BBC NEWS
Paula Radcliffe's 'bionic' kit
by John Hand
BBC News
Knee-length socks? Check. Nasal strip? Check. Titanium necklace? Check.
Britain's newly-crowned world marathon champion Paula Radcliffe wears a remarkable array of accessories when she competes in major races.
To assess whether such devices really help or are just gimmicks, ahead of the marathon BBC News spoke to three experts: athletics coach Fred Wooding, sports scientist Nick Morgan and Edzard Ernst, Professor of Complementary Medicine.
Click the links below for their views on Radcliffe's kit.
SUNGLASSES
For more than a decade, Radcliffe has worn specially shaped sunglasses for most of her distance races, only discarding them if the conditions are particularly wet or cloudy.
Fred Wooding, a coach for 40 years and now president at Radcliffe's home athletics club in Bedford, said: "She likes to be 100% prepared for any eventuality on the road. This would alleviate the problem of dust coming up off the road in a marathon."
Sports scientist Nick Morgan of the Sports Injury and Human Performance Centre at Lilleshall, said: "Sports science would see no great benefit in wearing sunglasses. But Paula has got to concentrate on every fine detail during her race and if it helps her do that, then it can only be a good thing."
Edzard Ernst, Professor of Complementary Medicine at the Peninsular Medical School at Exeter University, said: "Some people are sensitive to sunlight so controlling this can only be a good thing."
NASAL STRIP
Marketed to help breathing among endurance athletes, there was a phase in the 1990s when they were commonly seen on the noses of Premiership footballers but they have since fallen out of fashion. But Radcliffe has persevered in wearing hers.
Fred Wooding: "Paula has always dealt well with having asthma and really believes this helps her breathing. I don't doubt for a minute that it does."
Nick Morgan: "There is not an awful lot of sports science to back it up. It helps you take in a lot more air through the nose. But it's one thing taking the oxygen into your body and another to utlilise it effectively. Over the course of a 26-mile run, most people would be able to take in enough air through their mouth."
Professor Edzard Ernst: "Intuitively it does make sense but I'm not sure how much help it is. You need the extra air in your lungs, not just your nose."
TITANIUM NECKLACE
This bemused Radcliffe's fans when she first wore it during the 10,000m final in Helsinki, with one visitor to her website describing it as looking like a bike lock.
Afterwards, Radcliffe explained the Japanese-developed device - widely used by baseball players - was designed to improve blood circulation and reduce muscle stress, but she chose not to wear it for the marathon.
Fred Wooding: "I did wonder what it was when I saw it but I knew that Paula would be confident it was helping her. It looked a bit big on her neck so I am sure she would have tried it out in training first."
Nick Morgan: "It is important to keep the muscles relaxed. If you're very tense throughout an event, you end up expending waste energy. If you keep doing that you are going to have problems, either a performance detriment or injury."
Professor Edzard Ernst: "There is no evidence that it works. We have just completed research on neck pain and saw benefits from some devices but not titanium."
BACK STRAPS AND EMU OIL
Radcliffe has been wearing two see-through straps on her back to support muscles around her spine. She is also a keen exponent of emu oil after using it to speed up the healing of cuts and bruises sustained in a collision with a cyclist during a training session in 2003.
This elixir, made from oil taken from the fatty tissue on an emu's back and recommended by fellow athlete Sonia O'Sullivan, helped Radcliffe get fit in time to win that year's London Marathon.
Fred Wooding: "Paula would have a good team of physios who would know the best way to protect her and she would always follow their advice."
Nick Morgan: "Emu oil was a new one to me but anything that can safely help speed up recovery is key for endurance athletes, who need to be able to get back into a solid training routine."
Professor Edzard Ernst: "We have found no evidence that emu oil helps heal cuts. But sportspeople are very sensitive people and if they have a belief that a remedy helps them, then as long as it does not have any adverse side effects, that is a benefit in itself."
SPECIALIST WATCH
This is a straightforward piece of equipment but distance athletes are divided as to whether it is worth wearing a watch to monitor running times during events. Radcliffe is firmly in the camp who chooses to wear one at all times.
Fred Wooding: "Paula would be fully aware of where she wants to be time-wise at any stage of the race."
Nick Morgan: "A watch means she can check she matches her ideal times for the various splits. She is phenomenal in her ability to run an evenly-paced marathon."
COMPRESSION SOCKS
Radcliffe has worn these knee-length socks for many years to support her calf muscles. And her kit is completed by a pair of specially designed trainers, which complement the contours of her feet and offer extra padding.
Fred Wooding: "The socks would be an important aid to blood circulation over a long race. There would be a danger of a pooling of lactic acid and it is a fact that these would help her. As for her shoes, Paula would be wearing a pair that would both give her sufficient grip whatever weather conditions she faces and also plenty of padding to compensate for the fact that she's going to be repetitively pounding her feet for 26 miles."
Nick Morgan: "Actually a build-up of lactic acid is not likely to be a problem for a marathon runner. The socks would help blood flow but they would be even better in aiding her recovery after the race. And a good pair of trainers is essential - I'm sure hers will be designed precisely because every millimetre would have an effect on her running gait."
Professor Edzard Ernst: "Some people have a tendency for their legs to swell up due to venous insufficiency and these socks would help control this. For someone running 26 miles, swollen legs would be heavy legs and that would be no good thing."
Story from BBC NEWS:
http://news.bbc.co.uk/go/pr/fr/-/2/hi/uk_news/4136018.stm
Published: 2005/08/14 14:16:51 GMT
Saturday, September 5, 2009
Friday, September 4, 2009
Intermittent explosive disorder
Intermittent explosive disorder
http://www.minddisorders.com/Flu-Inv/Intermittent-explosive-disorder.html
Definition
Intermittent explosive disorder (IED) is a disorder characterized by impulsive acts of aggression, as contrasted with planned violent or aggressive acts. The aggressive episodes may take the form of "spells" or "attacks," with symptoms beginning minutes to hours before the actual acting-out. The Diagnostic and Statistical Manual of Mental Disorders , fourth edition, text revision (also known as DSM-IV-TR ) is the basic reference work consulted by mental health professionals in determining the diagnosis of a mental disorder. DSM-IV-TR classifies IED under the general heading of "Impulse-Control Disorders Not Elsewhere Classified." Other names for IED include rage attacks, anger attacks, and episodic dyscontrol.
Description
Intermittent explosive disorder was originally described by the eminent French psychiatrist Esquirol as a "partial insanity" related to senseless impulsive acts. Esquirol termed this disorder monomanies instinctives , or instinctual monomanias . These apparently unmotivated acts were thought to result from instinctual or involuntary impulses, or from impulses related to ideological obsessions.
People with intermittent explosive disorder have a problem with controlling their temper. In addition, their violent behavior is out of proportion to the incident or event that triggered the outburst. Impulsive acts of aggression, however, are not unique to intermittent explosive disorder. Impulsive aggression can be present in many psychological and nonpsychological disorders. The diagnosis of intermittent explosive disorder (IED) is essentially a diagnosis of exclusion, which means that it is given only after other disorders have been ruled out as causes of impulsive aggression.
Patients diagnosed with IED usually feel a sense of arousal or tension before an outburst, and relief of tension after the aggressive act. Patients with IED believe that their aggressive behaviors are justified; however, they feel genuinely upset, regretful, remorseful, bewildered or embarrassed by their impulsive and aggressive behavior.
Causes and symptoms
Causes
Recent findings suggest that IED may result from abnormalities in the areas of the brain that regulate behavioral arousal and inhibition. Research indicates that impulsive aggression is related to abnormal brain mechanisms in a system that inhibits motor (muscular movement) activity, called the serotoninergic system. This system is directed by a neurotransmitter called serotonin, which regulates behavioral inhibition (control of behavior). Some studies have correlated IED with abnormalities on both sides of the front portion of the brain. These localized areas in the front of the brain appear to be involved in information processing and controlling movement, both of which are unbalanced in persons diagnosed with IED. Studies using positron emission tomography (PET) scanning have found lower levels of brain glucose (sugar) metabolism in patients who act in impulsively aggressive ways.
Another study based on data from electroencephalograms (EEGs) of 326 children and adolescents treated in a psychiatric clinic found that 46% of the youths who manifested explosive behavior had unusual high-amplitude brain wave forms. The researchers concluded that a significant subgroup of people with IED may be predisposed to explosive behavior by an inborn characteristic of their central nervous system. In sum, there is a substantial amount of convincing evidence that IED has biological causes, at least in some people diagnosed with the disorder.
Other clinicians attribute IED to cognitive distortions. According to cognitive therapists, persons with IED have a set of strongly negative beliefs about other people, often resulting from harsh punishments inflicted by the parents. The child grows up believing that others "have it in for him" and that violence is the best way to restore damaged self-esteem. He or she may also have observed one or both parents, older siblings, or other relatives acting out in explosively violent ways. In short, people who develop IED have learned, usually in their family of origin, to believe that certain acts or attitudes on the part of other people "justify" aggressive attacks on them.
Although gender roles are not a "cause" of IED to the same extent as biological and familial factors, they are regarded by some researchers as helping to explain why most people diagnosed with IED are males. According to this theory, men have greater permission from society to act violently and impulsively than women do. They therefore have less reason to control their aggressive impulses. Women who act explosively, on the other hand, would be considered unfeminine as well as unfriendly or dangerous.
Symptoms
IED is characterized by violent behaviors that are impulsive as well as assaultive. One example involved a man who felt insulted by another customer in a neighborhood bar during a conversation that had lasted for several minutes. Instead of finding out whether the other customer intended his remark to be insulting, or answering the "insult" verbally, the man impulsively punched the other customer in the mouth. Within a few minutes, however, he felt ashamed of his violent act. As this example indicates, the urge to commit the impulsive aggressive act may occur from minutes to hours before the "acting out" and is characterized by the buildup of tension. After the outburst, the IED patient experiences a sense of relief from the tension. While many patients with IED blame someone else for causing their violent outbursts, they also express remorse and guilt for their actions.
Demographics
IED is apparently a rare disorder. Most studies, however, indicate that it occurs more frequently in males. The most common age of onset is the period from late childhood through the early 20s. The onset of the disorder is frequently abrupt, with no warning period. Patients with IED are often diagnosed with at least one other disorder—particularly personality disorders , substance abuse (especially alcohol abuse) disorders, and neurological disorders.
Diagnosis
As mentioned, IED is essentially a diagnosis of exclusion. Patients who are eventually diagnosed with IED may come to the attention of a psychiatrist or other mental health professional by several different routes. Some patients with IED, often adult males who have assaulted their wives and are trying to save their marriages, are aware that their outbursts are not normal and seek treatment to control them. Younger males with IED are more likely to be referred for diagnosis and treatment by school authorities or the juvenile justice system, or brought to the doctor by concerned parents.
A psychiatrist who is evaluating a patient for IED would first take a complete medical and psychiatric history. Depending on the contents of the patient's history, the doctor would give the patient a physical examination to rule out head trauma, epilepsy, and other general medical conditions that may cause violent behavior. If the patient appears to be intoxicated by a drug of abuse or suffering symptoms of withdrawal, the doctor may order a toxicology screen of the patient's blood or urine. Specific substances that are known to be associated with violent outbursts include phencyclidine (PCP or "angel dust"), alcohol, and cocaine. The doctor will also give the patient a mental status examination and a test to screen for neurological damage. If necessary, a neurologist may be consulted and imaging studies performed of the patient's brain.
If the physical findings and laboratory test results are normal, the doctor may evaluate the patient for personality disorders, usually by administering diagnostic questionnaires. The patient may be given a diagnosis of antisocial or borderline personality disorder in addition to a diagnosis of IED.
In some cases the doctor may need to rule out malingering , particularly if the patient has been referred for evaluation by a court order and is trying to evade legal responsibility for his behavior.
Treatments
Some adult patients with IED appear to benefit from cognitive therapy. A team of researchers at the University of Pennsylvania found that cognitive approaches that challenged the patients' negative views of the world and of other people was effective in reducing the intensity as well as the frequency of violent episodes. With regard to gender roles, many of the men reported that they were helped by rethinking "manliness" in terms of self-control rather than as something to be "proved" by hitting someone else or damaging property.
Several medications have been used for treating IED. These include carbamazepine (Tegretol), an antiseizure medication; propranolol (Inderal), a heart medication that controls blood pressure and irregular heart rhythms; and lithium, a drug used to treat bipolar type II manic-depression disorder. The success of treatment with lithium and other mood-stabilizing medications is consistent with findings that patients with IED have a high lifetime rate of bipolar disorder .
Prognosis
Little research has been done on patients who meet DSM-IV-TR criteria for IED, although one study did find that such patients have a high lifetime rate of comorbid (co-occurring) bipolar disorder. In some people, IED decreases in severity or resolves completely as the person grows older. In others, the disorder appears to be chronic.
Prevention
As of 2002, preventive strategies include educating young people in parenting skills, and teaching children skills related to self-control. Recent studies summarized by an article in a professional journal of psychiatry indicate that self-control can be practiced like many other skills, and that people can improve their present level of self-control with appropriate coaching and practice.
See also Gender issues in mental health ; Self-control strategies
Resources
BOOKS
Baumeister, Roy F., PhD. Chapter 8, "Crossing the Line: How Evil Starts." In Evil: Inside Human Violence and Cruelty. New York: W. H. Freeman and Company, 1999.
Beck, Aaron T., M.D. Prisoners of Hate: The Cognitive Basis of Anger, Hostility, and Violence. New York: HarperCollins, 1999.
Tasman, Allan, and others, eds. Psychiatry. 1st edition. Philadelphia: W. B. Saunders Company. 1997: 1249-1258.
PERIODICALS
Bars, Donald R., and others. "Use of Visual Evoked-Potential Studies and EEG Data to Classify Aggressive, Explosive Behavior of Youths." Psychiatric Services 52 (January 2001): 81-86.
McElroy, Susan L. "Recognition and Treatment of DSM-IV Intermittent Explosive Disorder." Journal of Clinical Psychiatry 60 (1999) [suppl. 15]: 12-16.
Strayhorn, Joseph M., Jr. "Self-Control: Theory and Research." Journal of the American Academy of Child and Adolescent Psychiatry 41 (January 2002): 7-16.
Laith Farid Gulli, M.D. Bilal Nasser, M.D.
Read more: http://www.minddisorders.com/Flu-Inv/Intermittent-explosive-disorder.html#ixzz0Q7Knb0J4
http://www.minddisorders.com/Flu-Inv/Intermittent-explosive-disorder.html
Definition
Intermittent explosive disorder (IED) is a disorder characterized by impulsive acts of aggression, as contrasted with planned violent or aggressive acts. The aggressive episodes may take the form of "spells" or "attacks," with symptoms beginning minutes to hours before the actual acting-out. The Diagnostic and Statistical Manual of Mental Disorders , fourth edition, text revision (also known as DSM-IV-TR ) is the basic reference work consulted by mental health professionals in determining the diagnosis of a mental disorder. DSM-IV-TR classifies IED under the general heading of "Impulse-Control Disorders Not Elsewhere Classified." Other names for IED include rage attacks, anger attacks, and episodic dyscontrol.
Description
Intermittent explosive disorder was originally described by the eminent French psychiatrist Esquirol as a "partial insanity" related to senseless impulsive acts. Esquirol termed this disorder monomanies instinctives , or instinctual monomanias . These apparently unmotivated acts were thought to result from instinctual or involuntary impulses, or from impulses related to ideological obsessions.
People with intermittent explosive disorder have a problem with controlling their temper. In addition, their violent behavior is out of proportion to the incident or event that triggered the outburst. Impulsive acts of aggression, however, are not unique to intermittent explosive disorder. Impulsive aggression can be present in many psychological and nonpsychological disorders. The diagnosis of intermittent explosive disorder (IED) is essentially a diagnosis of exclusion, which means that it is given only after other disorders have been ruled out as causes of impulsive aggression.
Patients diagnosed with IED usually feel a sense of arousal or tension before an outburst, and relief of tension after the aggressive act. Patients with IED believe that their aggressive behaviors are justified; however, they feel genuinely upset, regretful, remorseful, bewildered or embarrassed by their impulsive and aggressive behavior.
Causes and symptoms
Causes
Recent findings suggest that IED may result from abnormalities in the areas of the brain that regulate behavioral arousal and inhibition. Research indicates that impulsive aggression is related to abnormal brain mechanisms in a system that inhibits motor (muscular movement) activity, called the serotoninergic system. This system is directed by a neurotransmitter called serotonin, which regulates behavioral inhibition (control of behavior). Some studies have correlated IED with abnormalities on both sides of the front portion of the brain. These localized areas in the front of the brain appear to be involved in information processing and controlling movement, both of which are unbalanced in persons diagnosed with IED. Studies using positron emission tomography (PET) scanning have found lower levels of brain glucose (sugar) metabolism in patients who act in impulsively aggressive ways.
Another study based on data from electroencephalograms (EEGs) of 326 children and adolescents treated in a psychiatric clinic found that 46% of the youths who manifested explosive behavior had unusual high-amplitude brain wave forms. The researchers concluded that a significant subgroup of people with IED may be predisposed to explosive behavior by an inborn characteristic of their central nervous system. In sum, there is a substantial amount of convincing evidence that IED has biological causes, at least in some people diagnosed with the disorder.
Other clinicians attribute IED to cognitive distortions. According to cognitive therapists, persons with IED have a set of strongly negative beliefs about other people, often resulting from harsh punishments inflicted by the parents. The child grows up believing that others "have it in for him" and that violence is the best way to restore damaged self-esteem. He or she may also have observed one or both parents, older siblings, or other relatives acting out in explosively violent ways. In short, people who develop IED have learned, usually in their family of origin, to believe that certain acts or attitudes on the part of other people "justify" aggressive attacks on them.
Although gender roles are not a "cause" of IED to the same extent as biological and familial factors, they are regarded by some researchers as helping to explain why most people diagnosed with IED are males. According to this theory, men have greater permission from society to act violently and impulsively than women do. They therefore have less reason to control their aggressive impulses. Women who act explosively, on the other hand, would be considered unfeminine as well as unfriendly or dangerous.
Symptoms
IED is characterized by violent behaviors that are impulsive as well as assaultive. One example involved a man who felt insulted by another customer in a neighborhood bar during a conversation that had lasted for several minutes. Instead of finding out whether the other customer intended his remark to be insulting, or answering the "insult" verbally, the man impulsively punched the other customer in the mouth. Within a few minutes, however, he felt ashamed of his violent act. As this example indicates, the urge to commit the impulsive aggressive act may occur from minutes to hours before the "acting out" and is characterized by the buildup of tension. After the outburst, the IED patient experiences a sense of relief from the tension. While many patients with IED blame someone else for causing their violent outbursts, they also express remorse and guilt for their actions.
Demographics
IED is apparently a rare disorder. Most studies, however, indicate that it occurs more frequently in males. The most common age of onset is the period from late childhood through the early 20s. The onset of the disorder is frequently abrupt, with no warning period. Patients with IED are often diagnosed with at least one other disorder—particularly personality disorders , substance abuse (especially alcohol abuse) disorders, and neurological disorders.
Diagnosis
As mentioned, IED is essentially a diagnosis of exclusion. Patients who are eventually diagnosed with IED may come to the attention of a psychiatrist or other mental health professional by several different routes. Some patients with IED, often adult males who have assaulted their wives and are trying to save their marriages, are aware that their outbursts are not normal and seek treatment to control them. Younger males with IED are more likely to be referred for diagnosis and treatment by school authorities or the juvenile justice system, or brought to the doctor by concerned parents.
A psychiatrist who is evaluating a patient for IED would first take a complete medical and psychiatric history. Depending on the contents of the patient's history, the doctor would give the patient a physical examination to rule out head trauma, epilepsy, and other general medical conditions that may cause violent behavior. If the patient appears to be intoxicated by a drug of abuse or suffering symptoms of withdrawal, the doctor may order a toxicology screen of the patient's blood or urine. Specific substances that are known to be associated with violent outbursts include phencyclidine (PCP or "angel dust"), alcohol, and cocaine. The doctor will also give the patient a mental status examination and a test to screen for neurological damage. If necessary, a neurologist may be consulted and imaging studies performed of the patient's brain.
If the physical findings and laboratory test results are normal, the doctor may evaluate the patient for personality disorders, usually by administering diagnostic questionnaires. The patient may be given a diagnosis of antisocial or borderline personality disorder in addition to a diagnosis of IED.
In some cases the doctor may need to rule out malingering , particularly if the patient has been referred for evaluation by a court order and is trying to evade legal responsibility for his behavior.
Treatments
Some adult patients with IED appear to benefit from cognitive therapy. A team of researchers at the University of Pennsylvania found that cognitive approaches that challenged the patients' negative views of the world and of other people was effective in reducing the intensity as well as the frequency of violent episodes. With regard to gender roles, many of the men reported that they were helped by rethinking "manliness" in terms of self-control rather than as something to be "proved" by hitting someone else or damaging property.
Several medications have been used for treating IED. These include carbamazepine (Tegretol), an antiseizure medication; propranolol (Inderal), a heart medication that controls blood pressure and irregular heart rhythms; and lithium, a drug used to treat bipolar type II manic-depression disorder. The success of treatment with lithium and other mood-stabilizing medications is consistent with findings that patients with IED have a high lifetime rate of bipolar disorder .
Prognosis
Little research has been done on patients who meet DSM-IV-TR criteria for IED, although one study did find that such patients have a high lifetime rate of comorbid (co-occurring) bipolar disorder. In some people, IED decreases in severity or resolves completely as the person grows older. In others, the disorder appears to be chronic.
Prevention
As of 2002, preventive strategies include educating young people in parenting skills, and teaching children skills related to self-control. Recent studies summarized by an article in a professional journal of psychiatry indicate that self-control can be practiced like many other skills, and that people can improve their present level of self-control with appropriate coaching and practice.
See also Gender issues in mental health ; Self-control strategies
Resources
BOOKS
Baumeister, Roy F., PhD. Chapter 8, "Crossing the Line: How Evil Starts." In Evil: Inside Human Violence and Cruelty. New York: W. H. Freeman and Company, 1999.
Beck, Aaron T., M.D. Prisoners of Hate: The Cognitive Basis of Anger, Hostility, and Violence. New York: HarperCollins, 1999.
Tasman, Allan, and others, eds. Psychiatry. 1st edition. Philadelphia: W. B. Saunders Company. 1997: 1249-1258.
PERIODICALS
Bars, Donald R., and others. "Use of Visual Evoked-Potential Studies and EEG Data to Classify Aggressive, Explosive Behavior of Youths." Psychiatric Services 52 (January 2001): 81-86.
McElroy, Susan L. "Recognition and Treatment of DSM-IV Intermittent Explosive Disorder." Journal of Clinical Psychiatry 60 (1999) [suppl. 15]: 12-16.
Strayhorn, Joseph M., Jr. "Self-Control: Theory and Research." Journal of the American Academy of Child and Adolescent Psychiatry 41 (January 2002): 7-16.
Laith Farid Gulli, M.D. Bilal Nasser, M.D.
Read more: http://www.minddisorders.com/Flu-Inv/Intermittent-explosive-disorder.html#ixzz0Q7Knb0J4
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