Get Rid Of Tiredness and Sleep Less
The doctor has to consider, especially in the case of undifferentiated illness, whether the patient has a 'hidden agenda' for the presentation. 3 Of course, the patient may be depressed (overt or masked) or may have a true anxiety state. However, a presenting symptom such as tiredness may represent a 'ticket of entry' to the consulting room. It may represent a plea for help in a stressed or anxious patient. We should be sensitive to patients' needs and feelings, and as listening, caring, empathetic practitioners provide the right opportunity for the patient to communicate freely.
The term chronic fatigue syndrome may be applied to a patient whose persistent tiredness lacks a physical pathology to account for it. The diagnosis of neurasthenia was popular in the late nineteenth century, and its symptoms included fatigue after minimal effort, loss of interest, irritability, poor concentration, and sleep disturbance.
Physical symptoms are just as common as psychological ones and often form the presenting complaint when depressed patients consult in general practice. Core symptoms of depression include pain and tiredness. These have been recognized since the early days of psychiatry. (Indeed, a more insightful way of looking at the problem would be to retreat from the somewhat arbitrary mind body split in which, at any rate in Western societies, we view the experience of distress.) Sometimes, however, if patients feel reticent about their emotional distress, the pain or the tiredness may be presented as the main problem. Depression of mood is the underlying problem in many patients given otherwise mystifying labels of 'chronic fatigue syndrome' or 'chronic pain syndrome'.
The exchange of information and the professional conversation around genetic counselling is a human encounter in the service of the patient but, the counsellor is also there as a real person. The experienced and secure counsellor will have little difficulty acknowledging personal reactions but, sometimes, the less experienced or insecure can regard their personal emotional reactions as a lack of professionalism which needs to be hidden or denied. All counsellors are at risk of being disturbed at some point or another and they may experience physical sensations or feelings. Headaches, tiredness, or being depleted or stressed are common physical complaints depression, anxiety or feeling unexpectedly angry, common emotional reactions. These feelings and sensations are unpleasant but can be understood, alleviated or even prevented by a deeper understanding of the delicate, interactional processes by which individuals affect one another. This involves addressing counter-transference...
Disease affecting the parathyroid glands usually presents as a consequence of altered function. Hyperparathyroidism describes an altered metabolic state due to increased secretion of parathyroid hormone (parathormone). Rarely seen nowadays is the full spectrum of bones, stones, groans and moans biochemical investigation of non-specific complaints such as profound tiredness, nausea or thirst is the usual method of diagnosis although a small proportion of cases are detected during investigation of patients with organ-specific complaints. Primary hyperparathyroidism is due to an increased secretion of parathormone from one or more of the parathyroid glands, usually caused by an adenoma. Secondary hyperparathyroidism is due to the physiological response of the four parathyroid glands to persistent hypocalcaemia, usually renal failure, malabsorption syndromes or Vitamin D deficiency. Tertiary hyperparathyroidism is a result of persistent autonomous hypersecretion of parathormone in...
In addition to the complications described, the normal, uncomplicated course of events after a gastrectomy will include a number of expected but undesirable health consequences. The weakness and tiredness associated with any major surgery usually takes several months to resolve completely, and in the case of gastrectomy, this is further added to by the nutritional problems induced by removal of part or all of the stomach. Patients can expect to have a smaller appetite and small capacity, and to lose weight for some time after leaving hospital until they reach a stable metabolic state.
Considering that low dietary intakes of selenium have been linked with greater incidence of anxiety, depression and tiredness, several research groups have investigated whether higher dietary intakes or selenium supplementation will elevate mood and or reduce anxiety. Currently, results are equivocal however, it appears that selenium-replete individuals are most likely to respond to supplementation, if a response is observed. An early double-blind, crossover, study showed that short-term selenium supplementation (100 g day for 5 weeks) significantly elevated mood and decreased anxiety, depression and tiredness, with effects most marked in people with low dietary intake (Benton & Cook 1991). A study of 30 selenium replete men who were fed either a low (32.6 g day) or a high (226.5 g day) selenium diet for 1 5 weeks found that the mood of those with the higher selenium intake increased whereas mood worsened with low intake (Finley & Pen land 1998 as reported in Rayman 2005)....
In some cultures, symptoms of depression are not generally recognized as a case for mental disorders. In addition, symptoms of depression might be presented in somatic terms rather than sadness or guilt (Castillo, 1997). For example, among Latin American and Mediterranean cultures depressive experiences might be manifested in terms of complaints of nerves and headaches Asians may show similar experiences in terms of weakness, tiredness, or imbalance, whereas among people from the Middle East and American Indian tribes these experiences might be shown in terms of difficulties with the heart or being Heartbroken, respectively (see DSM-IV, 1994, pp. 324-325). The severity of the depression might also be evaluated differently across cultures (e.g., sadness may lead to less concern than irritability in some cultures). Hallucinations and delusions, which are sometimes part of Major Depressive Disorder, should be differentiated from cultural hallucinations and delusions (e.g., fear of being...
In typical mild, moderate, or severe depressive episodes, the patient suffers from lowering of mood, reduction of energy, and decrease in activity. Capacity for enjoyment, interest, and concentration is reduced, and marked tiredness after even minimum effort is common. Sleep is usually disturbed and appetite diminished. Self-esteem and self-confidence are almost always reduced and, even in the mild form, some ideas of guilt or worthlessness are often present. The lowered mood varies little from day to day, is unresponsive to circumstances and may be accompanied by 'somatic' symptoms, such as loss of interest and pleasurable feelings, waking in the morning several hours before
There are obvious problems with the practical use of ICD in daily clinical psychiatry, however. For example, there is no minimum time period. If one takes the description literally, a person who has a brief episode of, say, 'decrease in activity . . . and . . . marked tiredness after even minimum effort', and who is able to 'to continue with most activities' would nevertheless be diagnosable with a mild depressive episode.
Tan et al. (54) reported that irresistible sleepiness not preceded by obvious somnolence or warning was present in 14 of a Chinese PD population compared to less than 2 in controls (54). Such subjects may, therefore, be susceptible to falling asleep while driving or operating machinery. EDS needs to be differentiated from fatigue. Also, postprandial hypotension in PD may unmask sleepiness and akinesia (55). Fatigue may be present in up to 43 of PD patients and is usually associated with sleepiness, although tiredness is a key feature (56).
Specific tasks of grief counseling include emotional expression about the loss (which can include a wide range of feelings), accepting the loss, adjusting to life after the loss, and coping with the changes within oneself and the world after the loss. Typical feelings experienced by individuals, and addressed in grief counseling, include sadness, anxiety, anger, loneliness, guilt, relief, isolation, confusion, or numbness. Behavioral changes may also be noticed, such as being disorganized, feeling tired, having
It is important to utilise a type of fail-safe mechanism to avoid missing the diagnosis of these disorders. Some practitioners refer to consultations that make their 'head spin' in confusion and bewilderment, with patients presenting with a 'shopping list' of problems. It is in these patients that a checklist is useful. Consider the apparently neurotic patient who presents with headache, lethargy, tiredness, constipation, anorexia, indigestion, shortness of breath on exertion, pruritus, flatulence, sore tongue and backache. In such a patient we must consider a diagnosis that links all these symptoms, especially if the physical examination is inconclusive this includes iron deficiency anaemia, depression, diabetes mellitus, hypothyroidism and drug abuse.
Fatigue is one of the three most frequently disabling symptoms of MS (129) and may be considered abnormal in as many as 78 of patients (130,131). A particular feeling of enervation, severe enough to prevent a patient from carrying out duties and responsibilities or to interfere with work, family, or social life, occurs (132). This specific, but poorly understood, type of fatigue in MS must be distinguished from symptoms of depression, medication side effects, consequences of other medical conditions such as anemia, hypothyroidism, or simple physical tiredness. No definitive explanation for fatigue in MS has been established. One type of fatigue, so-called handicap fatigue, is characterized by the requirement for an increased effort to perform routine tasks. This may be a consequence of the fact that nerve conduction in demyelinated fibers is susceptible to exhaustion, rate-dependent block, and conduction block with increased temperature. Alternatively, patients with MS may experience...
An adequate record must be made of the whole anaesthetic process, from the induction to full recovery of the patient. Errors can occur for a variety of reasons ranging from inexperience and lack of training to tiredness, boredom, and inattention. Vigilance in an anaesthetist is a function of self-motivation.
The neurologic disorder in which fatigue has been best evaluated is multiple sclerosis in which at least 78 of these patients suffer from fatigue and is often the most disabling symptom of this disease (55). Similarly, in a study of over 1300 cancer patients, 58 of patients described problems with fatigue, yet less than 52 of those ever reported symptoms to their caregivers, and only 14 had received some type of treatment (56). Perhaps the greatest obstacle to recognizing fatigue is in terms of definition as various health care professionals define fatigue differently based on their area of expertise. The most common complaint heard in our outpatient brain tumor clinic on a daily basis from patients, regardless of stage of treatment, is that they feel fatigue. This may be further defined as tiredness, exhaustion, muscle weakness, lethargy, or depression. Because fatigue can mean different things to physicians and patients it is imperative that the physician obtain a comprehensive...
In a supervision discussion the counsellor revealed that an interview had been very upsetting and described the degree of tiredness experienced at the end of a home visit. In the supervision the counsellor explored a number of issues. Did the consultation have any personal significance Had the content of the consultation been particularly disturbing Was the grouping of the extended family frustrating, with tensions and conflicts triggered by the genetic problem The space given to the counsellor to explore, ponder and reflect may not have revealed the reason for the tiredness, but the process was supportive to the counsellor, especially as colleagues reported similar experiences.
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