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Common Mental Changes
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Agitation in the acute porphyrias is often in the form of restlessness.

Such agitation is a part of mental change that often occurs during the acute
episodes of porphyria.

Agitation is unpleasant state of extreme arousal.

Agitation can also appear in the form of increased tension, and irritability.

During acute episodes of porphyria anxiety, stress, and tension
may all occur.

Extreme agitation can lead to confusion.

Often acute porphyria patients will display confusion when taken to an emrgency

Another sign of extre,e agitation in porphyria patients in that of
hyperactivitym and sometimes outright hostility.

Agitation can come on suddenly or gradually.

Agitation can last for just a few minutes or for weeks and even months
depending when porphyria goes into complete remission,. Sometimes signs of
mental change will linger and become chronic if the porphyria remains chronic.

External stimuli, pain, stress, and fever all increase agitation.

Agitation by itself may not have much clinical significance; but, if viewed with
other symptoms, it can be a good indicator of a disease state. Agitation is
commonly associated with the mental change in porphyria.
Agitation is also commonly associated with anxiety which isoften present during
acute episodes of porphyria.

Caffeine can stimulate agitation and should be avoided in all
porphyria patients.

Poprhyria patients experiencing agitation should seek a calm environment and
get plenty of sleep.

Medical personal or family members should avoid restraining an overly-agitated
person if possible, since this usually makes the problem worse.

Communication of feelings is important. It is always important for caregivers to
notify medical personal of the patient's porphyria
especially when there are no other signs or symptoms present.

WIth anxiety the porphyria patients quite often has a feeling of being uptight.

Most often the patient will also feel they are under stress.

Just prior to the clinical onsret of an acute episode many prophyria patients
indicate feeling jittery or apprehensive. Both of these signs are commonly
assoicated with anxiety and the onset of an acute attack.

Anxiety is a feeling of apprehension or fear.

The source of this uneasiness is not always known or recognized, which can add
to the distress it can cause.
Stress is a normal part of life. In small quantities, stress is good -- it motivates
people and can help them be more productive. However, too much stress can
actually harm the brain and body.

Persistent and unrelenting stress often leads to anxiety. This is especially true in
acute porphyria patients as a part of the CNS signs an symptoms of porphyria.

Anxiety is an emotion often accompanied by various physical symptoms,
including the profused sweating, muscle tension, or seizure activity.

In porphyria it is not uncommon to also find a rapid or irregular heart rate in
association with stress, or irritability or insomnia that is a

part of an acute episode.

Finding and addressing the source of anxiety is the preferred and most effective
solution. Unfortunately, this is not always possible.

In most acute porphyria patients the stress and anxiety will lessen as the patient
goes into remission with their acute episode.

Irritability in acute porphyrias is an inconsolability.

Irritability is an excessive response to stimuli.
Irritability who often, in the presence of illness, is demonstrated by increased
fussiness, whining, and fretfulness despite attempts at comforting that would
normally be soothing to the patient.

Irritability is seen at the beginning of some metabolic diseases including the
acute porphyrias when CNS changes occur.

Irritability it can be a very early sign of impending problems.

Although irritability cannot be taken as a symptom or sign of any specific illness,
it should arouse early suspicion that something might be wrong even though
there may not yet be other symptoms.

If the anxiety is not accompanied by any worrisome physical signs and
symptoms as usually found in an acute epsidoe of porphyria, a referral to a
mental health care professional may be recommended for appropriate treatment.

Psychotherapy such as cognitive-behavioral therapy (CBT) has been shown to
significantly decrease anxiety.

Delirium is also a part of the mental change found during acute episodes of

Delirium is an acute confusional state.

Delirium is a condition of severe confusion.

Acute confusional states are usually the result of a physical illnessin porphyria
patients experiencing CNS mental changes.

Such delirium and mental changes are usually temporary and reversible.

Delirium may be caused by diseases of body systems by fluid/electrolyte
changes that take place. This is frequent in acute porphyria patients.

Infections such as urinary tract infections or pneumonia may trigger delirium in

Delirium involves a rapid alternation between mental states (for example, from
lethargy to agitation and back to lethargy), with attention disruption,
disorganized thinking, disorientation, changes in sensation and perception, and
other symptoms.

Neurologic examination may reveal abnormalities, including abnormal reflexes
and abnormal levels of normal reflexes.
Psychologic studies and tests of sensation, cognitive function, and motor
function may be abnormal.

The specific lesion, extent of damage, and cause of delirium may be indicated by
the results of tests and procedures, including, but not limited to serum
electrolytes, serum calcium, liver function tests,
ammonia levels,B-12 levels, and thyroid levels.

The goal of treatment is to control or reverse the cause of the symptoms, which
varies with the specific condition causing delirium.

The person should be in a pleasant, comfortable, non-threatening, physically
safe environment for diagnosis and initial care. Hospitalization may be required
for a short time.

Stopping or changing medications that worsen confusion, or that are not
essential to the care of the person, may improve cognitive functioning even
before treatment of the underlying disorder.

Delirium often lasts only about 1 week, although it may take several weeks for
cognitive function to return to normal levels. Full recovery is common.

Pain and stress go hand in hand.

When you're in pain, you're less able to handle the stress of everyday life.

Common hassles turn into major obstacles.

Stress may also cause you to do things that intensify your pain,
such as tense your muscles, grit your teeth and stiffen your shoulders.

In short, pain causes stress, and stress intensifies pain.

The first step in breaking this pain-stress cycle is to realize that stress is your
response to an event, not the event itself. It's something you can control.

That's why events that are stressful for some people aren't for

Dr. Kenneth Carlson
Neuropsychiatric Medicine

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