Living With Diabetes

If you’ve been diagnosed with diabetes, you will need to pay special attention to certain aspects of your lifestyle and health.

If you have diabetes, you should have regular eye tests. Watch a video about diabetic retinopathy.

Diabetes doesn't have to stop you from leading the life you want. Nor does it mean you'll necessarily have other serious health problems in the future.

With careful management you can ensure you control the condition and it doesn't control you. This will allow you to stay healthy, active and to live a full life.

Without taking these measures, you are putting yourself at an increased risk of health problems, which could force you to change your lifestyle entirely.

Structured education programmes can teach you more about managing diabetes. Learn more in diabetes education.

After diagnosis

When you were diagnosed, you should have been assigned to a diabetes care team who will have explained the most important aspects of managing your condition.

You may also have learned to monitor your blood glucose (sugar) level regularly, and to understand how it is affected by food and exercise.

If you need help to keep your blood glucose level stable, you may have been prescribed diabetes medication, or insulin to inject.

In order to stay well, it's important to use these aspects of your treatment properly. But it's also important you take other steps to help manage the condition and lower your risk of further health problems.

Learning to manage your diabetes takes time, patience and effort. You may also be coping with difficult emotions after diagnosis, such as anger, confusion or depression.

Diabetes health risks

Both type 1 and type 2 diabetes put you at increased risk of:

heart disease

stroke

circulation problems

nerve damage

foot ulcers

blindness, caused by diabetic retinopathy

kidney damage

skin lesions

damage to breast tissue in women

muscle-wasting and damage to ligaments and joints

Healthy living with diabetes

There's a lot you can do to minimise your risk of these problems.

First, it's important you take your insulin and other medicines properly.

As well as taking your medicines or insulin, there are a few key steps you can take to prevent or delay the health complications associated with diabetes.

Maintain a healthy weight – This will help control your blood glucose level, as well as your blood pressure and cholesterol. Learn more in our lose weight section.

Eat a healthy, balanced diet that’s low in fat, salt and sugar – This doesn’t mean you can never eat biscuits or cakes again, but try to eat sugary and fatty foods in moderation. Learn more in our food and diet section.

Don’t smoke – If you do smoke, find support to help you stop. Smoking increases your risk of heart disease and stroke even further. For help with giving up smoking, see our stop smoking section.

Get active for 30 minutes a day, five times a week – This helps you stay at a healthy weight and maintain good general health. It doesn’t have to be the gym: there are plenty of other ways to keep active, such as playing with your kids, gardening, or any activity that gently raises your heart rate. Learn more in the fitness section.

Check your feet every day – The nerve damage that can occur in diabetes most commonly affects feet. Learn more in diabetes and foot health.

Keep your appointments with your diabetes care team – Regular check-ups once every three months are an important part of managing your diabetes.

Causes of type 1 diabetes 

Type 1 diabetes occurs as a result of the body being unable to produce insulin, which moves glucose out of the blood and into your cells to be used for energy. 

Without insulin, your body will break down its own fat and muscle, resulting in weight loss. This can lead to a serious short-term condition called diabetic ketoacidosis, where the bloodstream becomes acidic and you develop dangerous levels of dehydration.

Type 1 diabetes is an autoimmune condition, where the immune system (the body's natural defence against infection and illness) mistakes the cells in your pancreas as harmful and attacks them.

Treating type 1 Diabetes

It's important that diabetes is diagnosed as early as possible so that treatment can be started.

Diabetes can't be cured, but treatment aims to keep your blood glucose levels as normal as possible, and control your symptoms to prevent health problems developing later.

If you're diagnosed with diabetes, you'll be referred to a diabetes care team for specialist treatment and monitoring.

As your body can't produce insulin, you'll need regular insulin injections to keep your glucose levels normal. You'll be taught how to do this and how to match the insulin you inject to the food you eat, taking into account your blood glucose level and how much exercise you do. 

Insulin injections comes in several different forms, with each working slightly differently. Some last up to a whole day (long-acting), some last up to eight hours (short-acting) and some work quickly but don't last very long (rapid-acting). You'll most likely need a combination of different insulin preparations.

There are alternatives to insulin injections but they're only suitable for a small number of patients. They are:

• insulin pump therapy - where a small device that constantly pumps insulin (at a rate you control) into your bloodstream through a needle that's inserted under the skin 
• islet cell transplantation - where healthy insulin-producing cells from the pancreas of a deceased donor are implanted into the pancreas of someone with type 1 diabetes (read about the criteria for having an islet transplant) 
• a complete pancreas transplant 

developing type 2 diabetes is due to:

• increasing levels of obesity 
• a lack of exercise 
• increase in unhealthy diets 
• an ageing population 

Even if you feel healthy, you may have a higher than normal blood glucose level (pre-diabetes) and be at risk of getting the condition.

It's therefore important to take preventative measures by making any necessary lifestyle changes, such as eating more healthily, losing weight (if you're overweight) and becoming more physically active. 

Diabetes can cause serious long-term health problems. It's the most common cause of visual impairment and blindness in people of working age. It's also responsible for most cases of kidney failure and lower limb amputation (other than accidents).

People with diabetes are up to five times more likely to have cardiovascular disease and stroke than those without diabetes.

Although all adults are at risk of developing type 2 diabetes, a number of groups have a particularly high risk of developing the condition. 

Your risk of developing type 2 diabetes is increased if:

• you're over 40 years of age (over 25 if you're South Asian) 
• you have a close family member with diabetes (a parent, brother or sister) 
• you're overweight or obese, with a waist size of over 80cm (31.5 inches) for women and 94cm (37 inches) for men, or 89cm (35 inches) for South Asian men  
• you're of South Asian, Chinese, African-Caribbean or black African origin (even if you were born in the UK)  
• you've ever had a cardiovascular disease, such as a heart attack or stroke
• you're a woman with polycystic ovary syndrome (PCOS) and also overweight 
• you're a woman and you've had gestational diabetes or given birth to a baby of over 10 pounds  
• you have a severe mental health condition, such as depression, schizophrenia or bipolar disorder, and you're taking medication for it 
• you've been told you have impaired glucose tolerance or impaired fasting glycaemia 

Treating type 2 diabetes

There is no cure for diabetes. However, treatment aims to keep your blood glucose levels as normal as possible, which will control your symptoms and minimise the risk of health problems developing later on.

If you're diagnosed with diabetes, you may be referred to a diabetes care team for specialist treatment, or your GP surgery may provide first-line diabetes care.

In some cases, it may be possible to control your diabetes symptoms by making changes to your lifestyle, such as eating a healthy diet and taking regular exercise (see below).

However, as type 2 diabetes is a progressive condition, you may eventually need to take medication to keep your blood glucose at normal levels. You may need to take tablets initially, but move on to injected therapies, such as insulin, at a later stage.

Causes of type 2 diabetes

Insulin is a hormone produced by the pancreas – a large gland located behind the stomach.

Insulin controls the amount of glucose in your blood. It moves glucose from the blood into your cells, where it's converted into energy.

In type 2 diabetes, not enough insulin is produced to maintain a normal blood glucose level (insulin deficiency), or your body is unable to use the insulin that's produced effectively. This is known as insulin resistance.

If you have type 2 diabetes, you will be advised to look after your health very carefully.

Caring for your health will also make treating your diabetes easier and minimise your risk of developing complications. You should:

• eat a healthy, balanced diet 
• lose weight (if you're overweight) and maintain a healthy weight  
• Stop smoking 
• drink alcohol in moderation 
• take plenty of regular exercise

It's seems that although scary at first, a diagnosis of diabetes is a manageable condition if you get the right help and support, sure lifestyle changes are a must but this could be a good thing, and yes you will have to change your diet, but hey this is also a good thing, we should all consider changing our lifestyles, if we smoke or drink to much, as well as our diets if we drink too many drinks with sugar in or eat too much fatty foods. 

If a relative is diagnosed with diabetes I think the whole family joining in with the changes would help a great deal, it would make the shopping easier for a start and on the grand scale it might bring the cases of diabetes down in the long term.

Chronic Fatigue Syndrome

Chronic fatigue syndrome (CFS) causes persistent fatigue (exhaustion) that affects everyday life and doesn't go away with sleep or rest. 

CFS is also known as ME, which stands for myalgic encephalomyelitis. Myalgia means muscle pain and encephalomyelitis means inflammation of the brain and spinal cord. Both CFS and ME are commonly used terms (see box on this page).

Sometimes the term 'myalgic encephalopathy' is used. Encephalopathy means a condition that affects brain function.

CFS is a serious condition that can cause long-term illness and disability, but many people – particularly children and young people – improve over time.

Who is affected

It is estimated that around 250,000 people in the UK have CFS. 

Anyone can get CFS, although it is more common in women than in men. It usually develops in the early 20s to mid-40s. Children can also be affected, usually between the ages of 13 and 15. 

How it affects quality of life

Most cases of CFS are mild or moderate, but up to one in four people with CFS have severe symptoms. These are defined as follows: 

• Mild: you are able to care for yourself, but may need days off work to rest.  
• Moderate: you may have reduced mobility, and your symptoms can vary. You may also have disturbed sleep patterns, and need to sleep in the afternoon. 
• Severe: you are able to carry out minimal daily tasks, such as brushing your teeth, but you have significantly reduced mobility. You may also have difficulty concentrating. 

Why it happens

It is not known exactly what causes CFS.

Various theories have been suggested, including:

• a viral infection 
• problems with the immune system 
• an imbalance of hormones 
• psychiatric problems, such as stress and emotional trauma 

Some people are thought to be more susceptible to the condition due to their genes, as the condition is more common in some families.

More research is needed to confirm exactly what causes the condition.

How it is diagnosed

There are specific guidelines issued by the National Institute for Health and Care Excellence (NICE) about the diagnosis and management of CFS.

NICE says that a diagnosis of CFS should be considered if you meet specific criteria regarding your fatigue (for example, it can't be explained by other conditions) and if you have other symptoms too, such as sleeping problems or problems thinking and concentrating.

The diagnosis can then be confirmed if these symptoms are experienced for several months.

How it is treated

There is no cure for CFS, so treatment aims to reduce the symptoms. Everyone with CFS responds to treatment differently, so your treatment plan will be tailored to you.

Some of the main treatments include:

• Cognitive behavioural therapy 
• a structured exercise programme called graded exercise therapy 
• medication to control pain, nausea and sleeping problems 

Treatments such as these can help improve CFS in most cases, although some people do not make a full recovery. It is also likely there will be periods when symptoms get better or worse.

Managing chronic fatigue syndrome can be as complex as the illness itself. There is no cure, no prescription drugs have been developed specifically for CFS, and symptoms can vary a lot over time. Thus, people with CFS should closely monitor their health and let their doctor know of any changes; and doctors should regularly monitor their patients' conditions and change treatment strategies as needed.

A team approach that involves doctors and patients is one key to successfully managing CFS. Patients and their doctors can work together to create an individualized treatment program that best meets the needs of the patient with CFS. This program should be based on a combination of therapies that address symptoms, coping techniques, and managing normal daily activities.

CFS affects patients in different ways, and the treatment plan should be tailored to address symptoms that are most disruptive or disabling for each patient. Helping the patient get relief from symptoms is the main goal of treatment. However, expecting a patient to return to usual activities should not be the immediate goal because the physical and mental exertion needed to try to reach that goal may aggravate the illness.

Because CFS is a complicated illness, its management may require input from a variety of medical professionals. Primary care providers can develop effective treatment plans based on their experience in treating other illnesses. Patients benefit when they can work in collaboration with a team of doctors and other health care professionals, who might also include rehabilitation specialists, mental health professionals, and physical or exercise therapists.

Difficulties 

Living with chronic fatigue syndrome can be difficult. Like other debilitating chronic illnesses, CFS can have a devastating impact on patients' daily lives and require them to make major lifestyle changes to adapt to many new limitations.

Common difficulties for CFS patients include problems coping with:

• the changing and unpredictable symptoms
• a decrease in stamina that interferes with activities of daily life
• memory and concentration problems that seriously hurt work or school performance
• loss of independence, livelihood, and economic security
• alterations in relationships with partners, family members, and friends
• worries about raising children

therapy

CBT aims to help reduce the severity of your symptoms and the distress associated with CFS. It works by breaking down overwhelming problems into smaller parts and by breaking the negative cycle of interconnected thoughts, feelings, physical sensations and actions.

Ideally, your CBT therapist will have experience in dealing with CFS and treatment will be offered on a one-to-one basis. The treatment will be tailored to your needs and may include some of the following:

• helping you to accept your diagnosis 
• challenging thoughts that could prevent your symptoms improving 
• trying to increase your sense of control over your symptoms 

The use of CBT does not mean CFS is considered to be a psychological condition. It is often used as a treatment for a variety of long-term conditions, such as cancer and rheumatoid arthritis 

Graded exercise therapy 

Graded exercise therapy (GET) is a structured exercise programme that aims to gradually increase how long you can carry out a physical activity. This will usually involve aerobic exercise (exercise that raises your heart rate) such as swimming or walking. You will have your own exercise programme adapted to your own physical capabilities.

GET should only be carried out by a trained specialist with experience in CFS and, if possible, should be offered on a one-to-one basis. After finding your 'baseline (what you can comfortably do already) in the exercise, you will gradually increase:

• the length of time that you do the exercise 
• the exercise intensity 

As part of your exercise programme, you and your therapist will set goals, such as being able to walk to the shops or carry out some gardening. It may take weeks, months or even years for you to achieve these goals, but it is very important that you do not exceed the exercise duration and intensity set for you. 

Activity management

Activity management is another aspect of your treatment programme that involves setting individual goals and gradually increasing your activity levels. You may be asked to keep a diary of your current activity and rest periods to establish your baseline. Activities can then be gradually increased in a way that you find manageable.

Medication

There is no medication available that can treat CFS specifically, but different medicines may be used to relieve some of the symptoms of the condition.

Over-the-counter painkillers can help ease any muscle pain, joint pain and headaches you may have. Stronger painkillers can also be prescribed by your GP, although they should only be used on a short-term basis. 

If you have chronic (long-term) pain, you may be referred to a pain management clinic. There are about 300 of these across the UK, mostly located in hospitals

If you experience severe nausea due to CFS, you may benefit from a type of medication called an anti-emetic.

Lifestyle advice

As well as these treatments, you may find the lifestyle advice below helpful.

Pacing

Pacing may be a useful way of controlling CFS symptoms. It involves balancing periods of activity with periods of rest.

Pacing means not overdoing it or pushing yourself beyond your limits. If you do, it could slow down your progress in the long term. Over time, you can gradually increase your periods of activity, while making sure they are balanced with periods of rest.

Learning how to make the most of your energy helps increase the amount that you can do. However, you may need to arrange your daily and weekly activities around when you can be active and when you need to rest.

If you pace your activities at a level that is right for you – rather than rushing to do as much as possible in a short space of time – you may be able to make steady progress.

However, it is important to note that there are some uncertainties about pacing. There is insufficient evidence on the benefits or harm of this treatment, although it is often recommended for CFS.

Other self-help techniques

The following recommendations may also help:

• avoid stressful situations 
• avoid alcohol, caffeine, sugar and sweeteners 
• avoid any food and drink that you are sensitive to 
• eat small, regular meals to help reduce any nausea 
• spend time relaxing 
• try not to sleep or nap excessively, as this does not help and may make any sleeping problems worse 

Relapses

A relapse is when your symptoms get worse for some time, leaving you unable to function at the level you previously managed.

Relapses are a common part of CFS and can be caused by a number of factors, such as an infection or an unplanned activity. Sometimes there is no clear cause. 

The healthcare professionals treating you can help you manage your relapse, by:

• including more breaks with your current levels of activities 
• teaching you relaxation and breathing techniques 
• encouraging you to be optimistic about your recovery 

Over time and with treatment, many people with CFS begin to show improvement.

How Possible Is Recovery

A 2014 systematic review reported that estimates of recovery from CFS ranged between 0 to 66% in intervention studies and 2.6 to 62% in naturalistic studies. There was a lack of consensus in the literature on how recovery should be defined, with almost all of the 22 included studies measuring recovery differently. Recovery was operationally defined by reference to, either alone or in combination: fatigue or related symptoms; function; premorbid function; and/or brief global assessment (which was the most common outcome measure, but does not provide information on symptoms and function, and does not "provide assurance that patients have substantially recovered rather than simply improved"). Focusing on only fatigue or function may overestimate recovery rates, because patients may show selective rather than overall change. A patient with reduced self-reported fatigue may still experience functional disruptions, pain, sleep disturbances, or malaise. "Recovery" in the reviewed studies was often based on limited assessments, less than a full restoration of health, and self-reports with a general lack of more objective measures. In the absence of definitive measures, recovery criteria should set high but reasonable standards for behavioural recovery which approach restoration of pre-morbid health. When objective measures are used, such as the relatively objective behavioural measure of actigraphy, the results have been contrary to the cognitive behavioural model of CFS which predicts increased physical functioning as a result of intervention, as otherwise 'successful' trials did not find significant changes in physical activity. The authors state "a more modest interpretation of 'recovery' might characterize such outcomes as successful adaptation of illness-related behaviour and attitudes to ongoing but perhaps diminished illness", "improved or recovered patients may have continued to avoid activity levels that provoked debilitating postexertional symptom flare-ups", which "would seem to be more consistent with a hypothesis of successful adaptation rather than recovery". It was concluded that more precise and accurate labels other than "recovery" (e.g. clinically significant improvement) may be more appropriate and informative for the improvements reported in previous research, and in keeping with commonly understood conceptions of recovery from illness, recommended a consistent definition of recovery that "captures a broad-based return to health with assessments of both fatigue and function as well as the patient’s perceptions of his/her recovery status" and "the recovery time following physical and mental exertion".

Living With Schizophrenia

Schizophrenia is a brain disorder that affects the way a person acts, thinks, and sees the world. People with schizophrenia have an altered perception of reality, often a significant loss of contact with reality. They may see or hear things that don’t exist, speak in strange or confusing ways, believe that others are trying to harm them, or feel like they’re being constantly watched. With such a blurred line between the real and the imaginary, schizophrenia makes it difficult—even frightening—to negotiate the activities of daily life. In response, people with schizophrenia may withdraw from the outside world or act out in confusion and fear.

Most cases of schizophrenia appear in the late teens or early adulthood. However, schizophrenia can appear for the first time in middle age or even later. In rare cases, schizophrenia can even affect young children and adolescents, although the symptoms are slightly different. In general, the earlier schizophrenia develops, the more severe it is. Schizophrenia also tends to be more severe in men than in women.

Although schizophrenia is a chronic disorder, there is help available. With support, medication, and therapy, many people with schizophrenia are able to function independently and live satisfying lives. However, the outlook is best when schizophrenia is diagnosed and treated right away. If you spot the signs and symptoms of schizophrenia and seek help without delay, you or your loved one can take advantage of the many treatments available and improve the chances of recovery.

Early warning signs of schizophrenia

In some people, schizophrenia appears suddenly and without warning. But for most, it comes on slowly, with subtle warning signs and a gradual decline in functioning long before the first severe episode. Many friends and family members of people with schizophrenia report knowing early on that something was wrong with their loved one, they just didn’t know what.

In this early phase, people with schizophrenia often seem eccentric, unmotivated, emotionless, and reclusive. They isolate themselves, start neglecting their appearance, say peculiar things, and show a general indifference to life. They may abandon hobbies and activities, and their performance at work or school deteriorates.

The most common early warning signs of schizophrenia include:

• Social withdrawal
• Hostility or suspiciousness
• Deterioration of personal hygiene
• Flat, expressionless gaze
• Inability to cry or express joy
• Inappropriate laughter or crying
• Depression
• Oversleeping or insomnia
• Odd or irrational statements
• Forgetful; unable to concentrate
• Extreme reaction to criticism
• Strange use of words or way of speaking

While these warning signs can result from a number of problems—not just schizophrenia—they are cause for concern. When out-of-the-ordinary behavior is causing problems in your life or the life of a loved one, seek medical advice. If schizophrenia or another mental problem is the cause, treatment will help.

Signs and symptoms of schizophrenia

There are five types of symptoms characteristic of schizophrenia: delusions, hallucinations, disorganized speech, disorganized behavior, and the so-called “negative” symptoms. However, the signs and symptoms of schizophrenia vary dramatically from person to person, both in pattern and severity. Not every person with schizophrenia will have all symptoms, and the symptoms of schizophrenia may also change over time.

Delusions

A delusion is a firmly-held idea that a person has despite clear and obvious evidence that it isn’t true. Delusions are extremely common in schizophrenia, occurring in more than 90% of those who have the disorder. Often, these delusions involve illogical or bizarre ideas or fantasies. Common schizophrenic delusions include:

• Delusions of persecution – Belief that others, often a vague “they,” are out to get him or her. These persecutory delusions often involve bizarre ideas and plots (e.g. “Martians are trying to poison me with radioactive particles delivered through my tap water”).
• Delusions of reference – A neutral environmental event is believed to have a special and personal meaning. For example, a person with schizophrenia might believe a billboard or a person on TV is sending a message meant specifically for them.
• Delusions of grandeur – Belief that one is a famous or important figure, such as Jesus Christ or Napolean. Alternately, delusions of grandeur may involve the belief that one has unusual powers that no one else has (e.g. the ability to fly).
• Delusions of control – Belief that one’s thoughts or actions are being controlled by outside, alien forces. Common delusions of control include thought broadcasting (“My private thoughts are being transmitted to others”), thought insertion (“Someone is planting thoughts in my head”), and thought withdrawal (“The CIA is robbing me of my thoughts”).

Hallucinations

Hallucinations are sounds or other sensations experienced as real when they exist only in the person's mind. While hallucinations can involve any of the five senses, auditory hallucinations (e.g. hearing voices or some other sound) are most common in schizophrenia. Visual hallucinations are also relatively common. Research suggests that auditory hallucinations occur when people misinterpret their own inner self-talk as coming from an outside source.

Schizophrenic hallucinations are usually meaningful to the person experiencing them. Many times, the voices are those of someone they know. Most commonly, the voices are critical, vulgar, or abusive. Hallucinations also tend to be worse when the person is alone.

Disorganized speech

Fragmented thinking is characteristic of schizophrenia. Externally, it can be observed in the way a person speaks. People with schizophrenia tend to have trouble concentrating and maintaining a train of thought. They may respond to queries with an unrelated answer, start sentences with one topic and end somewhere completely different, speak incoherently, or say illogical things.

Common signs of disorganized speech in schizophrenia include:

• Loose associations – Rapidly shifting from topic to topic, with no connection between one thought and the next.
• Neologisms – Made-up words or phrases that only have meaning to the patient.
• Perseveration – Repetition of words and statements; saying the same thing over and over.
• Clang – Meaningless use of rhyming words (“I said the bread and read the shed and fed Ned at the head").

Disorganized behavior

Schizophrenia disrupts goal-directed activity, causing impairments in a person’s ability to take care of him or herself, work, and interact with others. Disorganized behavior appears as:

• A decline in overall daily functioning
• Unpredictable or inappropriate emotional responses
• Behaviors that appear bizarre and have no purpose
• Lack of inhibition and impulse control

Negative symptoms (absence of normal behaviors)

The so-called “negative” symptoms of schizophrenia refer to the absence of normal behaviors found in healthy individuals. Common negative symptoms of schizophrenia include:

• Lack of emotional expression – Inexpressive face, including a flat voice, lack of eye contact, and blank or restricted facial expressions.
• Lack of interest or enthusiasm – Problems with motivation; lack of self-care.
• Seeming lack of interest in the world – Apparent unawareness of the environment; social withdrawal.
• Speech difficulties and abnormalities – Inability to carry a conversation; short and sometimes disconnected replies to questions; speaking in monotone.

Causes of schizophrenia

The causes of schizophrenia are not fully known. However, it appears that schizophrenia usually results from a complex interaction between genetic and environmental factors. 

Genetic causes of schizophrenia

Schizophrenia has a strong hereditary component. Individuals with a first-degree relative (parent or sibling) who has schizophrenia have a 10 percent chance of developing the disorder, as opposed to the 1 percent chance of the general population. 

But schizophrenia is only influenced by genetics, not determined by it. While schizophrenia runs in families, about 60% of schizophrenics have no family members with the disorder. Furthermore, individuals who are genetically predisposed to schizophrenia don’t always develop the disease, which shows that biology is not destiny. 

Environmental causes of schizophrenia

Twin and adoption studies suggest that inherited genes make a person vulnerable to schizophrenia and then environmental factors act on this vulnerability to trigger the disorder.

As for the environmental factors involved, more and more research is pointing to stress, either during pregnancy or at a later stage of development. High levels of stress are believed to trigger schizophrenia by increasing the body’s production of the hormone cortisol.

Research points to several stress-inducing environmental factors that may be involved in schizophrenia, including:

• Prenatal exposure to a viral infection
• Low oxygen levels during birth (from prolonged labor or premature birth)
• Exposure to a virus during infancy
• Early parental loss or separation
• Physical or sexual abuse in childhood

Abnormal brain structure

In addition to abnormal brain chemistry, abnormalities in brain structure may also play a role in schizophrenia. Enlarged brain ventricles are seen in some schizophrenics, indicating a deficit in the volume of brain tissue. There is also evidence of abnormally low activity in the frontal lobe, the area of the brain responsible for planning, reasoning, and decision-making. 

Some studies also suggest that abnormalities in the temporal lobes, hippocampus, and amygdala are connected to schizophrenia’s positive symptoms. But despite the evidence of brain abnormalities, it is highly unlikely that schizophrenia is the result of any one problem in any one region of the brain. 

Diagnosing schizophrenia

A diagnosis of schizophrenia is made based on a full psychiatric evaluation, medical history, physical exam, and lab tests.

• Psychiatric evaluation – The doctor or psychiatrist will ask a series of questions about you or your loved one's symptoms, psychiatric history, and family history of mental health problems.
• Medical history and exam – Your doctor will ask about your personal and family health history. He or she will also perform a complete physical examination to check for medical issues that could be causing or contributing to the problem.
• Laboratory tests – While there are no laboratory tests that can diagnose schizophrenia, simple blood and urine tests can rule out other medical causes of symptoms. The doctor may also order brain-imaging studies, such as an MRI or a CT scan, in order to look for brain abnormalities associated with schizophrenia.

Hope for schizophrenia

Treatment options for schizophrenia are good, and the outlook for the disorder continues to improve. With medication, therapy, and a strong support network, many people with schizophrenia are able to control their symptoms, gain greater independence, and lead fulfilling lives.

If you think that someone close to you has schizophrenia, you can make a difference by showing your love and support and helping that person get properly evaluated and treated. To learn more, see the related articles below.

Avoiding drugs and alcohol

While alcohol and drugs may provide short-term relief from your symptoms of schizophrenia, they are likely to make your symptoms worse in the long run. Alcohol can cause depression and psychosis, while illegal drugs may make your schizophrenia worse.

Drugs and alcohol can also react badly with antipsychotic medicines.

If you are currently using drugs or alcohol and finding it hard to stop, ask your care co-ordinator or GP for help.

Taking your medication

It is important to take your medication as prescribed, even if you start to feel better. Continuous medication can help prevent relapses. If you have questions or concerns about medication you are taking or any side effects, talk to your GP or care co-ordinator.

It may also be useful to read the information leaflet that comes with the medication about possible interactions with other drugs or supplements. It is worth checking with your healthcare team if you plan to take any over-the-counter remedies, such as painkillers, or any nutritional supplements. This is because these can sometimes interfere with your medication.

As part of the care programme approach, you will be in contact with your healthcare team regularly. A good relationship with the team means you can easily discuss your symptoms or concerns. The more the team knows, the more it can help you.

Self-care

Self-care is an integral part of daily life. It means you take responsibility for your own health and wellbeing with support from those involved in your care.

Self-care includes things you do each day to stay fit, maintain good physical and mental health, prevent illness or accidents, and effectively deal with minor ailments and long-term conditions.

Regular  reviews

People living with long-term conditions can benefit enormously if they have support for self-care. They can live longer, have less pain, anxiety, depression and fatigue, have a better quality of life and are more active and independent.

Schizophrenia and the family: How to help your loved one

If a family member or someone close to you has schizophrenia, you may be struggling with any number of difficult emotions, including fear, guilt, anger, frustration, and hopelessness. The illness may be difficult for you to accept. You may feel helpless in the face of your loved one’s symptoms. Or you may be worried about the stigma of schizophrenia, or confused and embarrassed by strange behaviors you don’t understand. You may even be tempted to hide your loved one’s illness from others.

In order to deal successfully with schizophrenia and help your family member, it’s important to:

• accept the illness and its difficulties
• be realistic in what you expect of the person with schizophrenia and of yourself
• maintain a sense of humor

Do your best to help your family member feel better and enjoy life, pay the same attention to your own needs, and remain hopeful.

Despite your best efforts to prevent relapse, there may be times when your family member’s condition deteriorates rapidly and drastically. During a schizophrenia crisis, you must get help for your family member as soon as possible. Hospitalization may be required to keep your loved one safe.

Emergency planning

It’s important for the family members of people with schizophrenia to prepare for such crisis situations. Having an emergency plan ready for an acute psychotic episode will help you handle the crisis safely and quickly. A good emergency plan for a family member with schizophrenia includes:

• A list of emergency contact information for your loved one’s doctor, therapists, and the police.
• The address and phone number of the hospital you will go to in case of emergency for psychiatric admission. 
• Friends or relatives who will take care of other children or dependents while you deal with the crisis.

It’s also wise to go over the emergency plan with your family member. The crisis situation may be less frightening and upsetting to your loved one If he or she knows what to expect during an emergency.

Living With Asperger Syndrome

About Asperger syndrome

There are many people with Asperger syndrome in the world. 

You cannot tell that someone has Asperger syndrome by looking at them. Because of this  Asperger syndrome is sometimes called a hidden disability.

Asperger syndrome lasts for all of a person's life. Some people know that they have Asperger syndrome when they are children. But sometimes people do not know they have Asperger syndrome until they are older. 

People with Asperger syndrome can do a lot of things and learn a lot of skills. 

 

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Some people with Asperger syndrome find these things difficult 

• They find it difficult to tell people what they need, and how they feel.
• They find it difficult to meet other people and to make new friends.
• They find it difficult to understand what other people think, and how they feel.

Not everyone with Asperger syndrome will find these things difficult. This is because everyone with Asperger syndrome is different. 

 

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What causes Asperger syndrome? 

No one knows why people have Asperger syndrome. 

If your child has Asperger syndrome, it is not because you are a bad parent. 

More than 1 person in a family may have Asperger syndrome. It can be genetic. This means Asperger syndrome can pass from parents to their children. 

 

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How do people with Asperger syndrome behave? 

Here are some ways in which people with Asperger syndrome might behave. 

• They can have good language skills. But some people with Asperger syndrome think that people always mean what they say. For example, someone with Asperger syndrome might not be able to tell when someone is joking.
• They may only talk about their favourite subject. 
• They may be very interested in some things. For example, they may be very interested in trains or the weather. 
• They may want to take part in games or activities with other people. But they may not know how to do this. 
• They may like to play the same game or do the same thing every day.

 

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What else is special about Asperger syndrome? 

Here is some more information about people with Asperger syndrome. 

• They can have a good IQ and may go to the same school as children who do not have a disability. Your IQ is a number. Your IQ is a way of thinking about how much you can learn and what you can do for your age. 
• They may be bullied at school because other children think they are different. Being bullied means being treated badly by other people. 
• They may be very good at something. For example, they may be very good at maths, art or music. 
• They may be very good at learning information. 
• They may be good at concentrating on one activity. Concentrating means to focus your mind on one thing. 
• They may find co-ordination difficult. This means that they may find it difficult to do things like use scissors, use knives and forks, or ride a bike. 
• They may have learning difficulties such as dyslexia. Dyslexia makes it difficult for a person to read and spell words. 
• They may have mental health problems, such as anxiety or depression. 

 

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The 5 senses 

The 5 senses are 

• sight
• sound
• smell
• touch
• taste. 

 

Here is some information about how Asperger syndrome can affect someone's senses. 

Sight 
Some people with Asperger syndrome may not like bright lights and colours. Other people with Asperger syndrome might like them a lot. 

Sound 
Some people with Asperger syndrome may not like loud noises. Other people with Asperger syndrome might like certain noises. 

Smell 
Some people with Asperger syndrome may not like some smells. Other people with Asperger syndrome might like a certain smell. 

Touch 
Some people with Asperger syndrome may not like being touched. Other people with Asperger syndrome might like being touched. 

Taste 
Some people with Asperger syndrome may like to eat the same food every day. Other people with Asperger syndrome might like lots of different food. 

 

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Autism 

Asperger syndrome is a type of autism. 

People with autism find the same things difficult as people with Asperger syndrome. People with autism may also have learning disabilities. Some people with autism may not speak. 

In 1944, an Austrian pediatrician named Hans Asperger observed four children in his practice who had difficulty integrating socially.  Although their intelligence appeared normal, the children lacked nonverbal communication skills, failed to demonstrate empathy with their peers, and were physically awkward.  Their speech was either disjointed or overly formal, and their all-absorbing interest in a single topic dominated their conversations.  Dr. Asperger called the condition “autistic psychopathy” and described it as a personality disorder primarily marked by social isolation. 

Asperger’s observations, published in German, were not widely known until 1981, when an English doctor named Lorna Wing published a series of case studies of children showing similar symptoms, which she called “Asperger’s” syndrome.  Wing’s writings were widely published and popularized.  AS became a distinct disease and diagnosis in 1992, when it was included in the tenth published edition of the World Health Organization’s diagnostic manual, International Classification of Diseases (ICD-10), and in 1994 it was added to the Diagnostic and Statistical  Manual of Mental Disorders (DSM-IV), the American Psychiatric Association’s diagnostic reference book.   However, scientific studies have not been able to definitively differentiate Asperger syndrome from highly functioning autism.  Because autism is defined by a common set of behaviors, changes that were announced in DSM-V (which took effect in mid-2013) represent the various forms under a single diagnostic category, ASD.

How is it diagnosed

The diagnosis of Asperger syndrome is complicated by the lack of a standardized diagnostic test.  In fact, because there are several screening instruments in current use, each with different criteria, the same child could receive different diagnoses, depending on the screening tool the doctor uses.  

Asperger syndrome, also sometimes called high-functioning autism (HFA), is viewed as being on the mild end of the ASD spectrum with symptoms that differ in degree  from  autistic disorder.

Some of the autistic behaviors may be apparent in the first few months of a child’s life, or they may not become evident until later.  

The diagnosis of Asperger syndrome and all other autism spectrum disorders is done as part of a two-stage process.  The first stage begins with developmental screening during a “well-child” check-up with a family doctor or pediatrician.  The second stage is a comprehensive team evaluation to either rule in or rule out AS.  This team generally includes a psychologist, neurologist, psychiatrist, speech therapist, and additional professionals who have expertise in diagnosing children with AS.

The comprehensive evaluation includes neurologic and genetic assessment, with in-depth cognitive and language testing to establish IQ and evaluate psychomotor function, verbal and non-verbal strengths and weaknesses, style of learning, and independent living skills.    An assessment of communication strengths and weaknesses includes evaluating non-verbal forms of communication (gaze and gestures); the use of non-literal language (metaphor, irony, absurdities, and humor); patterns of inflection, stress and volume modulation; pragmatics (turn-taking and sensitivity to verbal cues); and the content, clarity, and coherence of conversation.  The physician will look at the testing results and combine them with the child’s developmental history and current symptoms to make a diagnosis.

Are there treatments

There is no cure for Asperger syndrome and the autism spectrum disorders.  The ideal treatment plan coordinates therapies and interventions that meet the specific needs of individual children.  There is no single best treatment package for all children with AS, but most health care professionals agree that early intervention is best.

An effective treatment program builds on the child’s interests, offers a predictable schedule, teaches tasks as a series of simple steps, actively engages the child’s attention in highly structured activities, and provides regular reinforcement of behavior.  This kind of program generally includes:

• social skills training, a form of group therapy that teaches children with AS the skills they need to interact more successfully with other children

• cognitive behavioral therapy, a type of “talk” therapy that can help the more explosive or anxious children to manage their emotions better and cut back on obsessive interests and repetitive routines

• medication, if necessary, for co-existing conditions such as depression and anxiety

• occupational or physical therapy, for children with sensory integration problems or poor motor coordination

• specialized speech/language therapy, to help children who have trouble with the pragmatics of speech –the give and take of normal conversation, and

• parent training and support, to teach parents behavioral techniques to use at home.

  What research is being done

  Within the Federal government, the National Institute of Neurological Disorders and Stroke (NINDS), a part of the National Institutes of Health (NIH), supports and conducts research on the brain and nervous system.  The NINDS and other NIH components support research on autism spectrum disorders, either at NIH laboratories or through grants to major research institutions across the country.  

  In 1997, at the request of Congress, the NIH formed its Autism Coordinating Committee (NIH/ACC) to enhance the quality, pace, and coordination of efforts at the NIH to find a cure for autism (http://www.nimh.nih.gov/health/topics/autism-spectrum-disorders-pervasive-developmental-disorders/nih-initiatives/nih-autism-coordinating-committee.shtml). The NIH/ACC involves the participation of seven NIH Institutes and Centers: the National Institute of Neurological Disorders and Stroke, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Institute of Mental Health, the National Institute on Deafness and Other Communication Disorders,  the National Institute of Environmental Health Sciences, the National Institute of Nursing Research, and the National Center on Complementary and Alternative Medicine.  The NIH/ACC has been instrumental in the understanding of and advances in ASD research.  The NIH/ACC also participates in the broader Federal Interagency Autism Coordinating Committee (IACC) that is composed of representatives from various component agencies of the U.S. Department of Health and Human Services, as well as the U.S. Department of Education and other government organizations.

  In fiscal years 2007 and 2008, NIH began funding the 11 Autism Centers of Excellence (ACE), coordinated by the NIH/ACC.  The ACEs are investigating early brain development and functioning, social interactions in infants, rare genetic variants and mutations, associations between autism-related genes and physical traits, possible environmental risk factors and biomarkers, and a potential new medication treatment. 

Independant living with aspergers 

Since each case of Aspergers is unique, with symptoms ranging from mild to severe, the quest for independent living is different for each person. A highly functional person with mild Aspergers may require only a structured environment and a little therapy in order to live independently while a person with moderate to severe AS may need life skills training and daily support services to successfully live alone and hold a job.

Parents can prepare a child with Aspergers for independence as an adult by making sure they acquire the necessary skills for independent living and follow an effective intervention program.

Necessary Life Skills for Independent Living

Life skills training is important for all people with Aspergers. Some parents teach life skills at home and some skills are taught by therapists and reinforced by the parents at home. The person with Aspergers' level of impairment determines how much life skills training is necessary. There are life skills training programs for both children and adults for each life stage. Parents can enroll a child in a life skills program. Some programs are one-to-one training, while others are group training. People with Aspergers may need life skills training in the following areas in order to achieve independent living:

• Communication and social skills help
• Speech and language therapy
• Assistance with how to understand and follow directions
• Dressing appropriately for life activities
• Understanding the importance of daily grooming and personal hygiene
• Potty training
• Housekeeping and chore training
• Grocery shopping for balanced diet
• Budget management
• Student life assistance
• Job skills and work environment training

Independent Living Programs

Independent living programs include life skills training to prepare adults with Aspergers to live on their own. The programs provide the necessary skills for a person to deal with the daily life issues and social demands of living independently. Some independent living programs are residential, which require the participant to live on the premises. Under the guidance of trained professionals, participants gradually learn to rely on themselves until they are performing daily tasks independently. These programs can prepare a youth for living on campus in college or for an adult about to get his first apartment.

Therapies That Help Independent Living

A number of therapies can help prepare a person with Aspergers for independent living. Many of these therapies can start in childhood and continue into adulthood. These therapies include:

• Speech and Language Therapy: A person with Aspergers may need speech and language therapy, especially in the areas of participating in two-way conversations and understanding verbal instructions.
• Occupational Therapy: Occupational therapy can help a person with daily life activities necessary for independent living. Learning how to dress appropriately and achieving potty training are examples of occupational therapy.
• Behavioral Therapy: Behavioral therapy can help a person eliminate undesirable behavior that may interfere with independence.
• Sensory Integration Therapy: Sensory integration therapy can people deal with a sensory issue in order to function better without help.

Preparing a Child for Independence

Parents can prepare a child for independence by staying actively involved in all of the child's therapies and educational programs. Working closely with the child's therapists and teachers as well as providing a structured living environment can make a major difference in intervention success. The parental involvement can also help parents recognize when an intervention is working or when new methods are required to best meet the child's needs. Parents should also join family Aspergers support organizations and encourage adult children to seek out Aspergers supportorganizations and services.

Learning about Aspergers and what techniques have helped others achieve independence can help parents and affected individuals dealing with Aspergers. Reading the advice of experts, such as Temple Grandin, a college professor and autism activist who also has autism, can be helpful. Grandin has written extensively on how to help people with autism and Aspergers live independently. In her article, "Transition to Employment and Independent Living for Individuals with Autism and Aspergers," Grandin stresses that working while still in school helps prepare youth for living independently during adulthood. The work experience during her teen years helped her gradually acquire better social and job skills for adulthood, making the transition to college and work life easier. She also encourages adults with Aspergers who have not previously worked or lived alone to pursue job and life skills necessary for independence.

Independence Is Possible

Parents can take comfort in the fact that some level of independent living with Asperger's Syndrome is achievable for many people. The large number of Aspergers support services and programs, effective treatments and the growing Aspergers awareness among employers provide opportunities for a person with Aspergers to strive for independent living. Social service programs can assist people with more severe forms of Aspergers who need daily assistance to live independently. A child with Aspergers can grow up to have fulfilling career, meaningful relationships and independence.