Acanthosis Nigricans: A Skin Disorder

Many of us may not have heard or aware of the skin disorder called Acanthosis nigricans. U.S. National Library of Medicine (2012) stated that Acanthosis nigricans is a skin disorder in which there is darker, thick, soft skin in body folds and creases. Some people who have seen Acanthosis nigricans among their friends and relatives may perceive this as a dirty skin because of lack of personal hygiene, but the child and teenagers must be struggling to hide and cure it. Indeed, there is no relation of this skin disorder with unhygienic behavior and person may end up by using different chemicals in the skin that further irritate the skin and increase the level of stress.

 Acanthosis nigricans does not normally appear with other symptoms besides changes in the skin. Later on, dark, thick and smooth skin can spread in other parts of the body. I can be appeared in the groin, neck folds, knees, armpits, knuckles, fingers and toes.

Do not worry! Acanthosis nigricans is not dangerous and communicable in nature. Obesity can lead to this skin disorder, as can some endocrine disorders. It is often found in people with obesity-related insulin resistance. So, the important thing to consider is to control your obesity. As this disorder is seen with the children who are obese or overweight and the symptoms go away after losing the body weight. According to American Diabetes Association, 75% of kids with type 2 diabetes develop Acanthosis nigaricans (AN). Hence, do not forget to consult your healthcare provider in order to test your blood for sugar level because you are at greater risk for developing diabetes.

Dowshen (2010) suggested that practice eating healthy and exercise regularly or remain physically active, which will help lose your weight and ultimately the darkness of skin will become less noticeable.

My advice: Even though, the appearances of your skin can make you feel embarrassed and self-conscious about the body image, you should remain motivated to prevent future disorder by understanding the pattern of existing disease. Sharing is always the best idea to relieve your stress, so do not wait and afraid to share your feeling with the people who love you.

References

Dowshen, S. (2010). Acanthosis nigricans: TeensHealth. Retrieved from http://kidshealth.org/teen/your_body/skin_stuff/acanthosis.html

U.S. National Library of Medicine. (2012). Acanthosis nigaricans: PubMed Health. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001855/

Paranoid Personality Disorder

Paranoid Personality disorder is a long term psychiatric disorder with the extensive and unjustifiable suspicious characteristics that other people (especially spouse or partner) are aggressive and argumentative. These doubtful behaviors are persistently continues even in the absence of any real supporting evidence. American Journal of psychotherapy revealed that suspiciousness, feeling mistreated, and grandiosity constitute the classical triad associated with paranoid personality. According to DSM-IV-TR, at least four of the following criteria have to be fulfilled:

• Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her

• Preoccupied with unjustified doubts about the loyalty or trust-worthiness of friends or associates

• Reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her

• Reads benign remarks or events as threatening or humiliating

• Persistently bears grudges, i.e., is unforgiving of insults, injuries, or slights

• Perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack

• Has recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner.

Characteristics of Paranoid Personality

·         Outwardly, paranoid individuals are demanding, arrogant, mistrustful, driven, unromantic, moralistic, and acutely alert towards the external environment.

·         Internally, they are frightened, timid, self-doubting, gullible, inconsiderate, vulnerable to erotomania, and cognitively unable to grasp the totality of actual events.

Causes

The actual causes of paranoid personality disorders are unknown, but this disorder is more prevalent in a person who has family history of mental disorders. In addition, children who are exposed to adult anger and rage with no way to predict the outbursts and no way to escape or control them develop paranoid ways of thinking in an effort to cope with the stress. It would emerge when this type of thinking becomes part of the individual's personality when child becomes adult.

Symptoms

Although people with paranoid personality disorder do not have any hallucinations or delusions, they often feel insecure, remain isolated and misinterpret compliments. They search for the evidence to support their suspicions. They perceive day to day communication and inoffensive comments as an insult and blame others because they lack insights of real environment. Some symptoms are:

·         feelings of certainty, without justification or proof, that others are intent on harming or exploiting them

·         Unfriendly, grandiosity, aggressive, isolated,

·         Likely to blame others without strong reason

·         Suspiciousness and distrust of others

·          Questioning hidden motives in others

Diagnosis

Paranoid Personality Disorder is diagnosed on the basis of their symptoms, but there are no blood tests or genetic tests that can confirm the diagnosis. The diagnosis and treatment should be done by psychiatrist or mental health professionals.

Treatment

The treatment for paranoid personality patient is very difficult because patient of this disorder are suspicious and untrusting towards doctors and not likely to seek therapy by themselves. The role of patient's family members or relatives is crucial to encourage him or her to seek professional treatment. If treatment is accepted, talk therapy and medications can often be effective, but the nature of the disorder poses very serious challenges to therapists. The patients may actively resist or refuse to cooperate with others who are trying to help them. The best use of medication may be given for specific complaints of patients to develop trust worthy relationship with the patient. Once the patient start trusting the therapist enough, he/she will ask for relief from particular symptoms.

Psychotherapy, antidepressants, mood stabilizers, antipsychotics, anti-anxiety medications are effective for treating paranoid personality disorder. Encyclopedias of mental disorders mentioned that the selective serotonin reuptake inhibitor (fluoxetine or Prozac) can help to reduce anxiety, angriness, irritable and suspiciousness behaviors.

References

Akhtar, S. (1990). Paranoid personality disorder: a synthesis of developmental, dynamic, and descriptive features. American Journal of Psychotherapy. Retrieved from http://www.researchgate.net/publication/20971692_Paranoid_personality_disorder_a_synthesis_of_developmental_dynamic_and_descriptive_features

Encyclopedias of mental disorders. (2013). Paranoid Personality Disorder. Retrieved from http://www.minddisorders.com/Ob-Ps/Paranoid-personality-disorder.html

U.S. National Library of Medicine. (2010). Paranoid personality disorder: PubMed Health. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001934/

Increased Autonomy of Nurse Practitioner: A solution to the physician shortages

In the United States the issues of skyrocketed healthcare cost and shortage of primary care physician are more prevalent. Healthcare reform is the sizzling debate's topic between legislator and savvy people. Although some reluctant forces do not want to collaborate and give autonomy to Nurse Practitioners, NPs work has already proved that they can be the best solution of the existing shortages of primary care physician and increased healthcare cost. For this reason today I am going to reveal the importance of Nurse practitioner involvement in politics to gain increased autonomy over mandatory collaboration. 

Moreover, resolving the concern of primary care provider shortage and minimize the healthcare cost, Nurse Practitioners act as resolution. The political involvement of Nurse Practitioners assist in transforming the health care system and filling the gap of primary care physician in the under-served areas. All Nurse Practitioners and nursing associations should determinedly work together with policy makers to achieve reasonable and justifiable quality healthcare for all citizen including 48 million uninsured Americans, then only it is possible to change the mandatory collaboration. Pericak (2011) addressed that the solution of Physician Shortage can be done by increasing Nurse Practitioners Autonomy. Washington, New Hemisphere and Texas are the examples, who already succeeded in breaking the statutory collaborative practices because they worked together with the legislators. They did not give up their tenacious effort and unity with other advanced practice nurses. In addition, Texas was stricter in mandatory collaboration than New York, so New York NPs have to be inspired by the Texas NPs. They should be unified to focusing the social, economic, and political obstacles of healthcare, after that NPs can magnificently able to use their power to influence judicial decision.

            Furthermore, Association of American Medical Colleges (2008) depicted similar facts regarding the declined interest of medical student towards primary care. The medical school graduates of the United States choosing family medicine decreased by nearly 27% from 2002 to 2007 and the overall deficit of primary care providers are expected to worsen. Also, Healthy people 2020 outlined healthcare access, individual behavior, social environment, physical environment and genetics as the determinants of health and NPs are well educated to address these issues. Nurse practitioners can give high quality of patient centered care with nearly 155,000 solutions for this scarcity of primary care by lowering the cost (American Academy of Nurse practitioner, 2012). So, NPs can conjure up the cost of healthcare issues and fulfill the scarcity of primary care physician.

In contrast, even NPs can be a good reason for the solution of primary care providers' crisis, because of mandatory collaboration they are not allowed to practice in the underserved areas, where there is deficiency of physician to collaborate.  Additionally, Burgess and Purkis (2010, December) mentioned that politics plays the vital role for the autonomy of Nurse Practitioner and requires collaboration at all levels of healthcare system for the improvement of their role integration.  Burgess, Martin, and Senner (2011) found five keys for the NP role integration; role autonomy is one of them and pointed out that inconsistent support from site managers and policy leaders is a barrier.

Nurses are the center of healthcare system and there can be no healthcare systems without nurses. As the Patient protection and affordable healthcare act emphasized preventive approach through primary care settings, more nurse practitioners will be needed. Since, the number of doctors' interest in primary care is decreasing every year, to fill this void NPs require more autonomy and this can be achieved when they are connected to legislatures or work together to formulate policy. Furthermore, Nurse Practitioner should maintain their quality of education and sound practice to deliver affordable and quality services in underserved areas and throughout the world.

References

Association of American Medical Colleges (2008). Why is there a shortage of primary care doctors? Retrieved from https://www.aamc.org/linkableblob/70310-6/data/primarycarefs-data.pdf

American Academy of Nurse Practitioner (2012). What’s an NP? Retrieved from http://www.aanp.org/all-about-nps/what-is-an-np

Burgess, J.,& Purkis, ME (2010). The power and politics of collaboration in nurse practitioner role development. PubMed.org. 17(4):297-308. Doi: 10.1111/j.1440-1800.2010.00505.x.

Burgess, J., Martin, A., & Senner, M., (2011). A framework to assess nurse practitioner role integration in primary health care: Canadian Journal of Nursing Research, 43(1): 22-40

Pericak, A. (2011). Increased autonomy for nurse practitioners as a solution to the physician shortage. Journal of the New York State Nurses Association, 42(1-2), 4-7. PMID: 22187859 NLM UID: 7507218