Gonococcal arthritis is also known as disseminated gonococcal infection. It is usually the inflammation of joint which occurs due to gonorrhea infection.  The causes and risk factors are many. It is an infection of joint. The occurrence of this is mainly found in people who have gonorrhea that is caused by bacteria. The bacterium is called as Neisseria gonorrhoeae. More than men, the women are affected. It is very common among adolescent girls who are sexually active.

There are two forms of gonococcal arthritis:

  • In one form many joints and skin rashes are involved. The joints are usually large such as the ankle, wrist and knee.
  • The second form involves the spread of bacteria through blood. This causes an infection of a single joint.

The symptoms of this arthritis include:

  • Lower abdominal pain
  • Fever
  • Joint pain
  • Pain in wrists and hands owing to tendon inflammation
  • Burning or pain during urination
  • Pain in single joint
  • Skin rashes are pinkish. They also contain pus sometimes.

It is necessary to get the blood cultures tested. These tests are done for checking whether there is gonorrhea infection. This also involves taking the samples of stool, tissues and joint fluids. These are then sent to the laboratory for examination under microscope.  The tests include:

  • Culture of joint aspirate
  • Cervical gram stain
  • Throat culture
  • Joint fluid gram stain
  • Urine test for gonorrhea

Proper treatment of gonorrhea infection is very essential. There are various aspects involved in the treatment of this infection. The first one involves curing the person. The second one involves the location and treatment of the infected person for preventing further spread of disease.

Anemia is a medical condition which rises in human body due to the deficiency of hemoglobin in the blood and is commonly known as poor man disease. Irrespective of its anemia can cause to any human being from any class of society. There are several types of anemia which can be caused due to various reasons. But what’s important is that it should be taken seriously. The treatment of anemia is done on the basis of its factor. In medical terms anemia is not a disease but a deficiency which leads to other disorder in the body.  There are over 400 types of anemia however most of them are rare. Below are some of the common forms of anemia:

Forms of Anemia

Pernicious Anemia– Pernicious anemia causes due to the lack of Vitamin B12 in the human body. This type of anemia is quite common in age group of 50-60 years. Pernicious anemia is mostly caused due to hereditary factor but in some cases autoimmune disorders also cause Pernicious Anemia.  The symptoms of Pernicious anemia are Dyspnea, fatigue, heat palpitations and numbness or tingling sensation in the body.

Aplastic anemia- Aplastic anemiais generally caused due to the reduction in quantity of red blood cells in human blood. The major cause of Aplasitc anemia is heavy blood loss due to injury or heavy menstruation, exposure to toxins or hepatitis. The reduction in red blood cells make a human body exposed to various infections as less RBC results in decreased fighting ability of the body. The symptoms of aplastic anemia includes pale skin, increased heartbeat, multiple infections, heart failure, heavy bleeding and lethargy.

Sickle cell anemia– Sickle cell anemia is caused in a human body which is suffering from a lifelong disease. In Sickle cell anemia the red blood cells are formed in the form of sickle by human body, these red blood cells are tend to form clumps which get stuck in the blood vessels causing serious organ damage, pain and multiple infections. High fever, rapid heartbeat, fatigue, jaundice, pale skin and severe pain in the body are some of the symptoms of Sickle cell anemia.

Thalassemia – Thalassemia is a genetically inherited disorder which leads to heavy damages to red blood cells. The levels of Thalassemia totally depend upon how much haemoglobin is produced by blood cells during this time. The symptoms of Thalassemia are swelling in liver and spleen, chest pain, dizziness, dark colored urine.

Iron deficiency anemia – Iron deficiency anemia, as the name suggests, is caused due to the deficiency of iron in human body. Iron plays an important role in the production of red blood cells in human body. Any reduction in the quantity of iron in human body can affect the production of red blood cells which causes Iron deficiency anemia.  The deficiency of iron can be due to heavy blood loss, poor diet, chronic illness and gastrointestinal infections. The body suffering from Iron deficiency anemia shows symptoms such as frequent headaches, irritability, brittle hairs and nails, increased heartbeat.

Classification of Anemia

 

Anemia is broadly classified as:

 

Microcytic Anemia– Microcytic Anemia is a term used to characterize a type of anemia which is caused when the size of the red blood cells (RBC) is smaller than the usual. In Microcytic Anemia these red blood cells are even paler than usual RBCs as they cannot perform hemoglobin synthesis. Now Microcytic Anemia is a broad classification and some types of Anemia like Iron deficiency anemia, sideroblastic anemia, and anemia caused due to chronic disease, lead poisoning, pyridoxine deficiency all fall under this category.

 

Macrocytic Anemia- Macrocytic Anemia is again not a disease but a condition in where the red blood cells or RBCs are larger than their usual volume. In Macrocytic Anemia condition the larger red blood cells so the collective number of the cells decreases and also each cell contains insufficient amount of hemoglobin. Macrocytic Anemia can be further classified in two main parts which are known as megaloblastic anemia and non megaloblastic anemia. Megaloblastic anemia is caused due to the lack of vitamin b12 or folic acid in human body. Pernicious anemia can be characterized under Macrocytic Anemia as pernicious anemia is caused because of poor capability of human body to absorb vitamin b12.

 

Normocytic Anemia- Normocytic Anemia is caused when size of red blood cell remains normal but the overall level of hemoglobin is increased.  Some types of Anemia caused as a result of chronic disease, hemolytic anemia and aplastic anemia all can be categorized as Normocytic Anemia. Normocytic Anemia can also be caused when a person suffers from acute blood loss.

 

Dimorphic – Dimorphic is a condition when a human body suffers from two or more causes of anemia simultaneously.

Agitated Depression

It’s quite common to associate depression with state of low energy and slow physical or mental activity. Well, it is not always the case and Depression may manifest itself in form of physical and emotional agitation.

Agitated state of depression is basically a type of major depressive disorder that is characterized by physical and emotional restlessness, insomnia, and irritable mood.

The patients with agitated depression are driven by hypomania. They experience episodes of anger, agitation and irritability. Another name for agitated depression is mixed mania. Agitation is specifically severe in agitated depression patients.

Diagnostic Criteria for Agitated Depression

A psychiatrist does the diagnosis of agitated depression after carefully evaluating the symptoms of the patient. In some cases, agitation may also result from other severe cases of depression.

According to the Diagnostic criteria of Statistical Manual of Mental Disorders (DSM-IV), a patient is said to have agitated depression in case he/she meets both the following criteria.

  • Major depressive episode
  • Any two of the following manic episodes
  • Motor agitation
  • Psychic agitation
  • Racing thoughts

Forms of Agitated Depression

The agitated depression comprises of following three major forms.

  • Psychotic Agitated Depression (Severe form of melancholia)
  • Non-psychotic Agitated Depression (moderate form of agitation)
  • Excited Agitated Depression (Patient feels racing thoughts)

Treatment of Agitated Depression

The psychiatrists usually recommend the combination therapy including Psychotherapy and Medicines for treating agitated depression.

  • Psychotherapy involves imparting anger management skills and relaxing techniques to the patients.
  • Medication comprises of following medicines.
  • Mood stabilizers such as valproic acid and lamotrigine
  • Atypical antipsychotics such as olanzapine, ziprasidone and aripirizole

Psychotic depression

Hallucinations and delusions may be experienced by depressed patient in severe cases. Such form of depression is called as Psychotic depression that is characterised by severe depressive illness with co-existing psychosis.

Psychotic depression may be seen in patients hospitalised for depression. The psychosis may manifest in form of hallucinations, delusions, or unrealistic experiences. It is more common in patients suffering from schizophrenia.

Patients may see or hear imaginary sounds, voices and visuals. Unlike the manic depressive episodes, the hallucinations in psychotic depression are not “positive” and patient complains of frightening sounds and images.

Symptoms of Psychotic Depression

Patients with psychotic depression may present following symptoms.

  • Intellectual impairment
  • Physical immobility
  • Agitation
  • Insomnia
  • Anxiety
  • Psychosis
  • Constipation
  • Hypochondria

Treatment of Psychotic Depression

The treatment for psychotic depression is done by experienced psychiatrists in the hospital.

Medications used for treating psychotic depression include combinations of antidepressants and antipsychotic medications.

Common Antipsychotic/ Neuroleptic drugs are quetiapine, ziprasidone, risperidone, and olanzapine.

These affect neurotransmitters and are better tolerated than earlier antipsychotics drugs.

The antipsychotic medications are usually effective and patients are usually recovered within a year. In some cases, psychiatrists may recommend electroconvulsive therapy (ECT) for those patients who do not respond to medications.

As the psychotic depression is a serious disease, it is imperative for the patients to work closely with the doctors so that doctors can prescribe most effective drugs with minimum side effects.