 Trichotillomania is psychological condition that involves strong urges to pull out one's own hair. More common among girls, the condition actually started during the adolescent stage. However, there are reports that trichotillomania can start in children as early as one year old (Kidshealth.org). People with trichotillomania pull hair out at the root from places like the scalp, eyebrows, eyelashes, or pubic area. Some people pull large handfuls of hair, which can leave bald patches on the scalp or eyebrows.
The boy that you see here, is 11-year-old, with the said disorder. According to his mother 'He started to pull out his eyebrows when he was in second grade, then he quit. Then, when he started fourth grade, he started to pull out his hair.'
HOW DID IT START?
Trichotillomania is actually a form of obsessive-compulsive disorder that arises from boredom or anxiety. By their hair one-by-one, somehow, it gives them the satisfaction and calms their nerves. The act then repeats until it becomes a cycle up to the point that the person will become bald in the end. The boy's mother confess that his son is intelligent and tends to get bored at school.
TREATMENT OPTIONS
Management of trichotillomania entails several methods. Primarily, the person needs to receive hair replacement as soon as possible to overcome social stigma. Further social scrutiny can increase the anxiety level of the person and this can just add up to the existing condition. Some authorities believed that instead of hair replacements, a semi-permanent hair piece made of synthetic fibers and woven into a hair piece is the most effective way to provide a positive self-image and minimizes the tendency for future hair-pulling since the hair piece is glued to the scalp. Because of this, the urge to pull hairs can be diverted into other ways. For this boy, he stretches a rubber band.
Overcoming hair-pulling urges may involve a specific type of talk therapy called CBT (cognitive behavioral therapy), medication, or a combination of both. Therapists teach people with trichotillomania special behavior techniques that help them to recognize the urge to pull hair before it becomes too strong to resist (kidshealth.org).
Chronic Obstructive Pulmonary Disease (COPD) is a respiratory condition characterized by irreversible airflow obstruction that interferes with normal breathing and gas exchange. The airflow limitation is progressive and associated with an abnormal inflammatory response of the lungs to noxious particles
or gases. This debilitating disease is actually a combination of chronic bronchitis and emphysema.
The figure on above illustrates the structure of normal lung vs. emphysemic lung.
Host factors play a role in the development of chronic obstructive pulmonary disease (COPD) in smokers. Cigarette smoke activates alveolar macrophages to secrete proteases (multiple cathepsins and matrix metalloproteinases). The activated macrophages release the neutrophil chemoattractants leukotriene B4 and interleukin-8 (amplified by tumor necrosis factor-α [TNF-α]), and the chemoattractants also stimulate neutrophils to release more than the usual amount of cathepsin G and neutrophil elastase. Several oxidants that are present in cigarette smoke or are generated from products of cigarette smoke interact with hydrogen peroxide released from activated alveolar macrophages and neutrophils to oxidize and inactivate α1-antitrypsin and other antiproteases. Cigarette smoke may inhibit the synthesis of elastin, thereby retarding repair of damaged elastin fibers. There is an increased oxidative burden from cigarette smoke and the inflammatory cells (macrophages and neutrophils), and the antioxidant system appears to be inadequate for dealing with the increased oxidants, producing an imbalance. Adverse effects of the oxidant stress include inactivation of antiproteases, membrane lipid peroxidation, DNA and matrix damage, and epithelial injury. As a consequence of the excesses of proteases and the inhibition of antiproteases, the walls of the respiratory bronchioles and the alveoli are damaged, and the altered repair mechanisms prevent remodeling and fibrosis, resulting in emphysema. The oxidative imbalance damages the walls of the airway and, along with the excess proteases, stimulates mucus hypersecretion, producing chronic bronchitis.
| | Chronic bronchitis is defined as cough and sputum production for at least 3 months in each of 2 consecutive years with inflammation and eventual scarring of the bronchial tube lining. When the bronchi are inflamed, airflow to and from the lungs decreases and excessive mucus accumulates, which obstructs the airways. The lining of the bronchial tubes becomes thickened and inflamed and the patient develops an irritating cough. Once inflammation progress, airways become constricted and results into difficulty of airflow. That's why most persons with chronic bronchitis appears blue or cyanotic.
| | Emphysema is the destruction of air sacs (alveoli) in the lungs. Fewer large air sacs means less surface area for oxygen and carbon dioxide (CO2) exchange. This poor exchange leads to shortness of breath and hypoxemia. Symptoms of emphysema include cough, shortness of breath, and limited exercise tolerance.
The culprit, of course, is no other than CIGARETTE SMOKING. Since this condition take its toll in the later part of life, the ability of the person to control smoking is already late, thus treatment and management is seldom futile to most healthcare providers.
Last year, in commemoration with the World COPD Day, a new treatment protocol was released and offered a glimmer of hope in managing COPD. I will include here resources and assessment tools in light with the best practices in
| | The CAT Test The COPD Assessment Test (CAT) is a new questionnaire for people with COPD. It is designed to measure the impact of COPD on a person's life, and how this changes over time. The CAT is very simple to administer, and aims to help clinicians manage a patient's COPD better. (Available in English and Filipino)
Healthcare Professional User Guide for COPD Assessment The GOLD REport (April 2011) Here is the link to download the Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2010. Available from: http://www.goldcopd.org.
Identification of and Risk Factors for COPD Exacerbations PREVENTION OF COPD EXACERBATIONS
 Announcer: Parents and caregivers have always been fascinated with the development of children- their physical and intellectual growth. Studying the development of the adolescent brain has been the life work of National Institute of Mental Health researcher Dr. Jay Giedd.
Dr. Giedd: At different ages of life certain parts of the brain have much more dynamic growth than at other times. And so for very early in life we have our five senses where our visual system and audio system is getting established and optimized for the world around us. In adolescents, the key changes are in the frontal part of the brain involved in controlling our impulses, long range planning, judgment, decision making.
 Announcer: Imaging has shown by the time children reach the first grade the physical size of the brain is nearly complete. But what goes on within the brain is nothing short of remarkable.
Dr. Giedd: The brain can grow extra connections sort of like branches, twigs and roots to use a gardening metaphor and then after it has these connections there’s also another gardening metaphor called pruning or cutting back or eliminating the excess or unused connections. And it’s this process of overproducing and then having fierce competition amongst all these connections to see which ones are most useful and which are most helpful for us to adapt to the environment.
Announcer: Our brains have been challenged by the effects of multi-tasking in many ways brought on by the age of social media and use of computer gadgets.
Dr. Giedd: The way that we get information, entertain ourselves and interact with each other has changed more in the last ten years than in the previous five hundred- since Gutenberg’s introduction of the printing press. And so these changes are a real challenge for researchers because they happen so rapidly. So, that adolescents today average about eleven and a half hours of media time. And this is up from six and a half hours just five years ago so that the activities of children and teens has been changing so much. We’ve been challenged- how do we keep up with the changing world and how do we assess the impact for good or for bad on the developing brain.
Announcer: So how well are our children handing multi-tasking in a digital age that changes, seemingly, by the hour? Early evidence suggests -pretty well. In fact, the human brain has a track record of successfully adapting to challenges it wasn’t initially designed to take on- such as reading.
Dr. Giedd: It’s sobering to realize most humans that have lived and died have never read. And so, we’ve been able to change what our brain does based on having the written word and having this environment. And so now the questions is will we be able to change to keep up with the new flood of information coming from all kinds of sources. And up until now the human brain has done a great job of changing- adapting to these environments but there are limitations to this capacity. And so it will be very interesting to see that these so-called digital natives… the children that have grow up never not knowing the multimedia devices… whether their brains will be able to adapt differently than older people.
 Announcer: So, what was the human brain originally developed to do? Well, Dr. Giedd says our brains are fundamentally designed to learn through example. Dr. Giedd: This learning by example is very powerful and that parents are teaching even when they don’t realize they are teaching just by how they handle everyday aspects of their life. How they treat each other as spouses. How they talk about work. When they get stuck in traffic. How they manage their time and their emotions. And this is how most of the teaching is done. It’s not when you set down at these special moments and have a conversation- it’s the everyday moments that really have a huge impact on how the brain forms and adapts. Announcer: Through the work of Dr. Giedd and his colleagues, we’ve learned so much about the development of the adolescent brain. But researchers like Dr. Giedd may be entering a new golden age of research… as these so-called “digital natives” lead us to new findings in the ever-evolving childhood brain. Adapted from: http://www.nimh.nih.gov/media/video/giedd.shtml
 Heather Hazlett, in the department of psychiatry at the Carolina Institute for Developmental Disabilities, and her colleagues, recently published the results of their research on increasing brain size as relative to autism spectrum disorders (ASD) among children. The results suggest that: - The children with ASD had on average 6% more total brain volume and 9% more volume in the cerebral cortex, the region of the brain that contains the “newest” sprouting of neurons and is responsible for everything from receiving signals and input from the environment to processing memory and attention.
- The children with autism had more surface area in their cortex, in the form of greater convolutions and in-foldings of the tissue. This lead to a conclusion that new nerve cells are being produced that creates the enlarged surface area of the cortex.
IMPLICATIONS: The results of this research can open a new window into understanding the critical early phases of the disorder, when, scientists hope, doctors may be able to intervene and perhaps even reverse the abnormal course of development that leads to autism's social and behavioral symptoms.
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