Wednesday, 15 August 2012


Tongue acts as an easily accessible organ for the assessment of health of an individual and shows the state of hydration of the body. It is said that tongue is the mirror of the gastrointestinal system and any abnormal functioning of the stomach and intestines will be reflected on the tongue. 

Some characteristic changes occur in the tongue in some particular diseases.That is why the examination of the tongue is very essential and will give some clues for diagnosis. All doctors examine the tongue and they consider the changes in size,shape,colour,moisture,coating,nature of papillae and movements ect. 

Appearance of tongue in some abnormal conditions:- 

1) Movements of the tongue:-

a) In one sided paralysis of the body(hemiplegia)tongue moves towards the parylised side when protruded. 

b) Tremulus movement of the tongue is seen in diseases like thyrotoxicosis,delirium tremens and parkinsonisum.Tremor is also seen in nervous patients. 

c) In progressive bulbar palsy there will be wasting and paralysis of the tongue with fibrillation. Eventually the tongue gets shrivelled and lies functionless in the floor of the mouth. This condition is associated with dribbling of saliva and loss of speech. 

d) In chorea(involuntary rhythmic movements) the patient may not be able to keep the protruded tongue in rest,it will be moving involuntarily.

2) Moistness of the tongue:-

The moistness of the tongue gives some indication about the state of hydration of the body.Water volume depletion leads to peripheral circulatory failure characterised by weakness,thirst,restlessness,anorexia,nausea,vomiting, dry and parched tongue.

Dryness of the tongue is seen in following conditions.

a) Diarrhoea
b) Later stages of severe illness
c) Advanced uraemia
d) Hypovolumic shock
e) Heat exhaustion
f) Hyponatraemia
g) Acute intestinal obstruction
h) Starvation
i) Prlonged fasting.

3) Change in colour of tongue:-

a) Central cyanosis:-

Cyanosis is the bluish discolouration of the mucus membrane due to decrease in the amount of oxygen in the blood.This is seen in heart failure,respiratory failure and in anoxia.In cyanosis tongue,lips ect becomes pale bluish.

b) Jaundice:-

This is the yellowish discolouration of all mucus surfaces of the body (including tongue)due to increase of bilirubin in the blood.Jaundice is seen in hepatitis,bile duct obstruction,increased destruction of RBCs and ect...

c) Advanced uremia:-

This is the increase of urea and other nitrogenous waste products in the blood due to kidney failure.Here the tongue become brown in colour. 

d) Keto acidosis:-

This is the acidosis with accumulation of ketone bodies seen mainly in diabetes mellitus.Here the tongue become brown with a typical ketone smell from the mouth. 

e) Riboflavin deficiency:-

Deficiency of this vitamin (vitamin B2) produces megenta colour of the tongue with soreness and fissures of lips. 

f) Niacin deficiency:-

Deficiency of niacin (vitamin B3)and some other B complex vitamins results in bright scarlet or beefy red tongue. 

g) Anaemia:-

It is the decrease in haemoglobin percentage of the blood.In severe anaemia tongue becomes pale. 

4) Coating on the tongue:-

a) Bad breath:-

The main cause for bad breath is formation of a pasty coating(bio film) on the tongue which lodges thousands of anaerobic bacteria resulting in the production of offenssive gases.Those who complain about bad breath may have thick coating on the posterior part of the tongue. 

b) Typhoid fever:-

In typhoid fever tongue becomes white coared like a fur. 

c) Candidiasis;-

It is a fungal infection which affects the mucus surfaces of the body.On the tongue there will be sloughing white lesions.

d) In diabetes and hypoadrenalism there will be sloughing white lesions.

e) Secondary syphilis:-

Syphilis is a sexually transmitted diseased caused by trepenoma pallidum infection.In secondary stage of this disease we can see mucous patches which are painless,smooth white glystening opalescent plaques which can not be scraped off easily. 

f) Leokoplakia:-

Here white keratotic patches are seen on the tongue and oral cavity.This is a precancerous condition.

g) AIDS:-

In these patients hairy leukoplakia is seen. 

h) Peritonitis:-

It is the inflammation of the peritonium(inner covering of abdominal cavity which also covers the intestines and keep them in position) in this condition there is white furring of the tongue. 

i) Acute illness:-

Furring is also seen in some acute diseases. 

5) Papillae:-

These are small projections on the rongue associated with taste.There are different type of papillae on the healthy tongue.In some diseases there are some abnormal changes which are following. 

a) Hairy tongue:-

This condition is due to elongation of filiform papillae seen in poor oral hygeine ,general debility and indigestion. 

b) Geographic tongue:-

Here irregular red and white patches appear on the tongue.These lesions looks like a geographic map.The excact cause is not known. 

c) Median rhomboid glossitis:-

In this condition there is smooth nodular red area in the posterior mid line of the tongue.This is a congenital condition. 

d) Nutritional deficiency:-

In nutrional deficiency there is glossitis(inflammation of tongue) leading to papillary hypertrophy followed by atrophy. 

e) Benign migratory glossitis:-

It is an inflamatory condition of the tongue where multiple annular areas of desquamation of papillae appear on the tongue which shift from area to area in few days.

f) Thiamine and riboflavin deficiency:-

Deficiency of these vitamins cause hypertrophied filiform and fungiform papillae.

g) Niacin and iron deficiency:-

In this condition there is atrophy of papillae.Smooth tongue is encountered in iron deficiency. 

h) Vitamin A deficiency:-

This causes furrowed tongue. 

i) In nutritional megaloblastic anaemia tongue becomes smooth. 

j) Folic acid deficiency:-

Here macrocytic megaloblastic anaemia with glossitis is seen. 

k) Cyano coblamine deficiency:-

Here glossitis with macrocytic megaloblastic anaemia and peripheral neuropathy is encountered. 

l) Scarlet fever;-

In this streptococcal infection there is bright red papillae standing out of a thick white fur ,later the white coat disappear leaving enlarged papillae on the bright red surface and is called strawberry tongue. 

6) Ulcers on the tongue:-- 

a) Apthous ulcer:-

These are round painful ulcers appear in stressed individuals frequently. May be associated with food allergy.Usual sites are tongue,lips,oral mucosa and ect. 

b) Herpes simplex:-

It is an acute vesicular eruptions produced by herpes simplex virus.When these vesicles rupture it forms ulcers. 

c) Ulcer in cancer:-

Cancerous ulcers are having everted edges with hard base.Bleeding is also seen.Cancer of the tongue is common in tobacco chewers. 

d) Syphilitic ulcers:-

Syphilitic fissures are longitudinal in direction.In primary syphilis extra genital chancre is seen on the tongue.In secondary syphilis multiple shallow ulcers are seen on the under surface and sides of the tongue.In tertiary syphilis gumma may be seen on the midline of the dorsum of the tongue.

e) Dental ulcers:-

These ulcers are produced by sharp edges of carious teeth.

Saturday, 11 August 2012

Osessive Compulsive Disorder (OCD)

Obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by uncontrollable, unwanted thoughts and repetitive, ritualized behaviors you feel compelled to perform. If you have OCD, you probably recognize that your obsessive thoughts and compulsive behaviors are irrational – but even so, you feel unable to resist them and break free.

Like a needle getting stuck on an old record, obsessive-compulsive disorder (OCD) causes the brain to get stuck on a particular thought or urge. For example, you may check the stove twenty times to make sure it’s really turned off, wash your hands until they’re scrubbed raw, or drive around for hours to make sure that the bump you heard while driving wasn’t a person you ran over.

Understanding OCD obsessions and compulsions

Obsessions are involuntary, seemingly uncontrollable thoughts, images, or impulses that occur over and over again in your mind. You don’t want to have these ideas but you can’t stop them. Unfortunately, these obsessive thoughts are often disturbing and distracting.
Compulsions are behaviors or rituals that you feel driven to act out again and again. Usually, compulsions are performed in an attempt to make obsessions go away. For example, if you’re afraid of contamination, you might develop elaborate cleaning rituals. However, the relief never lasts. In fact, the obsessive thoughts usually come back stronger. And the compulsive behaviors often end up causing anxiety themselves as they become more demanding and time-consuming.
Most people with obsessive-compulsive disorder (OCD) fall into one of the following categories:
  • Washers are afraid of contamination. They usually have cleaning or hand-washing compulsions.
  • Checkers repeatedly check things (oven turned off, door locked, etc.) that they associate with harm or danger.
  • Doubters and sinners are afraid that if everything isn’t perfect or done just right something terrible will happen or they will be punished.
  • Counters and arrangers are obsessed with order and symmetry. They may have superstitions about certain numbers, colors, or arrangements.
  • Hoarders fear that something bad will happen if they throw anything away. They compulsively hoard things that they don’t need or use.
Just because you have obsessive thoughts or perform compulsive behaviors does NOT mean that you have obsessive-compulsive disorder. With OCD, these thoughts and behaviors cause tremendous distress, take up a lot of time, and interfere with your daily life and relationships.

Signs and symptoms of obsessive-compulsive disorder (OCD)

Most people with obsessive-compulsive disorder (OCD) have both obsessions and compulsions, but some people experience just one or the other.

OCD signs and symptoms: Obsessive thoughts

Common obsessive thoughts in obsessive-compulsive disorder (OCD) include:
  • Fear of being contaminated by germs or dirt or contaminating others.
  • Fear of causing harm to yourself or others.
  • Intrusive sexually explicit or violent thoughts and images.
  • Excessive focus on religious or moral ideas.
  • Fear of losing or not having things you might need.
  • Order and symmetry: the idea that everything must line up “just right.”
  • Superstitions; excessive attention to something considered lucky or unlucky.

    OCD signs and symptoms: Compulsive behaviors

    Common compulsive behaviors in obsessive-compulsive disorder (OCD) include:
    • Excessive double-checking of things, such as locks, appliances, and switches.
    • Repeatedly checking in on loved ones to make sure they’re safe.
    • Counting, tapping, repeating certain words, or doing other senseless things to reduce anxiety.
    • Spending a lot of time washing or cleaning.
    • Ordering or arranging things “just so.”
    • Praying excessively or engaging in rituals triggered by religious fear.
    • Accumulating “junk” such as old newspapers or empty food containers.

    Obsessive-compulsive disorder (OCD) symptoms in children

    While the onset of obsessive-compulsive disorder usually occurs during adolescence or young adulthood, younger children sometimes have symptoms that look like OCD. However, the symptoms of other disorders, such as ADD, autism, and Tourette’s syndrome, can also look like obsessive-compulsive disorder, so a thorough medical and psychological exam is essential before any diagnosis is made.

    Therapy as treatment for obsessive-compulsive disorder (OCD)

    The most effective treatment for obsessive-compulsive disorder is often cognitive-behavioral therapy. Antidepressants are sometimes used in conjunction with therapy, although medication alone is rarely effective in relieving the symptoms of OCD.

    Cognitive-behavioral therapy for obsessive-compulsive disorder (OCD)

    Cognitive-behavioral therapy for obsessive-compulsive disorder (OCD) involves two components:
    1. Exposure and response prevention involves repeated exposure to the source of your obsession. Then you are asked to refrain from the compulsive behavior you’d usually perform to reduce your anxiety. For example, if you are a compulsive hand washer, you might be asked to touch the door handle in a public restroom and then be prevented from washing. As you sit with the anxiety, the urge to wash your hands will gradually begin to go away on its own. In this way, you learn that you don’t need the ritual to get rid of your anxiety—that you have some control over your obsessive thoughts and compulsive behaviors.
    2. Cognitive therapy focuses on the catastrophic thoughts and exaggerated sense of responsibility you feel. A big part of cognitive therapy for OCD is teaching you healthy and effective ways of responding to obsessive thoughts, without resorting to compulsive behavior.

      Four Steps for Conquering Symptoms of Obsessive-Compulsive Disorder (OCD)

      Psychiatrist Jeffrey Schwartz, author of Brain Lock: Free Yourself from Obsessive-Compulsive Behavior, offers the following four steps for dealing with OCD:
      • RELABEL – Recognize that the intrusive obsessive thoughts and urges are the result of OCD. For example, train yourself to say, "I don't think or feel that my hands are dirty. I'm having an obsession that my hands are dirty." Or, "I don't feel that I have the need to wash my hands. I'm having a compulsive urge to perform the compulsion of washing my hands."
      • REATTRIBUTE – Realize that the intensity and intrusiveness of the thought or urge is caused by OCD; it is probably related to a biochemical imbalance in the brain. Tell yourself, "It's not me—it’s my OCD," to remind you that OCD thoughts and urges are not meaningful, but are false messages from the brain.
      • REFOCUS – Work around the OCD thoughts by focusing your attention on something else, at least for a few minutes. Do another behavior. Say to yourself, "I'm experiencing a symptom of OCD. I need to do another behavior."
      • REVALUE – Do not take the OCD thought at face value. It is not significant in itself. Tell yourself, "That's just my stupid obsession. It has no meaning. That's just my brain. There's no need to pay attention to it." Remember: You can't make the thought go away, but neither do you need to pay attention to it. You can learn to go on to the next behavior.
      Source: Westwood Institute for Anxiety Disorders

      Family therapy for OCD treatment

      Because OCD often causes problems in family life and social adjustment, family therapy can often be beneficial.
      • Family therapy promotes understanding of the disorder and can help reduce family conflicts.
      • It can motivate family members and teach them how to help their loved one.

      Group therapy for OCD treatment

      Through interaction with fellow OCD sufferers, group therapy provides support and encouragement and decreases feelings of isolation.

      Self-help for OCD tip 1: Challenge obsessive thoughts and compulsive behaviors

      If you have obsessive-compulsive disorder (OCD), there are many ways you can help yourself in addition to seeking therapy.

      Refocus your attention

      Learn to recognize and reduce stress

      When you’re experiencing OCD thoughts and urges, try shifting your attention to something else.
      • You could exercise, jog, walk, listen to music, read, surf the web, play a video game, make a phone call, or knit. The important thing is to do something you enjoy for at least 15 minutes, in order to delay your response to the obsessive thought or compulsion.
      • At the end of the delaying period, reassess the urge. In many cases, the urge will no longer be quite as intense. Try delaying for a longer period. The longer you can delay the urge, the more it will likely change.

      Write down your obsessive thoughts or worries

      Keep a pad and pencil on you, or type on a laptop, smartphone, or tablet. When you begin to obsess, write down all your thoughts or compulsions.
      • Keep writing as the OCD urges continue, aiming to record exactly what you're thinking, even if you’re repeating the same phrases or the same urges over and over.
      • Writing it all down will help you see just how repetitive your obsessions are.
      • Writing down the same phrase or urge hundreds of times will help it lose its power.
      • Writing thoughts down is much harder work than simply thinking them, so your obsessive thoughts are likely to disappear sooner.

      Anticipate OCD urges

      By anticipating your compulsive urges before they arise, you can help to ease them. For example, if your compulsive behavior involves checking that doors are locked, windows closed, or appliances turned off, try to lock the door or turn off the appliance with extra attention the first time.
      • Create a solid mental picture and then make a mental note. Tell yourself, “The window is now closed,” or “I can see that the oven is turned off.”
      • When the urge to check arises later, you will find it easier to relabel it as “just an obsessive thought.”

        Create an OCD worry period

        Rather than trying to suppress obsessions or compulsions, develop the habit of rescheduling them.
        • Choose one or two 10 minute “worry periods” each day, time you can devote to obsessing. Choose a set time and place (e.g. in the living room from 8:00 to 8:10 a.m. and 5:00 to 5:10 p.m.) that’s early enough it won’t make you anxious before bedtime.
        • During your worry period, focus only on negative thoughts or urges. Don’t try to correct them. At the end of the worry period, take a few calming breaths, let the obsessive thoughts or urges go, and return to your normal activities. The rest of the day, however, is to be designated free of obsessions and compulsions.
        • When thoughts or urges come into your head during the day, write them down and “postpone” them to your worry period. Save it for later and continue to go about your day.
        • Go over your “worry list” during the worry period. Reflect on the thoughts or urges you wrote down during the day. If the thoughts are still bothering you, allow yourself to obsess about them, but only for the amount of time you’ve allotted for your worry period. 

          Create a tape of your OCD obsessions

          Focus on one specific worry or obsession and record it to a tape recorder, laptop, or smartphone.
          • Recount the obsessive phrase, sentence, or story exactly as it comes into your mind.
          • Play the tape back to yourself, over and over for a 45-minute period each day, until listening to the obsession no longer causes you to feel highly distressed.
          • By continuously confronting your worry or obsession you will gradually become less anxious. You can then repeat the exercise for a different obsession.

            Self-help for OCD tip 2: Take care of yourself

            A healthy, balanced lifestyle plays a big role in keeping OCD behavior, fears, and worry at bay.

            Practice relaxation techniques

            While stress doesn’t cause OCD, a stressful event can trigger the onset of obsessive and compulsive behavior, and stress can often make obsessive-compulsive behavior worse.
            • Mindful meditation, yoga, deep breathing, and other stress-relief techniques may help reduce the symptoms of anxiety brought on by OCD.
            • Try to practice a relaxation technique for at least 30 minutes a day.

            Adopt healthy eating habits

            Start the day right with breakfast, and continue with frequent small meals throughout the day. Going too long without eating leads to low blood sugar, which can make you feel more anxious.
            • Eat plenty of complex carbohydrates such as whole grains, fruits, and vegetables. Not only do complex carbs stabilize blood sugar, they also boost serotonin, a neurotransmitter with calming effects.

            Exercise regularly

            Exercise is a natural and effective anti-anxiety treatment that helps to control OCD symptoms by refocusing your mind when obsessive thoughts and compulsions arise.
            • For maximum benefit, try to get 30 minutes or more of aerobic activity on most days. Aerobic exercise relieves tension and stress, boosts physical and mental energy, and enhances well-being through the release of endorphins, the brain’s feel-good chemicals.

            Avoid alcohol and nicotine

            Alcohol temporarily reduces anxiety and worry, but it actually causes anxiety symptoms as it wears off. Similarly, while it may seem that cigarettes are calming, nicotine is actually a powerful stimulant. Smoking leads to higher, not lower, levels of anxiety and OCD symptoms.

            Get enough sleep

            Not only can anxiety and worry cause insomnia, but a lack of sleep can also exacerbate anxious thoughts and feelings. When you’re well rested, it’s much easier to keep your emotional balance, a key factor in coping with anxiety disorders such as OCD.

            Self-help for OCD tip 3: Reach out for support

            Obsessive-compulsive behavior (OCD) can get worse when you feel powerless and alone, so it’s important to build a strong support system. The more connected you are to other people, the less vulnerable you’ll feel. Just talking about your worries and urges can make them seem less threatening.

            Stay connected to family and friends

            Obsessions and compulsions can consume your life to the point of social isolation. In turn, social isolation can aggravate your OCD symptoms. It’s important to have a network of family and friends you can turn to for help and support. Involving others in your treatment can help guard against setbacks and keep you motivated.

            Join an OCD support group

            You’re not alone in your struggle with OCD, and participating in a support group can be an effective reminder of that. OCD support groups enable you to both share your own experiences and learn from others who are facing the same problems. For a searchable database of OCD support groups, see the Resources and References section below.

            Helping a loved one with obsessive-compulsive disorder (OCD)

            If a friend or family member has OCD, your most important job is to educate yourself about the disorder. Share what you’ve learned with your loved one and let them know that there is help available. Simply knowing that OCD is treatable can sometimes provide enough motivation for your loved one to seek help.

            Tips for helping a friend or family member with OCD

            The way you react to a loved one’s OCD symptoms can have a big impact.
            • Negative comments or criticism can make OCD worse, while a calm, supportive environment can help improve the outcome of treatment. Focus on the sufferer’s positive qualities and avoid making personal criticisms.
            • Don’t scold someone with OCD or tell the person to stop performing rituals. They can’t comply, and the pressure to stop will only make the behaviors worse. Remember, your loved one’s OCD behaviors are symptoms, not character flaws.
            • Be as kind and patient as possible. Each sufferer needs to overcome problems at their own pace. Praise any successful attempt to resist OCD, and focus attention on positive elements in the person’s life.
            • Do not play along with your loved one’s OCD rituals. Helping the sufferer with rituals will only reinforce the behavior. Support the person, not their rituals.
            • Create a pact to not allow OCD to take over family life. Sit down as a family and decide how you will work together to tackle your loved one’s OCD symptoms. Try to keep family life as normal as possible and the home a low-stress environment.
            • Communicate positively, directly and clearly. Communication is important so you can find a balance between standing up to the OCD and not further distressing your loved one.
            • Find the humor. Seeing the humor and absurdity in some OCD symptoms can help the sufferer become more detached from the disorder. Of course, a situation is only humorous if the sufferer finds it funny, too.

            Best Of Luck...