) in children

Definition:

 Attention-deficit/hyperactivity disorder (ADHD) is a chronic condition that affects millions of children and often persists into adulthood. ADHD includes some combination of problems, such as difficulty sustaining attention, hyperactivity and impulsive behavior. Children with ADHD also may struggle with low self-esteem, troubled relationships and poor performance in school.

While treatment won't cure ADHD, it can help a great deal with symptoms. Treatment typically involves medications and behavioral interventions.
A diagnosis of ADHD can be scary, and symptoms can be a challenge for parents and children alike. However, treatment can make a big difference, and most children with ADHD grow up to be normal adults.

Symptoms:

ADHD has been called attention-deficit disorder (ADD) in the past. But, ADHD is now the preferred term because it describes both primary aspects of the condition: inattention and hyperactive-impulsive behavior.

While many children who have ADHD tend more toward one category than the other, most children have some combination of inattention and hyperactive-impulsive behavior. ADHD symptoms become more apparent during activities that require focused mental effort.
In order to be diagnosed with ADHD, signs and symptoms of the disorder must appear before the age of 7. In some children, signs of ADHD are noticeable as early as 2 or 3 years of age.
Signs and symptoms of inattention may include:

• Often fails to pay close attention to details or makes careless mistakes in schoolwork or other activities
• Often has trouble sustaining attention during tasks or play
• Seems not to listen even when spoken to directly
• Has difficulty following through on instructions and often fails to finish schoolwork, chores or other tasks
• Often has problems organizing tasks or activities
• Avoids or dislikes tasks that require sustained mental effort, such as schoolwork or homework
• Frequently loses needed items, such as books, pencils, toys or tools
• Can be easily distracted
• Often forgetful

Signs and symptoms of hyperactive and impulsive behavior may include:

• Fidgets or squirms frequently
• Often leaves his or her seat in the classroom or in other situations when remaining seated is expected
• Often runs or climbs excessively when it's not appropriate or, if an adolescent, might constantly feel restless
• Frequently has difficulty playing quietly
• Always seems on the go
• Talks excessively
• Blurts out the answers before questions have been completely asked
• Frequently has difficulty waiting for his or her turn
• Often interrupts or intrudes on others' conversations or games

ADHD behaviors can be different in boys and girls:

• Boys are more likely to be primarily hyperactive, whereas girls are more frequently undiagnosed as they tend to be quietly inattentive.
• Girls who have trouble paying attention often daydream, but inattentive boys are more likely to play or fiddle aimlessly.
• Boys tend to be less compliant with teachers and other adults, so their behavior is often more conspicuous.

You may suspect your child's behavior is caused by ADHD if you notice consistently inattentive or hyperactive, impulsive behavior that:

• Lasts more than six months
• Occurs in more than just one setting (typically at home and at school)
• Regularly disrupts school, play and other daily activities
• Causes problems in relationships with adults and other children

Normal behavior vs. ADHD
Most healthy children are inattentive, hyperactive or impulsive at one time or another. For instance, parents may worry that a 3-year-old who can't listen to a story from beginning to end may have ADHD. But it's normal for preschoolers to have short attention spans and be unable to stick with one activity for long. Even in older children and adolescents, attention span often depends on the level of interest. Most teenagers can listen to music or talk to their friends for hours but may be a lot less focused about homework.

The same is true of hyperactivity. Young children are naturally energetic — they often wear their parents out long before they're tired. And they may become even more active when they're tired, hungry, anxious or in a new environment. In addition, some children just naturally have a higher activity level than do others. Children should never be classified as having ADHD just because they're different from their friends or siblings.

Children who have problems in school but get along well at home or with friends are likely struggling with something other than ADHD. The same is true of children who are hyperactive or inattentive at home, but whose schoolwork and friendships remain unaffected.

When to see a doctor
If you're concerned that your child is displaying signs of ADHD, such as trouble concentrating, difficulty sitting still, or an inability to control his or her behavior, see your pediatrician or family doctor. Your doctor may refer you to a specialist, but it's important to have a medical evaluation first to check for other causes of your child's difficulties.

If your child is already being treated for ADHD, he or she should see the doctor regularly — at least every six months if his or her symptoms are stable. Be sure to discuss how often your child should be seen for appointments with his or her doctor.

 Call the doctor if your child has any medication side effects, such as loss of appetite, trouble sleeping or increased irritability. Some children taking stimulant medications may lose their appetite and have difficulty maintaining the same height and weight growth rate. However, they will most likely reach their full growth potential by adulthood.

Causes:


Parents may blame themselves when a child is diagnosed with ADHD, but the causes likely have more to do with inherited traits than parenting choices. At the same time, certain environmental factors may contribute to or worsen a child's behavior. Although there's still a lot that isn't known about ADHD, several factors may cause it:

• Altered brain function and anatomy. While the exact cause of ADHD remains a mystery, brain scans have revealed important differences in the structure and brain activity of people with ADHD. For example, there appears to be less activity in the areas of the brain that control activity levels and attention.
• Heredity. ADHD tends to run in families. Several genes that may be associated with ADHD are currently being studied.
• Maternal smoking, drug use and exposure to toxins. Pregnant women who smoke are at increased risk of having children with ADHD. Alcohol or drug abuse during pregnancy may reduce activity of the nerve cells (neurons) that produce neurotransmitters. Pregnant women who are exposed to environmental poisons also may be more likely to have children with symptoms of ADHD.
• Childhood exposure to environmental toxins. Preschool children exposed to certain toxins are at increased risk of developmental and behavioral problems. Exposure to lead, which is found mainly in paint and pipes in older buildings, has been linked to disruptive and even violent behavior and to a short attention span.
• Food additives. Substances added to food, such as artificial coloring or food preservatives, may contribute to hyperactive behavior. Although sugar is a popular suspect in causing hyperactivity, there's no reliable proof of this.

Complications:


ADHD can make life difficult for children. Children with ADHD:

• Often struggle in the classroom, which can lead to academic failure and judgment by other children and adults
• Tend to have more accidents and injuries of all kinds than do children who don't have the disorder
• Are more likely to have trouble interacting with peers and adults
• Are at increased risk of alcohol and drug abuse and other delinquent behavior

Coexisting conditions
ADHD doesn't cause other psychological or developmental problems. However, children with ADHD are more likely than are other children to also have conditions such as:

• Oppositional defiant disorder (ODD). This condition is generally defined as a pattern of negative, defiant and hostile behavior toward authority figures.
• Conduct disorder. A more serious condition than ODD, conduct disorder is marked by antisocial behavior such as stealing, fighting, destroying property and harming people or animals.
• Depression and bipolar disorder. Depression frequently occurs in children with ADHD. Some children may have bipolar disorder, which includes depression as well as manic behavior.
• Anxiety disorders. Anxiety disorders tend to occur fairly often in children with ADHD and may cause overwhelming worry, nervousness and worsening of ADHD symptoms. Once anxiety is treated and under control, children are better able to deal with the symptoms of ADHD.
• Learning disabilities. Learning disabilities are common in children with ADHD. However, gifted learners also may have ADHD. Children with both ADHD and learning disabilities may need extra attention in the classroom or special education services.
• Tourette syndrome. Many children with ADHD also have Tourette syndrome, a neurological disorder characterized by compulsive muscle or vocal tics.

Treatments and drugs:


Standard treatments for ADHD in children include medications and counseling. Other treatments to ease the effects of ADHD symptoms include special accommodations in the classroom, and family and community support.
Medications
Currently, stimulant drugs (psychostimulants) and the nonstimulant medication atomoxetine (Strattera) are the most commonly prescribed medications for treating ADHD.
Stimulant medications for ADHD include:

• Methylphenidate (Ritalin, Concerta, Daytrana)
• Dextroamphetamine-amphetamine (Adderall)
• Dextroamphetamine (Dexedrine, Dextrostat)

Stimulants appear to boost and balance levels of brain chemicals called neurotransmitters. These ADHD medications help improve the core signs and symptoms of inattention, impulsivity and hyperactivity — sometimes dramatically. However, these medications only work for a limited time. Additionally, the right dose varies from child to child, so it may take some time in the beginning to find the correct dose.
Stimulant drugs are available in short-acting and long-acting forms.

• The short-acting forms last about four hours, while the long-acting preparations usually last between six and 12 hours.
• Methylphenidate is available in a long-acting patch that can be worn on the hip (Daytrana). It delivers medication for about nine hours. While the long-lasting effects mean your child won't need to take medication as often, it can take up to three hours to start working. For it to work in the morning, the patch may need to be put in place early while your child is still asleep.

Stimulant medication side effects
The most common side effects of stimulant medications in children include:

• Decreased appetite
• Weight loss
• Problems sleeping
• Irritability as the effect of the medication tapers off

A few children may develop jerky muscle movements, such as grimaces or twitches (tics), but these usually disappear when the dose of medication is lowered. Stimulant medications may also be associated with a slightly reduced growth rate in children, although in most cases growth isn't permanently affected.

ADHD medications and heart problems
Although rare, several heart-related deaths occurred in children and adolescents taking stimulant medications. The increased risk of sudden death is believed to be in people who already have underlying heart disease or a heart defect. Your child's doctor will make sure your child doesn't have any signs of a heart condition, and will ask about family risk factors for heart disease before prescribing a stimulant medication.

Nonstimulant medication
Atomoxetine is generally given to children with ADHD when stimulant medications aren't effective or cause side effects. In addition to reducing ADHD symptoms, atomoxetine may also reduce anxiety. Given one or two times a day, atomoxetine side effects can include nausea and sedation. It can also cause reduced appetite and weight loss.

Nonstimulant medication side effects
Atomoxetine has been linked to rare side effects that include liver problems. If your child is taking atomoxetine and develops yellow skin (jaundice), dark-colored urine or unexplained flu symptoms, contact the doctor right away.
There may also be a slightly increased risk of suicidal thinking in children and adolescents taking atomoxetine. Contact your child's doctor if you notice any signs of suicidal thinking or other signs of depression.

Other medications used to treat ADHD include:

• Antidepressants. These medications are generally used in children who don't respond to stimulants or atomoxetine, or who have a mood disorder as well as ADHD.
• Clonidine (Catapres) and guanfacine (Intuniv, Tenex). These are high blood pressure medications shown to help with ADHD symptoms. They may be prescribed to reduce tics or insomnia caused by other ADHD medications, or to treat aggression caused by ADHD.

Giving medications safely
Making sure your child takes the right amount of the prescribed medication is very important. Parents may be concerned about stimulants and the risk of abuse and addiction. Dependence hasn't been shown in children who take these drugs for appropriate reasons and at the proper dose. That's because medication levels in the brain rise too slowly to produce a "high." On the other hand, there's concern that siblings and classmates of children and teenagers with ADHD might abuse stimulant medications. To keep your child's medications safe and to make sure your child is getting the right dose of medication at the right time:

• Administer medications carefully. Children and teens shouldn't be in charge of their own ADHD medication.
• At home, keep medication locked in a childproof container. An overdose of stimulant drugs is serious and potentially fatal.
• Don't send supplies of medication to school with your child. Deliver any medicine yourself to the school nurse or health office.

ADHD counseling and therapy
Children with ADHD often benefit from behavior therapy or counseling, which may be provided by a psychiatrist, psychologist, social worker or other mental health care professional. Some children with ADHD may also have other conditions such as anxiety disorder or depression. In these cases, counseling may help both ADHD and the coexisting problem.
Counseling types include:

• Behavior therapy. Teachers and parents can learn behavior-changing strategies for dealing with difficult situations. These strategies may include token reward systems and timeouts.
• Psychotherapy. This allows older children with ADHD to talk about issues that bother them, explore negative behavioral patterns and learn ways to deal with their symptoms.
• Parenting skills training. This can help parents develop ways to understand and guide their child's behavior
• Family therapy. Family therapy can help parents and siblings deal with the stress of living with someone who has ADHD.
• Social skills training. This can help children learn appropriate social behaviors.
• Support groups. Support groups can offer children with ADHD and their parents a network of social support, information and education.

The best results usually occur when a team approach is used, with teachers, parents, and therapists or physicians working together. You can help by making every effort to work with your child's teachers and by referring them to reliable sources of information to support their efforts in the classroom.
Symptoms often lessen with age. However, most people never completely outgrow their ADHD symptoms.

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Adenomyosis

Adenomyosis

Definition:

Adenomyosis (ad-uh-no-my-O-sis) occurs when endometrial tissue, which normally lines the uterus, exists within and grows into the muscular wall of the uterus. This happens most often late in your childbearing years after having children.

Adenomyosis differs from endometriosis — a condition in which the uterine lining becomes implanted outside the uterus — although women with adenomyosis often also have endometriosis. The cause of adenomyosis remains unknown, but the disease typically disappears after menopause. For women who experience severe discomfort from adenomyosis, certain treatments can help, but hysterectomy is the only cure.

Symptoms:

Sometimes, adenomyosis is silent — causing no signs or symptoms — or only mildly uncomfortable. In other cases, adenomyosis may cause:

• Heavy or prolonged menstrual bleeding
• Severe cramping or sharp, knife-like pelvic pain during menstruation (dysmenorrhea)
• Menstrual cramps that last throughout your period and worsen as you get older
• Pain during intercourse
• Bleeding between periods
• Passing blood clots during your period

Your uterus may double or triple in size. Although you might not know if your uterus is enlarged, you may notice that your lower abdomen seems bigger or feels tender.
When to see a doctor
If you experience any signs or symptoms of adenomyosis, such as prolonged, heavy bleeding during your periods or severe cramping, and they interfere with regular activities, make an appointment to see your doctor.

Causes:


The cause of adenomyosis isn't known. Expert theories about a possible cause include:

• Invasive tissue growth. Some experts believe that adenomyosis results from the direct invasion of endometrial cells from the surface of the uterus into the muscle that forms the uterine walls. Uterine incisions made during an operation such as a cesarean section (C-section) may promote the direct invasion of the endometrial cells into the wall of the uterus.
• Developmental origins. Other experts speculate that adenomyosis originates within the uterine muscle from endometrial tissue deposited there when the uterus first formed in the female fetus.
• Uterine inflammation related to childbirth. Another theory suggests a link between adenomyosis and childbirth. An inflammation of the uterine lining during the postpartum period might cause a break in the normal boundary of cells that line the uterus.
• Stem cell origins. A recent theory proposes that bone marrow stem cells may invade the uterine muscle, causing adenomyosis.

Regardless of how adenomyosis develops, its growth depends on the circulating estrogen in a woman's body. When estrogen production decreases at menopause, adenomyosis eventually goes away.

Complications:


Although not harmful, the pain and excessive bleeding associated with adenomyosis can have a negative effect on your lifestyle. You may find yourself avoiding activities that you previously enjoyed because you have no idea when or where you might start bleeding. Painful periods can cause you to miss work or school and can strain relationships. Recurring pain can lead to depression, irritability, anxiety, anger and feelings of helplessness. That's why it's important to seek medical evaluation if you suspect you may have adenomyosis.
If you experience prolonged, heavy bleeding, chronic anemia may result.

Treatments and drugs:


Adenomyosis usually goes away after menopause, so treatment may depend on how close you are to that stage of life.
Treatment options for adenomyosis include:

• Anti-inflammatory drugs. If you're nearing menopause, your doctor may have you try anti-inflammatory medications, such as ibuprofen (Advil, Motrin IB, others), to control the pain. By starting an anti-inflammatory medicine two to three days before your period begins and continuing to take it during your period, you can reduce menstrual blood flow and help relieve pain.
• Hormone medications. Controlling your menstrual cycle through combined estrogen-progestin oral contraceptives or through hormone-containing patches or vaginal rings may lessen the heavy bleeding and pain associated with adenomyosis. Progestin-only contraception, such as an intrauterine device containing progestin or a continuous-use birth control pill, often leads to amenorrhea — the absence of your menstrual periods — which may provide relief.
• Hysterectomy. If your pain is severe and menopause is years away, your doctor may suggest surgery to remove your uterus (hysterectomy). Removing your ovaries isn't necessary to control adenomyosis.

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Addison's disease

Addison's disease

Definition:

Addison's disease is a disorder that occurs when your body produces insufficient amounts of certain hormones produced by your adrenal glands. In Addison's disease, your adrenal glands produce too little cortisol and often insufficient levels of aldosterone as well.
Also called adrenal insufficiency, Addison's disease occurs in all age groups and affects both sexes. Addison's disease can be life-threatening.
Treatment for Addison's disease involves taking hormones to replace the insufficient amounts being made by your adrenal glands, in order to mimic the beneficial effects produced by your naturally made hormones.

Symptoms:

Addison's disease symptoms usually develop slowly, often over several months, and may include:

• Muscle weakness and fatigue
• Weight loss and decreased appetite
• Darkening of your skin (hyperpigmentation)
• Low blood pressure, even fainting
• Salt craving
• Low blood sugar (hypoglycemia)
• Nausea, diarrhea or vomiting
• Muscle or joint pains
• Irritability
• Depression
• Body hair loss or sexual dysfunction in women

Acute adrenal failure (addisonian crisis)
Sometimes, however, the signs and symptoms of Addison's disease may appear suddenly. In acute adrenal failure (addisonian crisis), the signs and symptoms may also include:

• Pain in your lower back, abdomen or legs
• Severe vomiting and diarrhea, leading to dehydration
• Low blood pressure
• Loss of consciousness
• High potassium (hyperkalemia)

Causes:


Addison's disease results when your adrenal glands are damaged, producing insufficient amounts of the hormone cortisol and often aldosterone as well. These glands are located just above your kidneys. As part of your endocrine system, they produce hormones that give instructions to virtually every organ and tissue in your body.

Your adrenal glands are composed of two sections. The interior (medulla) produces adrenaline-like hormones. The outer layer (cortex) produces a group of hormones called corticosteroids, which include glucocorticoids, mineralocorticoids and male sex hormones (androgens).
Some of the hormones the cortex produces are essential for life — the glucocorticoids and the mineralocorticoids.

• Glucocorticoids. These hormones, which include cortisol, influence your body's ability to convert food fuels into energy, play a role in your immune system's inflammatory response and help your body respond to stress.
• Mineralocorticoids. These hormones, which include aldosterone, maintain your body's balance of sodium and potassium to keep your blood pressure normal.
• Androgens. These male sex hormones are produced in small amounts by the adrenal glands in both men and women. They cause sexual development in men and influence muscle mass, libido and a sense of well-being in both men and women.

Primary adrenal insufficiency
Addison's disease occurs when the cortex is damaged and doesn't produce its hormones in adequate quantities. Doctors refer to the condition involving damage to the adrenal glands as primary adrenal insufficiency.
The failure of your adrenal glands to produce adrenocortical hormones is most commonly the result of the body attacking itself (autoimmune disease). For unknown reasons, your immune system views the adrenal cortex as foreign, something to attack and destroy.
Other causes of adrenal gland failure may include:

• Tuberculosis
• Other infections of the adrenal glands
• Spread of cancer to the adrenal glands
• Bleeding into the adrenal glands

Secondary adrenal insufficiency
Adrenal insufficiency can also occur if your pituitary gland is diseased. The pituitary gland makes a hormone called adrenocorticotropic hormone (ACTH), which stimulates the adrenal cortex to produce its hormones. Inadequate production of ACTH can lead to insufficient production of hormones normally produced by your adrenal glands, even though your adrenal glands aren't damaged. Doctors call this condition secondary adrenal insufficiency.
Another more common cause of secondary adrenal insufficiency occurs when people who take corticosteroids for treatment of chronic conditions, such as asthma or arthritis, abruptly stop taking the corticosteroids.
Addisonian crisis
If you have untreated Addison's disease, an addisonian crisis may be provoked by physical stress, such as an injury, infection or illness.

Treatments and drugs:

All treatment for Addison's disease involves hormone replacement therapy to correct the levels of steroid hormones your body isn't producing. Some options for treatment include:

• Oral corticosteroids. Your doctor may prescribe fludrocortisone to replace aldosterone. Hydrocortisone (Cortef), prednisone or cortisone acetate may be used to replace cortisol.
• Corticosteroid injections. If you're ill with vomiting and can't retain oral medications, injections may be needed.
• Androgen replacement therapy. To treat androgen deficiency in women, dehydroepiandrosterone can be prescribed. Some studies suggest that this therapy may improve overall sense of well-being, libido and sexual satisfaction.

An ample amount of sodium is recommended, especially during heavy exercise, when the weather is hot, or if you have gastrointestinal upsets, such as diarrhea. Your doctor will also suggest a temporary increase in your dosage if you're facing a stressful situation, such as an operation, an infection or a minor illness.
Addisonian crisis
An addisonian crisis is a life-threatening situation that results in low blood pressure, low blood levels of sugar and high blood levels of potassium. This situation requires immediate medical care. Treatment typically includes intravenous injections of:

• Hydrocortisone
• Saline solution
• Sugar (dextrose)

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Acute sinusitis

Acute sinusitis

Definition:

Acute sinusitis (acute rhinosinusitis) causes the cavities around your nasal passages (sinuses) to become inflamed and swollen. This interferes with drainage and causes mucus to build up.
With acute sinusitis, it may be difficult to breathe through your nose. The area around your eyes and face may feel swollen, and you may have throbbing facial pain or a headache.
Acute sinusitis is most often caused by the common cold. Other triggers include bacteria, allergies and fungal infections. Treatment of acute sinusitis depends on the cause. In most cases, home remedies are all that's needed. However, persistent sinusitis can lead to serious infections and other complications. Sinusitis that lasts more than 12 weeks, or keeps coming back, is called chronic sinusitis.

Symptoms:

Acute sinusitis symptoms often include:

• Drainage of a thick, yellow or greenish discharge from the nose or down the back of the throat
• Nasal obstruction or congestion, causing difficulty breathing through your nose
• Pain, tenderness, swelling and pressure around your eyes, cheeks, nose or forehead
• Aching in your upper jaw and teeth
• Reduced sense of smell and taste
• Cough, which may be worse at night

Other signs and symptoms can include:

• Ear pain
• Headache
• Sore throat
• Bad breath (halitosis)
• Fatigue
• Fever

When to see a doctor
If you have mild symptoms of sinusitis, try self-care.
Contact your doctor if you have any of the following:

• Symptoms that don't improve within a few days or symptoms that get worse
• A persistent fever
• A history of recurrent or chronic sinusitis

See a doctor immediately if you have signs or symptoms that may indicate a serious infection:

• Pain or swelling around your eyes
• Swollen forehead
• Severe headache
• Confusion
• Double vision or other vision changes
• Stiff neck
• Shortness of breath

Causes:

When you have sinusitis, the mucous membranes of your nose, sinuses and throat (upper respiratory tract) become inflamed. Swelling obstructs the sinus openings and prevents mucus from draining normally, causing facial pain and other sinusitis symptoms.
Blocked sinuses create a moist environment that makes it easier for infection to take hold. Sinuses that become infected and can't drain become pus filled, leading to symptoms such as thick, yellow or greenish discharge and other symptoms of infection.
Acute sinusitis can be caused by:

• Viral infection. Most cases of acute sinusitis are caused by the common cold.
• Bacterial infection. When an upper respiratory tract infection persists longer than seven to 10 days, it's more likely to be caused by a bacterial infection than by a viral infection.
• Fungal infection. You're at increased risk of a fungal infection if you have sinus abnormalities or a weakened immune system.

Some health conditions can increase your risk of getting a sinus infection that causes sinusitis, or can increase your risk of getting sinusitis that isn't caused by an underlying infection. These conditions include:

• Allergies such as hay fever. Inflammation that occurs with allergies may block your sinuses.
• Nasal polyps or tumors. These tissue growths may block the nasal passages or sinuses.
• Deviated nasal septum. A crooked septum — the wall between the nostrils — may restrict or block sinus passages.
• Tooth infection. A small number of cases of acute sinusitis are caused by an infected tooth.
• Enlarged or infected adenoids in children. Adenoids are located in the upper back part of the throat.
• Other medical conditions. The complications of cystic fibrosis, gastroesophageal reflux disease (GERD) or immune system disorders may result in blocked sinuses or an increased risk of infection. 

Complications:

Acute sinusitis complications include:

• Asthma flare-ups. Acute sinusitis can trigger an asthma attack.
• Chronic sinusitis. Acute sinusitis may be a flare-up of a long-term problem known as chronic sinusitis. Chronic sinusitis is sinusitis that lasts longer than 12 weeks.
• Meningitis. This occurs when infection spreads to the lining of the brain.
• Vision problems. If infection spreads to your eye socket, it can cause reduced vision or even blindness. This is a medical emergency that requires immediate treatment to prevent potentially permanent damage.
• Ear infection. Acute sinusitis may occur along with an ear infection.

Treatments and drugs:
 
Most cases of acute sinusitis don't need treatment because they are caused by viruses that cause the common cold. Self-care techniques are usually the only treatment needed to speed recovery and ease symptoms.
Treatments to relieve symptoms
Your doctor may recommend treatments to help relieve sinusitis symptoms, including:

• Saline nasal spray, which you spray into your nose several times a day to rinse your nasal passages.
• Nasal corticosteroids. These nasal sprays help prevent and treat inflammation. Examples include fluticasone (Flonase), mometasone (Nasonex), budesonide (Rhinocort Aqua), triamcinolone (Nasacort AQ) and beclomethasone (Beconase AQ).
• Decongestants. These medications are available in over-the-counter (OTC) and prescription liquids, tablets and nasal sprays. OTC oral decongestants include Sudafed, Actifed and Drixoral. Nasal sprays include phenylephrine (Neo-Synephrine, others) and oxymetazoline (Afrin, others). These medications are generally taken for only a few days at most. Otherwise they can cause the return of more severe congestion (rebound congestion).
• Over-the-counter pain relievers such as aspirin, acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others). Aspirin has been linked with Reye's syndrome, so use caution when giving aspirin to children or teenagers. Though aspirin is approved for use in children older than age 2, children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. Talk to your doctor if you have concerns.

Antibiotics
Antibiotics usually aren't needed to treat acute sinusitis.

• Antibiotics won't help when acute sinusitis is caused by a viral or fungal infection.
• Most cases of bacterial sinusitis improve without antibiotics.
• Antibiotic treatment is generally needed only if you have a bacterial infection, especially if the infection is severe, recurrent or persistent.

Antibiotics used to treat acute sinusitis caused by a bacterial infection include amoxicillin (Amoxil, Trimox, others), doxycycline (Doryx, Monodox, others) or the combination drug trimethoprim-sulfamethoxazole (Bactrim, Septra, others). If the infection doesn't go away or if the sinusitis comes back, your doctor may try a different antibiotic.
If your doctor does prescribe antibiotics, it's critical to take the entire course of medication. Generally, this means you'll need to take them for 10 to 14 days — even after your symptoms get better. If you stop taking them early, your symptoms may come back.
Antifungal medications
Rarely, acute sinusitis is caused by a fungal infection, which can be treated with antifungal medication. The dose of medication — as well as how long you'll need to take it — depends on the severity of your infection and how quickly your symptoms improve.
Immunotherapy
If allergies are contributing to your sinusitis, allergy shots (immunotherapy) that help reduce the body's reaction to specific allergens may help treat your symptoms.

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Acute myelogenous leukemia (AML)

Acute myelogenous leukemia (AML)

Definition:

Acute myelogenous leukemia (AML) is a cancer of the blood and bone marrow — the spongy tissue inside bones where blood cells are made.
The word "acute" in acute myelogenous leukemia denotes the disease's rapid progression. It's called myelogenous (my-uh-LOHJ-uh-nus) leukemia because it affects a group of white blood cells called the myeloid cells, which normally develop into the various types of mature blood cells, such as red blood cells, white blood cells and platelets.
Acute myelogenous leukemia is also known as acute myeloid leukemia, acute myeloblastic leukemia, acute granulocytic leukemia and acute nonlymphocytic leukemia.

Symptoms:

General signs and symptoms of the early stages of acute myelogenous leukemia may mimic those of the flu or other common diseases. Signs and symptoms may vary based on the type of blood cell affected. Signs and symptoms of acute myelogenous leukemia include:

• Fever
• Bone pain
• Lethargy and fatigue
• Shortness of breath
• Pale skin
• Frequent infections
• Easy bruising
• Unusual bleeding, such as frequent nosebleeds and bleeding from the gums

When to see a doctor
Make an appointment with a doctor if you develop any signs or symptoms that seem unusual or that worry you.

Causes:

Acute myelogenous leukemia is caused by damage to the DNA of developing cells in your bone marrow. When this happens, blood cell production goes awry. The bone marrow produces immature cells that develop into leukemic white blood cells called myeloblasts. These abnormal cells are unable to function properly, and they can build up and crowd out healthy cells.
In most cases, it's not clear what causes the DNA mutations that lead to leukemia. Radiation, exposure to certain chemicals and some chemotherapy drugs are known risk factors for acute myelogenous leukemia.

Treatments and drugs:

 Treatment of acute myelogenous leukemia depends on several factors, including the subtype of the disease, your age, your overall health and your preferences. In general, treatment falls into two phases:

• Remission induction therapy. The purpose of the first phase of treatment is to kill the leukemia cells in your blood and bone marrow. However, remission induction usually doesn't wipe out all of the leukemia cells, so you need further treatment to prevent the disease from returning.
• Consolidation therapy. Also called post-remission therapy, maintenance therapy or intensification, this phase of treatment is aimed at destroying the remaining leukemia cells. It's considered crucial to decreasing the risk of relapse.

Therapies used in these phases include:

• Chemotherapy. Chemotherapy is the major form of remission induction therapy, though it can also be used for consolidation therapy. Chemotherapy uses chemicals to kill cancer cells in your body. People with AML generally stay in the hospital during chemotherapy treatments because the drugs destroy many normal blood cells in the process of killing leukemia cells. If the first cycle of chemotherapy doesn't cause remission, it can be repeated.
• Other drug therapy. Arsenic trioxide (Trisenox) and all-trans retinoic acid (ATRA) are anti-cancer drugs that can be used alone or in combination with chemotherapy for remission induction of a certain subtype of AML called promyelocytic leukemia. These drugs cause leukemia cells with a specific gene mutation to mature and die, or to stop dividing.
• Stem cell transplant. Stem cell transplant, also called bone marrow transplant, may be used for consolidation therapy. Stem cell transplant helps re-establish healthy stem cells by replacing unhealthy bone marrow with leukemia-free stem cells that will regenerate healthy bone marrow. Prior to a stem cell transplant, you receive very high doses of chemotherapy or radiation therapy to destroy your leukemia-producing bone marrow. Then you receive infusions of stem cells from a compatible donor (allogeneic transplant). You can also receive your own stem cells (autologous transplant) if you were previously in remission and had your healthy stem cells removed and stored for a future transplant.
• Clinical trials. Some people with leukemia choose to enroll in clinical trials to try experimental treatments or new combinations of known therapies.

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Acute lymphocytic leukemia

Acute lymphocytic leukemia

Definition:

Acute lymphocytic leukemia (ALL) is a type of cancer of the blood and bone marrow — the spongy tissue inside bones where blood cells are made.
The word "acute" in acute lymphocytic leukemia comes from the fact that the disease progresses rapidly and creates immature blood cells, rather than mature ones. The "lymphocytic" in acute lymphocytic leukemia refers to the white blood cells called lymphocytes, which ALL affects. Acute lymphocytic leukemia is also known as acute lymphoblastic leukemia.
Acute lymphocytic leukemia is the most common type of cancer in children, and treatments result in a good chance for a cure. Acute lymphocytic leukemia can also occur in adults, though the chance of a cure is greatly reduced.

Symptoms :

Signs and symptoms of acute lymphocytic leukemia may include:

• Bleeding from the gums
• Bone pain
• Fever
• Frequent infections
• Frequent or severe nosebleeds
• Lumps caused by swollen lymph nodes in and around the neck, underarm, abdomen or groin
• Pale skin
• Shortness of breath
• Weakness, fatigue or a general decrease in energy

When to see a doctor
Make an appointment with your doctor or your child's doctor if you notice any persistent signs and symptoms that concern you. Many signs and symptoms of acute lymphocytic leukemia mimic those of the flu. However, flu signs and symptoms eventually improve. If signs and symptoms don't improve as expected, make an appointment with your doctor.

Causes:

 Acute lymphocytic leukemia occurs when a bone marrow cell develops errors in its DNA. The errors tell the cell to continue growing and dividing, when a healthy cell would normally stop dividing and die. When this happens, blood cell production becomes abnormal. The bone marrow produces immature cells that develop into leukemic white blood cells called lymphoblasts. These abnormal cells are unable to function properly, and they can build up and crowd out healthy cells.
It's not clear what causes the DNA mutations that can lead to acute lymphocytic leukemia. But doctors have found that most cases of acute lymphocytic leukemia aren't inherited.

Treatments and drugs:


In general, treatment for acute lymphocytic leukemia falls into separate phases:

• Induction therapy. The purpose of the first phase of treatment is to kill most of the leukemia cells in the blood and bone marrow and to restore normal blood cell production.
• Consolidation therapy. Also called post-remission therapy, this phase of treatment is aimed at destroying any remaining leukemia in the body, such as in the brain or spinal cord.
• Maintenance therapy. The third phase of treatment prevents leukemia cells from regrowing. The treatments used in this stage are often given at much lower doses over a long period of time, often years.
• Preventive treatment to the spinal cord. People with acute lymphocytic leukemia may also receive treatment to kill leukemia cells located in the central nervous system during each phase of therapy. In this type of treatment, chemotherapy drugs are often injected directly into the fluid that covers the spinal cord.

Depending on your situation, the phases of treatment for acute lymphocytic leukemia can span two to three years.
Treatments may include:

• Chemotherapy. Chemotherapy, which uses drugs to kill cancer cells, is typically used as an induction therapy for children and adults with acute lymphocytic leukemia. Chemotherapy drugs can also be used in the consolidation and maintenance phases.
• Targeted drug therapy. Targeted drugs attack specific abnormalities present in cancer cells that help them grow and thrive. A certain abnormality called the Philadelphia chromosome is found in some people with acute lymphocytic leukemia. For these people, targeted drugs may be used to attack cells that contain that abnormality. Targeted drugs include imatinib (Gleevec), dasatinib (Sprycel) and nilotinib (Tasigna). These drugs are approved only for people with the Philadelphia chromosome-positive form of ALL and can be taken during or after chemotherapy.
• Radiation therapy. Radiation therapy uses high-powered beams, such as X-rays, to kill cancer cells. If the cancer cells have spread to the central nervous system, your doctor may recommend radiation therapy.
• Stem cell transplant. A stem cell transplant may be used as consolidation therapy in people at high risk of relapse or for treating relapse when it occurs. This procedure allows someone with leukemia to re-establish healthy stem cells by replacing leukemic bone marrow with leukemia-free marrow from a healthy person.
  A stem cell transplant begins with high doses of chemotherapy or radiation to destroy any leukemia-producing bone marrow. The marrow is then replaced by bone marrow from a compatible donor (allogeneic transplant).
  
• Clinical trials. Clinical trials are experiments to test new cancer treatments and new ways of using existing treatments. While clinical trials give you or your child a chance to try the latest cancer treatment, treatment benefits and risks may be uncertain. Discuss the benefits and risks of clinical trials with your doctor.

ALL in older adults
Older adults, such as those older than 60, tend to experience more complications from ALL treatments. And older adults generally have a worse prognosis than children who are treated for ALL. Discuss your options with your doctor.

Based on your overall health and your goals and preferences, you may decide to undergo treatment for your ALL. Some people may choose to forgo treatment for the cancer, instead focusing on treatments that improve their symptoms and help them make the most of the time they have remaining.

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Acute liver failure

Acute liver failure

Definition:

Acute liver failure occurs when your liver rapidly loses its ability to function. More commonly, liver failure develops slowly over the course of years. But in acute liver failure, liver failure develops in a matter of days.

Acute liver failure can cause many complications, including excessive bleeding and increasing pressure in the brain. Another term for acute liver failure is fulminant hepatic failure.
Acute liver failure is a medical emergency that requires hospitalization. Some causes of acute liver failure can be reversed with treatment. But in other situations, a liver transplant may be the only cure for acute liver failure.

Symptoms:

Signs and symptoms of acute liver failure may include:

• A yellowing of your skin and eyeballs (jaundice)
• Pain in the upper right area of your abdomen
• Nausea
• Vomiting
• A general sense of not feeling well
• Difficulty concentrating
• Disorientation or confusion
• Sleepiness

When to see a doctor
Acute liver failure can develop quickly in an otherwise healthy person, and it is life-threatening. If you or someone you know suddenly develops a yellowing of the eyes or skin, tenderness in the upper abdomen or any unusual changes in mental state, personality or behavior, seek medical attention right away.

Causes:

Acute liver failure occurs when liver cells are damaged significantly and no longer able to function. Acute liver failure has many potential causes, including:

• Acetaminophen overdose. Taking too much acetaminophen (Tylenol, others) is the most common cause of acute liver failure in the United States. Acute liver failure can occur if you take a very large dose of acetaminophen all at once, or it can occur if you take higher-than-recommended doses every day for several days, especially in people with chronic liver disease.
• Prescription medications. Some prescription medications, including antibiotics, nonsteroidal anti-inflammatory drugs and anticonvulsants, can cause acute liver failure.
• Herbal supplements. Herbal drugs and supplements, including kava, ephedra, skullcap and pennyroyal, have been linked to acute liver failure.
• Hepatitis and other viruses. Hepatitis A, hepatitis B and hepatitis E can cause acute liver failure. Other viruses that can cause acute liver failure include Epstein-Barr virus, cytomegalovirus and herpes simplex virus.
• Toxins. Toxins that can cause acute liver failure include the poisonous wild mushroom Amanita phalloides, which is sometimes mistaken for edible species.
• Autoimmune disease. Liver failure can be caused by autoimmune hepatitis — a disease in which your immune system attacks liver cells, causing inflammation and injury.
• Diseases of the veins in the liver. Vascular diseases, such as Budd-Chiari syndrome, can cause blockages to form in the veins of the liver and lead to acute liver failure.
• Metabolic disease. Rare metabolic diseases, such as Wilson's disease and acute fatty liver of pregnancy, infrequently cause acute liver failure.
• Cancer. Cancer that begins in your liver or cancer that spreads to your liver from other places in your body can cause your liver to fail.

Many cases of acute liver failure have no apparent cause.

Complications:

Acute liver failure often causes complications, including:

• Excessive fluid in the brain (cerebral edema). Excessive fluid causes pressure to build in your brain, which can displace brain tissue outside of the space it normally occupies (herniation). Cerebral edema can also deprive your brain of oxygen.
• Bleeding disorders. A failing liver isn't able to produce sufficient amounts of clotting factors, which help blood to clot. Bleeding from ulcers in the gastrointestinal tract or other locations is difficult to control because blood doesn't clot quickly.
• Infections. People with acute liver failure are at an increased risk of developing a variety of infections, particularly in the blood and in the respiratory and urinary tracts.
• Kidney failure. Kidney failure often occurs following liver failure, especially in cases of acetaminophen overdose, which damages both your liver and your kidneys.

Treatments and drugs:

 People with acute liver failure are treated in the intensive care unit of a hospital. When it's possible, your doctor will work to treat your acute liver failure. But in many cases, the treatment involves controlling complications and giving your liver time to heal.
Treatments for acute liver failure
Acute liver failure treatments may include:

• Medications to reverse poisoning. Acute liver failure caused by acetaminophen overdose or mushroom poisoning is treated with drugs that can reverse the effects of the toxin.
• Liver transplant. Acute liver failure can't be reversed in many cases. In these situations, the only treatment may be a liver transplant. During a liver transplant, a surgeon removes your damaged liver and replaces it with a healthy liver from a donor.

Treatments for complications
Your doctor will work to control signs and symptoms you're experiencing and try to prevent complications caused by acute liver failure. This care may include:

• Relieving excess fluid in the brain. Cerebral edema caused by acute liver failure can increase pressure on your brain. Medications can help reduce the fluid buildup in your brain.
• Screening for infections. Your medical team will take periodic samples of your blood and urine to be tested for signs of infection. If your doctor suspects that you have an infection, you'll receive medications to treat the infection.
• Preventing severe bleeding. People with acute liver failure often develop bleeding ulcers in the gastrointestinal tract. Your doctor can give you medications to reduce the risk of bleeding. If you lose a lot of blood, you may require blood transfusions.

 

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Acute kidney failure

Acute kidney failure

Definition:

Acute kidney failure occurs when your kidneys suddenly become unable to filter waste products from your blood. When your kidneys lose their filtering ability, dangerous levels of wastes may accumulate and your blood's chemical makeup may get out of balance.
Acute kidney failure — also called acute renal failure or acute kidney injury — develops rapidly over a few hours or a few days. Acute kidney failure is most common in people who are already hospitalized, particularly in critically ill people who need intensive care.
Acute kidney failure can be fatal and requires intensive treatment. However, acute kidney failure may be reversible. If you're otherwise in good health, you may recover normal kidney function.

Symptoms:

Signs and symptoms of acute kidney failure may include:

• Decreased urine output, although occasionally urine output remains normal
• Fluid retention, causing swelling in your legs, ankles or feet
• Drowsiness
• Shortness of breath
• Fatigue
• Confusion
• Nausea
• Seizures or coma in severe cases
• Chest pain or pressure

Sometimes acute kidney failure causes no signs or symptoms and is detected through lab tests done for another reason.
When to see a doctor
Make an appointment with your doctor if you have any signs or symptoms of acute kidney failure.

Complications:

Potential complications of acute kidney failure include:

• Fluid buildup. Acute kidney failure may lead to a buildup of fluid in your chest, which can cause shortness of breath.
• Chest pain. If the lining that covers your heart becomes inflamed, you may experience chest pain.
• Muscle weakness. When your body's fluids and electrolytes — your body's blood chemistry — are out of balance, muscle weakness can result. Elevated levels of potassium in your blood are particularly dangerous.
• Permanent kidney damage. Occasionally, acute kidney failure causes permanent loss of kidney function, or end-stage renal disease. People with end-stage renal disease require either permanent dialysis — a mechanical filtration process used to remove toxins and wastes from your body — or a kidney transplant to survive.
• Death. Acute kidney failure can lead to loss of kidney function and, ultimately, death. The risk of death is highest in people who had kidney problems before acute kidney failure.

Treatments and drugs:

 Treatment for acute kidney failure typically requires a hospital stay. Most people with acute kidney failure are already hospitalized. How long you'll stay in the hospital depends on the reason for your acute kidney failure and how quickly your kidneys recover.
Treating the underlying cause of your kidney failure
Treatment for acute kidney failure involves identifying the illness or injury that originally damaged your kidneys. Your treatment options will depend on what's causing your kidney failure.
Treating complications until your kidneys recover
Your doctor will also work to prevent complications and allow your kidneys time to heal. Treatments that help prevent complications include:

• Treatments to balance the amount of fluids in your blood. If your acute kidney failure is caused by a lack of fluids in your blood, your doctor may recommend intravenous (IV) fluids. In other cases, acute kidney failure may cause you to have too much fluid, leading to swelling in your arms and legs. In these cases, your doctor may recommend medications (diuretics) to cause your body to expel extra fluids.
• Medications to control blood potassium. If your kidneys aren't properly filtering potassium from your blood, your doctor may prescribe calcium, glucose or sodium polystyrene sulfonate (Kayexalate, Kionex) to prevent the accumulation of high levels of potassium in your blood. Too much potassium in the blood can cause dangerous irregular heartbeats (arrhythmias) and muscle weakness.
• Medications to restore blood calcium levels. If the levels of calcium in your blood drop too low, your doctor may recommend an infusion of calcium.
• Dialysis to remove toxins from your blood. If toxins build up in your blood, you may need temporary hemodialysis — often referred to simply as dialysis — to help remove toxins and excess fluids from your body while your kidneys heal. Dialysis may also help remove excess potassium from your body. During dialysis, a machine pumps blood out of your body through an artificial kidney (dialyzer) that filters out waste. The blood is then returned to your body.

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Acute coronary syndrome

Acute coronary syndrome

Definition :

Acute coronary syndrome is a term used for any condition brought on by sudden, reduced blood flow to the heart. Acute coronary syndrome can describe chest pain you feel during a heart attack, or chest pain you feel while you're at rest or doing light physical activity (unstable angina).

 Acute coronary syndrome is often diagnosed in an emergency room or hospital.
Acute coronary syndrome is treatable if diagnosed quickly. Acute coronary syndrome treatments vary, depending on your signs, symptoms and overall health condition.

Symptoms:

Many acute coronary syndrome symptoms are the same as those of a heart attack. And if acute coronary syndrome isn't treated quickly, a heart attack will occur. It's important to take acute coronary syndrome symptoms very seriously. Get medical help right away if you have these signs and symptoms and think you're having a heart attack:

• Chest pain (angina) that feels like burning, pressure or tightness and lasts several minutes or longer
• Pain elsewhere in the body, such as the left upper arm or jaw (referred pain)
• Nausea
• Vomiting
• Shortness of breath (dyspnea)
• Sudden, heavy sweating (diaphoresis)

If you're having a heart attack, the signs and symptoms may vary depending on your sex, age and whether you have an underlying medical condition, such as diabetes. Some unusual heart attack symptoms include:

• Abdominal pain
• Pain similar to heartburn
• Clammy skin
• Lightheadedness, dizziness or fainting
• Unusual or unexplained fatigue
• Feeling restless or apprehensive

When to see a doctor
If you're having chest pain and you believe it's an emergency situation, seek medical help immediately. Whenever possible, get emergency medical assistance rather than driving yourself to the hospital. You could be having a heart attack.
If you have recurring chest pain, talk to your doctor. It could be a form of angina, and your doctor can help you decide the best course of treatment.

Causes:

Acute coronary syndrome may develop slowly over time by the building up of plaques in the arteries in your heart. These plaques, made up of fatty deposits, cause the arteries to narrow and make it more difficult for blood to flow through them. This buildup of plaques is known as atherosclerosis. Eventually, this buildup means that your heart can't pump enough oxygen-rich blood to the rest of your body, causing chest pain (angina) or a heart attack.
Another medical term closely related to acute coronary syndrome is coronary artery disease. Coronary artery disease refers to the damage to your heart arteries from atherosclerosis.
If one of the plaques in your coronary arteries ruptures, it can cause a heart attack. In fact, many instances of coronary artery syndrome develop after a plaque ruptures. A blood clot will form on the site of the rupture, blocking the flow of blood through that artery.

Treatments and drugs:

Treatment for acute coronary syndrome varies, depending on your symptoms and how blocked your arteries are.
Medications
It's likely that your doctor will recommend medications that can relieve chest pain and improve flow through the heart. These could include:

• Aspirin. Aspirin decreases blood clotting, helping to keep blood flowing through narrowed heart arteries. Aspirin is one of the first things you may be given in the emergency room for suspected acute coronary syndrome. You may be asked to chew the aspirin, so it's absorbed into your bloodstream more quickly. If your doctor diagnoses your symptoms as acute coronary syndrome, he or she may recommend taking aspirin daily.
• Thrombolytics. These drugs, also called clotbusters, help dissolve a blood clot that's blocking blood flow to your heart. If you're having a heart attack, the earlier you receive a thrombolytic drug after a heart attack, the greater the chance you will survive and lessen the damage to your heart.
• Nitroglycerin. This medication for treating chest pain and angina temporarily widens narrowed blood vessels, improving blood flow to and from your heart.
• Beta blockers. These drugs help relax your heart muscle, slow your heart rate and decrease your blood pressure, which decreases the demand on your heart. These medications can increase blood flow through your heart, decreasing chest pain and the potential for damage to your heart during a heart attack.
• Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs). These drugs allow blood to flow from your heart more easily. Your doctor may prescribe ACE inhibitors or ARBs if you've had a moderate to severe heart attack that has reduced your heart's pumping capacity. These drugs also lower blood pressure and may prevent a second heart attack.
• Calcium channel blockers. These medications relax the heart and allow more blood to flow to and from the heart. Calcium channel blockers are generally given if symptoms persist after you've taken nitroglycerin and beta blockers.
• Cholesterol-lowering drugs. Commonly used drugs known as statins can lower your cholesterol levels, making plaque deposits less likely. The goal of statin therapy is to reduce the low density lipoprotein (LDL, or "bad") cholesterol levels to under 100 milligrams per deciliter (mg/dL).
• Clopidogrel. The medication clopidogrel (Plavix) can help prevent blood clots from forming by making your blood platelets less likely to stick together. However, clopidogrel increases your risk of bleeding, so be sure to let everyone on your health care team know that you're taking it, particularly if you need any type of surgery.

Surgery and other procedures
If medications aren't enough to restore blood flow through your heart, your doctor may recommend one of these procedures:

• Angioplasty and stenting. In this procedure, your doctor inserts a long, thin tube (catheter) into the blocked or narrowed part of your artery. A wire with a deflated balloon is passed through the catheter to the narrowed area. The balloon is then inflated, compressing the deposits against your artery walls. A mesh tube (stent) is usually left in the artery to help keep the artery open. Angioplasty may also be done with laser technology.
• Coronary bypass surgery. This procedure creates an alternative route for blood to go around a blocked coronary artery.

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Actinic keratosis

Actinic keratosis

Definition  :
An actinic keratosis (ak-TIN-ik ker-uh-TOE-sis) is a rough, scaly patch on your skin that develops from years of exposure to the sun. It's most commonly found on your face, lips, ears, back of your hands, forearms, scalp or neck — areas of skin typically exposed to the sun.

An actinic keratosis, also known as solar keratosis, enlarges slowly and usually causes no signs or symptoms other than a patch or small spot on your skin. An actinic keratosis takes years to develop, usually first appearing in older adults. Many doctors consider an actinic keratosis to be precancerous because it can develop into skin cancer.
You can reduce your risk of actinic keratosis by minimizing your sun exposure and protecting your skin from ultraviolet (UV) rays.

Symptoms:
The signs and symptoms of an actinic keratosis include:

• Rough, dry or scaly patch of skin, usually less than 1 inch (2.5 centimeters) in diameter
• Flat to slightly raised patch or bump on the top layer of skin
• In some cases, a hard, wart-like surface
• Color ranging from pink to red to brown, or flesh-colored
• Itching or burning in the affected area

Actinic keratoses are found primarily on areas exposed to the sun, including your face, lips, ears, back of your hands, forearms, scalp and neck.
An actinic keratosis sometimes resolves on its own, but typically returns again after additional sun exposure. If just scratched or picked off, an actinic keratosis will return.
When to see a doctor
Because it can be difficult to distinguish between noncancerous spots and cancerous ones, it's best to have new skin changes evaluated by a doctor, especially if a spot or lesion persists, grows or bleeds. See your doctor or ask for a referral to a dermatologist if a skin lesion:

• Is painful
• Itches or burns
• Oozes or bleeds
• Becomes scaly or crusty
• Changes in size, shape, color or elevation

Causes:
Frequent or intense exposure to UV rays, typically from the sun, causes an actinic keratosis.
An actinic keratosis begins in your skin's top layer — the epidermis. The epidermis is as thin as a pencil line, and it provides a protective layer of skin cells that your body continually sheds.
Normally, skin cells within the epidermis develop in a controlled and orderly way. In general, healthy new cells push older cells toward the skin's surface, where they die and eventually are sloughed off. When skin cells are damaged through UV radiation, changes occur in the skin's texture and color, causing blotchiness and bumps or lesions.

Most of the damage to skin cells results from exposure to UV radiation from sunlight and commercial tanning lamps and beds. The damage adds up over time, so the more time you spend in the sun or in a tanning booth, the greater your chance of developing skin cancer. Your risk increases even more if most of your outdoor exposure occurs at times of the day or in locations where the sunlight is most intense.

Complications:
If treated early, almost all actinic keratoses can be eliminated before developing into skin cancer. However, if left untreated some of these spots or patches may progress to squamous cell carcinoma, a serious form of skin cancer.

An actinic keratosis may be the earliest form of squamous cell carcinoma. This type of cancer usually isn't life-threatening if detected and treated early. In a few cases, however, squamous cell carcinoma can grow to be large and invade surrounding tissues, with some even spreading (metastasizing) to other parts of your body.

Treatments and drugs:
It's impossible to tell exactly which patches or lesions will develop into skin cancer. Therefore, actinic keratoses are usually removed as a precaution. Your doctor can discuss with you which treatment is appropriate for you. With most of these procedures, the treated area takes a few days to several weeks to heal.
Actinic keratosis treatment options may include:

• Freezing (cryotherapy). An extremely cold substance, such as liquid nitrogen, is applied to skin lesions. The substance freezes the skin surface, causing blistering or peeling. As your skin heals, the lesions slough off, allowing new skin to appear. This is the most common treatment, takes only a few minutes and can be performed in your doctor's office. Side effects may include blisters, scarring, changes to skin texture, infection and darkening of the skin at the site of treatment.
• Scraping (curettage). In this procedure, your surgeon uses a device called a curet to scrape off damaged cells. Scraping may be followed by electrosurgery, in which a pencil-shaped instrument is used to cut and destroy the affected tissue with an electric current. This procedure requires a local anesthetic. Side effects may include infection, scarring and changes in skin coloration at the site of treatment.
• Creams or ointments. Some topical medications contain fluorouracil (Carac, Fluoroplex, Efudex), a chemotherapy drug. The medication destroys actinic keratosis cells by blocking essential cellular functions within them. Another treatment option is imiquimod (Aldara), a topical cream that modifies the skin's immune system to stimulate your body's own rejection of precancerous cells. Diclofenac gel (Voltaren, Solaraze), a nonsteroidal anti-inflammatory topical drug, may help, too. Side effects may include skin irritation such as pain, itching, stinging or burning sensation, crusting, and sensitivity to sun exposure at the site of treatment.
• Chemical peeling. This involves applying one or more chemical solutions — trichloroacetic acid (Tri-Chlor), for example — to the lesions. The chemicals cause your skin to blister and eventually peel, allowing new skin to form. Skin peeling usually lasts for five to seven days. Other side effects may include stinging or burning sensation, redness, crusting, changes in skin coloration, infections and, rarely, scarring. This procedure may not be covered by insurance, as it's often considered cosmetic.
• Photodynamic therapy. With this procedure, an agent that makes your damaged skin cells sensitive to light (photosensitizing agent) is either injected or applied topically. Your skin is then exposed to intense laser light to destroy the damaged skin cells. Side effects may include redness, swelling and a burning sensation during therapy.
• Laser therapy. A special laser is used to precisely remove the actinic keratoses and the affected skin underneath. Local anesthesia is often used to make the procedure more comfortable. Some pigment loss and scarring may result from laser therapy.
• Dermabrasion. In this procedure, the affected skin is removed using a rapidly moving brush. Local anesthetic is used to make the procedure more tolerable. The procedure leaves skin red and raw-looking. It takes several months for the skin to heal, but the new skin generally appears smoother.

Talk to your doctor about your treatment options. The procedures have various advantages and disadvantages, including side effects, risk of scarring, and the number of treatment sessions required. Afterward you'll likely have regular follow-up visits to check for new patches or lesions.

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