What is Depression?

What is depression?

The word 'depression' causes much confusion. It's often used to describe when someone is feeling 'low', 'miserable', 'in a mood' or having 'got out of bed on the wrong side'.
However, doctors use the word in two different ways. They can use it to describe the symptom of a 'low mood', or to refer to a specific illness, ie a 'depressive illness'. This factsheet relates to depression, the illness.
This confusion is made all the worse because it is often difficult to tell the difference between feeling gloomy and having a depressive illness.
Doctors make a diagnosis of depression after assessing the severity of the low mood, other associated symptoms and the duration of the problem.
Depression is very common. Almost anybody can develop the illness; it's certainly NOT a sign of weakness.
Depression is also treatable. You may need to see a doctor, but there are things you can do yourself or things you can do to help somebody suffering from the illness.
What you cannot do is 'pull yourself together' – no matter whether this is what you think you should be able to do or what other people tell you to do.
People who have experienced an episode of depression are at risk of developing another in the future. A small proportion may experience an episode of depression as part of a bipolar affective disorder(manic depression), which is characterised by episodes of both low and high moods.

Who gets depressed?

• Depression is very common.
• Between 5 and 10 per cent of the population are suffering from the illness to some extent at any one time.
• Over a lifetime you have a 20 per cent, or one in five, chance of having an episode of depression.
• Women are twice as likely to get depression as men.
• Bipolar affective disorder is less common than depressive illness with a life-time risk of around one to two per cent. Men and women are equally affected.

Getting depression is not a sign of weakness. There are no particular 'personality types' that are more at risk than others.
However, some risk factors have been identified. These include inherited (genetic) factors – such as having parents or grandparents, who have suffered from depression, and non-genetic factors – such as the death of a parent when you were young.

What causes depression?

• We do not fully understand the causes of depression.
• Genes or early life experiences may make some people vulnerable.
• Stressful life events, such as losing a job or a relationship ending, may trigger an episode of depression.
• Depression can be triggered by some physical illness, drug treatments and recretional drugs.

It's often impossible to identify a 'cause' in many people, and this can be distressing for people who want to understand the reasons why they are ill.
However depression, like any illness, can strike for no apparent reason.
It's clear that there are definite changes in the way the brain works when a person is depressed.

• Modern brain scans that can look at how 'hard' the brain is working have shown that some areas of the brain (such as at the front) are not working as well as normal.
• Depressed patients have higher than normal levels of stress hormones.
• Various chemical systems in the brain may not be working correctly, including one known as the serotonin or 5-HT system.
• Antidipresent may help to reverse these changes.

Symptoms of depression

Stress can lead to you to feeling 'down' and 'miserable'. What is different about a depressive illness is that these feelings last for weeks or months, rather than days.
In addition to feeling low most or all of the time, many other symptoms can occur in depressive illness (though not everybody has every one).

• Being unable to gain pleasure from activities that normally would be pleasurable.
• Losing interest in normal activities, hobbies and everyday life.
• Feeling tired all of the time and having no energy.
• Difficulty sleeping or waking early in the morning (though some feel that they can't get out of bed and 'face the world').
• Having a poor appetite, no interest in food and losing weight (though some people overeat and put on weight – 'comfort eating').
• Losing interest in sex.
• Finding it difficult to concentrate and think straight.
• Feeling restless, tense and anxious..
• Being irritable.
• Losing self-confidence.
• Avoiding other people.
• Finding it harder than usual to make decisions.
• Feeling useless and inadequate – 'a waste of space'.
• Feeling guilty about who you are and what you have done.
• Feeling hopeless – that nothing will make things better.
• Thinking about suicide – this is very common. If you feel this way, talk to somebody about it. If you think somebody else might be thinking this way, ask them about it – it will not make them more likely to commit suicide.

How is depression diagnosed?

Unfortunately, there's no brain scan or blood test that can be used to diagnose when a person has a depressive illness.
The diagnosis can only be made from the symptoms.
Generally speaking a diagnosis of depression will be made if a person has a persistently low mood that significantly influences their everyday life and has been present for two weeks or more, and there are also three or four or more other symptoms of depression.

Who treats people with depression?

• general practisners(GP), most commonly help treat people with depression.
• Patients may also be seen by counsellors, who are often attached to GP surgeries.
• If the diagnosis is unclear, or the person is particularly ill, the GP may refer the patient to a psychiatrict.
• Patients may be referred tocommunity psychiatric nurses (CPNs)  by their GP or psychiatrist.
• People suffering from depression may also be seen by CBT therapist and other psychotherapist.

Treatments for depression

Sometimes when we are going through a 'bad patch' in our life, it's enough to talk through our problems with a friend or relative.
However, this may not be enough and we may need to seek professional help.
The important thing to remember about depression is that it's treatable.
There are many different types of treatment. These include medication and talking therapies (psychotherapy).

Psychotherapy

• There are many different forms of psychotherapy.
• Simply talking to somebody or your doctor about your problems is a form of psychotherapy and can help greatly.
• It's far better to talk about your problems than 'bottling-up' your emotions.
• More formal psychotherapy includes counselling, cognitive behavioral therapy(CBT), interpersonal psychotherapy (IPT) and dynamic psychotherapy or psychoanalysis.

As a general, rule psychotherapies are as effective as medication for the treatment of mild depression. However, for more severe illnesses, medication is likely to be needed but may be supplemented with psychotherapy.
Exactly which type of therapy a doctor recommends depends on the particular problems a patient is suffering from, the views of the patient and local availability of psychotherapy. There's little evidence to suggest that one form of therapy is better than another.

Medication

• Antidepressant medication (for example fluoxetine) helps to correct the 'low' mood and other symptoms experienced during depression – they are NOT 'happy pills'.
• Antidepressants do not change your personality.
• Antidepressants are NOT addictive.

In the last few years, there has been an explosion of new antidepressant medications. The main advantage of these new drugs is that they have fewer side effects than older drugs and so are more pleasant to take.
Your doctor will choose which medication to prescribe for you based on the side-effects of the drugs and your particular symptoms. We do not fully understand how antidepressants work. However, they appear to act on chemicals in the brain to correct the abnormalities that cause the illness.
When taking medication, it's important to remember:

• to take your medication regularly
• you are unlikely to see any improvement in your symptoms for two to four weeks after starting the medication
• once you have started to respond, you should slowly improve over several weeks
• current World Health Organization guidelines recommend that patients continue to take their medication for six months after having recovered. This is to prevent a recurrence of the illness when the medication is stopped
• antidepressants are effective for both treating episodes of depression and also for preventing further episodes of illness. Some patients who have had severe or many episodes of illness are therefore recommended to take medication for a long time
• stopping to take medication once you feel well is a common cause of a return of the symptoms of depression. You should therefore only stop after discussion with your doctor
• generally coming off antidepressants is not a problem, though usually you should gradually reduce the dose of the medication over a few weeks rather than stopping abruptly. If you stop antidepressants abruptly you may notice anxiety, headache, stomach upset, sleep disturbance or other symptoms.

What happens if you do not respond to treatment?

Some people unfortunately do not get better with simple straightforward treatments.
It may be that they need to try a higher dose or different antidepressants. A combination of medication and psychotherapy could also be helpful.
It may be necessary for these people to be referred to a psychiatrist for more specialised help. The psychiatrist will want to talk about the problems the person is suffering and find out about background information, such as work and family, previous health or emotional problems and current medication.
The psychiatrist may then recommend different treatments. Rarely, it may be necessary for the person to be admitted to hospital if the depression is very severe. This is only necessary in about 1 in 100 patients with depression.

Electroconvulsive therapy (ECT)

Most people do not like the idea of electroconvulsive therapy (ECT). It's a treatment that is reserved only for patients who have severe depression, for which it's highly effective and can work faster than medication.
It involves having a brief anaesthetic, which sends the person to sleep for 5 to 10 minutes. While asleep, a muscle-relaxing drug is given and a small electric current is passed through the brain for a fraction of a second.
Once the person has woken, it takes half an hour or so to get over the effects of the anaesthetic.
ECT is only given under the close supervision of an anaesthetist, a psychiatrist and nursing staff.
Most commonly, ECT is administered twice a week and around 6 to 10 treatments are necessary to treat the depression, though an effect may be seen after the first one or two treatments.
There's no evidence that properly administered ECT damages the brain in any way.

What to do if you are depressed

• Talk to people about how you feel. Don't bottle things up. It is NOT a sign of weakness to get help for your problems, in the same way that it would not be to get medical help for a broken leg or a chest infection.
• Although you may not be able to do the things you normally would (such as work), try to keep active as much as you can. Lying in bed or sitting thinking about your problems can make them seem worse. Physical exercise can also help depression and keep your mind off your worries.
• Do not increase your alcohol intake to try and 'drown your sorrows' or help you sleep better. Alcohol will only make the depression worse and harder to treat.
• If you are having problems sleeping, try not to lie in bed thinking about your problems and anxieties. Do something to take your mind off your worries, such as reading or listening to the radio.
• Self-help books may be helpful. Check out the health section of any good bookshop.
• If you are feeling suicidal or desperate contact a voluntary sector organisation, such as the samaritans.
• Always remember that you are suffering from an illness. It is not you being weak, and you can NOT simply 'pull yourself together'. Your illness is treatable. You are also NOT ALONE. Depression is extremely common.

What to do if you know somebody who is depressed

Sometimes people are not aware that they are depressed. This can happen when the depression comes on slowly.
In addition many people suffering from depression blame themselves for not coping as they normally would, rather than thinking there might be some illness that has caused them to be this way. The illness can make a person think that it would be a sign of weakness to seek help for their difficulties. If you think that this has happened to somebody, you should try to talk to him or her about it.
Also try to remember the following.

• Listening can really help.
• Avoid saying, 'pull yourself together' or other remarks that make the person think that it is their fault that they are ill.
• If the person's problems do not sort themselves out in a week or so, suggest that the person seek professional help. Remind the person that this is not a sign of weakness or of being a failure.
• Don't nag the person or try to get them to do what they normally would. Remember they are suffering from an illness.
• Remind the person that they have an illness, it's not their fault and they'll get better no matter how hopeless they feel.
• Try to help them avoid resorting to alcohol, which does not help the situation. If the person talks of harming themself or committing suicide, take this seriously. Insist that they see a doctor.
• Remember that it does NOT increase the chances of a person committing suicide to talk to them about it.

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Detailed about Schizophrenia ?

What is schizophrenia?

Schizophrenia is a major mental illness that causes changes in perception, thoughts and behaviour.
It is a complex condition that defies simple description, but a distinction can be made between two broad types: acute schizophrenia and chronic schizophrenia.

Acute schizophrenia

This is the form that probably most comes to mind when people think of schizophrenia.
Acute schizophrenia is when a previously healthy person, generally a young adult, shows increasingly odd behaviour over a fairly short period of time of perhaps a few weeks.
It can take the form of hallucinations, irrational beliefs or disordered thoughts, ie illogical or incoherent thinking of any degree of severity.

'Positive' symptoms

The most common symptoms of acute schizophrenia are:

• lack of insight
• auditory hallucinations (hearing sounds, voices or music)
• delusions of persecution
• suspiciousness
• flat mood
• thoughts spoken aloud.

These symptoms are called the positive symptoms of schizophrenia.
Not all patients with acute schizophrenia experience all of these symptoms.

Mood disturbance often accompanies acute schizophrenia and can be of any type, such as depression and anxiety, irritability or euphoria.
Emotional responses are often inappropriate for their surroundings – for example, laughing at sad news or appearing unconcerned by important events.
Generally, a schizophrenic knows where they are in time and place, but the presence of disordered thoughts may make them feel confused.
Higher mental reasoning is usually impaired and they often lack insight into their condition. They find it difficult to plan things or organise themselves.

Spotting the signs

Usually a person suffering from schizophrenia will not know they are experiencing symptoms of the illness.
By definition, hallucinations and delusions are experienced as real by the person having them.
As a result, the person with schizophrenia may have different perceptions of the world compared with the rest of us.

Delusions

The following delusions are strongly suggestive of schizophrenia:

• the belief they are under the control of another influence
• that thoughts are being put into or taken out of their mind.

If a person has delusions of persecution, they may be suspicious of any questions about their mental state.

Often the person may feel persecuted or 'got at' in some way, which can cause fear and anxiety.
Other people may notice a change in the person's behaviour, or in the content of their speech.
Sufferers may become preoccupied with certain issues that seem bizarre to those around them.
They may express paranoid ideas or respond to the hallucinations they experience. These hallucinations usually take the form of hearing voices that other people cannot hear.

Chronic schizophrenia

This is the longer-term state and is characterised by:

• a lack of drive
• underactivity
• social withdrawal.

Left to their own devices, schizophrenics may spend long periods of time doing nothing, or engage in repeated and purposeless activity. Sometimes they can neglect themselves quite markedly.
As with the acute state, hallucinations and delusions are common.
Sometimes in chronic schizophrenia the person appears to become used to these disordered thoughts.
For example, they might harbour the idea that someone is trying to get at them, but this does not cause any emotional reaction.

'Negative' symptoms

The most common symptoms of chronic schizophrenia are:

• social withdrawal
• underactivity and slowness
• lack of conversation or interests
• odd ideas or behaviour
• neglect of appearance
• depression.

These symptoms are often called the negative symptoms of schizophrenia.
Not all people with chronic schizophrenia experience all of the symptoms.

How common is schizophrenia?

Worldwide schizophrenia is present in two to four people per 1000 of the population at any one time. One in 100 people will develop schizophrenia in their lifetime.

How does schizophrenia develop?

The cause of schizophrenia is unknown, but it may have a genetic component.
There is no 'gene for schizophrenia' but a family history of the illness increases the risk of being affected:

• if a grandparent had the illness, the risk rises to 3 per cent
• if one parent was affected, the risk is as high as 10 per cent
• this rises to 40 per cent if both parents have schizophrenia.

Other predisposing factors in the development of schizophrenia include complications during pregnancy or childbirth and difficulties in childhood development.
Factors that may trigger an episode of schizophrenia include stressful life events, and the use of illegal drugs, such as cannabis.

What can schizophrenics and their families do to help themselves?

If you think you are experiencing symptoms of schizophrenia, you should seek help from your doctor.
However, one of the features of the disease is sufferers do not understand they are unwell during acute episodes of illness. It is therefore important that family and friends are able to seek help on their behalf.
The first point of call should be the person's family doctor or mental health team worker.
Schizophrenics who are on long-term medication should continue to take this medication, because it has a protective effect against future relapses.

How does the doctor make a diagnosis?

The diagnosis is based on an assessment of the history given by the patient and by any other people who are able to give further information.

What is the course of the disease?

• About a quarter of the people diagnosed with schizophrenia will have one episode of illness, make a good recovery and have no further problems.
• A further 25 per cent will develop a long-term chronic illness with no periods of remission.
• The remaining 50 per cent of those diagnosed will have a long-term illness that comes and goes with periods of remission and relapse.

The long-term outcome may be worse in people:

• with poor social support
• with a strong family history of schizophrenia
• in whom the illness came on slowly
• in whom treatment was delayed.

Male sex and continuing use of illicit drugs are also associated with a poorer outcome.
The risk of relapse is significantly improved by continuing appropriate medication for at least six months after an acute episode.
Positive family intervention may also help to maintain periods without illness, as can help with social skills training and psychological therapy.
People with schizophrenia have higher rates of depression than the general population. There are also high rates of suicide among people with schizophrenia.

What medicines can treat schizophrenia?

Injections

Antipsychotic drugs can be given as an injection that lasts for days or weeks, called a depot injection.
It is often used to prevent a relapse after recovery from acute illness.
It also helps those who prefer it to remembering daily medication.

There are many different  avaantipsychotic medicinesilable, all of which aim to calm someone without making them excessively drowsy.
Modern treatments are called atypical antipsychotics and include:
These are said to have fewer side-effects than some of the older antipsychotics, and so are now the usual treatment for most patients.
Examples of the older treatments include:     amisulpride (eg Solian)olanzapine (eg Zyprexa)quetiapine (eg Seroquel)risperidone (eg Risperdal)clozapine (eg Clozaril)     chlorpromazine (eg Largactil)hyaloperidol (eg Haldol)trifluoperazine (eg Stelazine)
  
Although not a cure, studies show antipsychotic medicines improve the symptoms of schizophrenia and help prevent relapse.
They are effective against the positive symptoms of schizophrenia, eg hallucinations, but have little impact on the negative symptoms, such as lack of motivation and flat mood.
Antipsychotic medicines have important short-term and long-term side-effects.
Side-effects can include:

• sedation
• dry mouth
• constipation
• blurred vision
• light-headedness.

Antipsychotic medicines can also affect movement, for example in slowing gait or causing tremor or abnormal face and body movements.
If these side-effects occur, your doctor may change your dose or prescribe other medicines to help with the side-effects, or another antipsychotic medicine can be tried that may cause less problems.
A long-term movement problem known as tardive dyskinesia occurs in some patients who are on treatment for a prolonged period.
Because there is a high risk that schizophrenia symptoms will recur, treatment should continue for at least one to two years.
If taking medication is a problem then a GP or specialist can prescribe injectable antipsychotic treatment usually given monthly and many patients find this very useful.

Is therapy helpful?

Research shows interventions with the families of schizophrenics can reduce relapse rates.
These family interventions usually last several weeks and consist of education about the illness and help with problem solving.
Research also suggests a type of psychological therapy known as cognitive behavioural therapy may help to reduce relapse rates. Further studies are required in this area.
There is limited evidence that giving people with schizophrenia help and training in social skills may help prevent relapses.

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Detailed about Tuberculosis?

What is tuberculosis?

Tuberculosis (TB) is a disease caused by an infection with the bacteria Mycobacterium tuberculosis complex.
During the 19th century, up to 25 per cent of deaths in Europe were caused by this disease. It used to be called the 'white death' as opposed to the Black Death caused by plague.
The death toll began to fall as living standards improved at the start of the 20th century, and from the 1940s, effective medicines were developed.
However, there are now more people in the world with TB than there were in 1950, and 3 million individuals will die this year from this disease – mainly in less developed countries.
It is estimated that any one time, up to a third of the world's population have been infected with TB.
The disease is more common in areas of the world where poverty, malnutrition, poor general health and social disruption are present.
In the UK, too, the number of TB cases is again rising.alcholic, hiv positive person, some recent immigrants and healthcare workers are at increased risk.
The disease is most commonly found in places such as hostels for the homeless, prisons, and centres for immigrants arriving from areas with high rates of hiv infection or inadequate health provision.

What parts of the body are affected by tuberculosis?

Lung TB: TB commonly presents as a disease of the lungs. However, the infection can spread via blood from the lungs to all organs in the body.
This means that you can develop tuberculosis in the pleura (the covering of the lungs), in the bones, the urinary tract and sexual organs, the intestines and even in the skin.
Lymph nodes in the lung root and on the throat can also get infected.
Tuberculous meningitis is sometimes seen in newly infected children. This form of the disease is a life-threatening condition.
Non-lung TB is an important cause of skin, bowel and gynaecological problems.

How do you catch tuberculosis?

Lung TB: the bacteria that cause the disease are inhaled in the form of microscopic droplets that come from a person with tuberculosis.
When coughing, speaking or sneezing, the small droplets are expelled into the air. They dry out quickly, but the bacteria itself can remain airborne for hours.
However, the tuberculosis bacteria are killed when exposed to ultraviolet light, including sunlight.
Non-Lung TB: infected milk or dairy products can cause the mycobacterium to set up infections in the gastro-intestinal tract and also affect the reproductive systems in men and women.

How does the disease develop inside the body?

Lung TB: after the tuberculosis bacteria have been inhaled they reach the lungs and, within approximately six weeks, a small infection appears that rarely gives any symptoms. This is called a primary infection.
After this, the bacteria can then spread through the blood. If you have a healthy immune system, in most cases the infection will remain dormant without doing any obvious harm.
Non-Lung TB: a similar process as above but the route of entry may be through the gut.
Months or even years later, however, the disease can become reactivated in different organs if the immune system is weakened. The lungs are the favourite place for the illness to strike.

What are the symptoms?

Typical signs of tuberculosis are:

• chronic or persistent cough and sputum production. If the disease is at an advanced stage the sputum will contain blood
• fatigue
• lack of appetite
• weight loss
• fever
• night sweats.

Tuberculosis can mimic many forms of disease and must always be considered if no firm diagnosis has been made.
Other non-tuberculous mycobacteria found in soil and water can cause disease in susceptible patients with a history of cystic fibrosis, chronic lung damage, alcoholism and immunosuppression (suppression of immune responses by a disease or drugs).
These atypical mycobacteria can be present as colonising organisms without necessarily causing disease.

When should I see a doctor?

If you have a persistent cough with sputum for more than three weeks or you see blood in your sputum or unexplained weight loss or unexplained night ,sweats, you should contact your doctor.

How does the doctor make the diagnosis?

Lung TB: the doctor cannot always hear enough to make a diagnosis by just using a stethoscope.
If your physician suspects there is something wrong and that it is not just a cold, you may be referred to an outpatient department for people with lung diseases or to an X-ray department.
The chest x ray examination is the most important test. If there are changes in the lungs, a sample of sputum will be sent for microscopic element and culture.
Culture of tuberculosis bacteria will take 4 to 12 weeks. For this reason, it takes some time before an accurate diagnosis is possible.
Quicker methods using DNA techniques are now available, and a skin reaction Mantoux test can sometimes be a great help.
In this test, tuberculin, which is a substance extracted from the tubercle bacteria, is injected into the skin.
If the skin shows a strong reaction after 72 hours, it means there is hypersensitivity to tuberculin protein acquired either by a previous BCG vaccination, or possibly due to an active infection.
Non-Lung TB: The diagnosis may only be made after surgical exploration.
In both lung and non-lung TB, we now have blood tests that can tell if you are on of the two-thirds in the world never infected (a negative test).
If the test is positive you either have active TB (which may be infective to others) or you have latent TB (which may become active if your immune system is made less effective by steroids, age or HIV).

Are there other diseases with similar symptoms?

Lung TB: bronchitis,  pneumonia, smoker's lung and lung cancercan all show practically the same symptoms as tuberculosis.
If tuberculosis is suspected, tests will need to be done to rule out the presence of these other diseases. Examination of sputum will usually include a check for cancer if the chest X-ray raises any suspicion of this type of diagnosis.
Non-Lung TB: can be confused with cancers, it can be a cause of a wide range of gastro-intestinal symptoms, infertility and unusual skin lesions.

Where can I get a vaccination against tuberculosis?

In the UK, BCG vaccination (with live but weakened tubercle bacteria) is no longer routinely given to all children of secondary school age.
The highest rates of the disease occur in particular risk groups and it now makes more sense to target BCG vaccination for people who are at greatest risk of the disease.
The vaccine is now recommended for:

• infants under one year of age living in areas where the incidence of TB is 40 cases per 100,000 people or higher (technically this applies to London, UK)
• infants under one year of age whose parents or grandparents were born in a country with an incidence of TB of 40 cases per 100,000 people or higher
• children with risk factors for TB who have not previously been vaccinated
• new immigrants from countries with a high incidence of TB who have not already been vaccinated
• contacts of people diagnosed with TB affecting the lungs
• health care workers, veterinary staff, staff working in prisons, residential homes, shelters for the homeless or hostels for refugees
• people intending to live, travel or work in countries with a high incidence of TB for more than a month.

Vaccination is thought to reduce the likelihood of subsequent pulmonary TB and effectively prevents varieties of blood-borne tuberculosis such as miliary TB or tuberculosis meningitis in infants, which can be difficult to diagnose in time and can cause devastating damage.

How is tuberculosis treated?

Today, treatment involves three or four different kinds of antibiotic  given in combination over six to nine months.
Multiple medicines are necessary to prevent the emergence of resistance, which would lead to treatment failure and the nightmare of multiple drug-resistant organisms.
Single medicines must never be added to a failing treatment regime. Therapy should be directed by a chest physician who will have specialist knowledge of the complications and side-effects of TB medicines.
Attention to the details of treatment are vital. The main cause of treatment failure is non-compliance with what is perceived as a demanding and prolonged programme of therapy.
Those patients who are microscopy or smear positive are infectious and, if possible, should avoid contact with other people for two weeks.
Patients do not require hospital admission in order to start treatment. Other patients with a lower bacterial load are smear negative but culture positive on testing. These patients are not as infectious but should still have therapy along conventional lines.
Chemoprophylaxis with a single medicine, isoniazid, may be given for 6 to 12 months with the aim of preventing future disease in individuals who show no evidence of disease, but have a strongly positive tuberculin skin test and no evidence of previous BCG vaccine to explain the positive skin test.
pregnent women with TB must be treated urgently as the disease may progress rapidly with high risk to both mother and baby.

Is it possible to become resistant to the medicine?

Yes, if medication is not taken every day or as prescribed by the doctor.
In some parts of the world there are problems with resistance to medication and even multi-drug resistance.
This is a very serious situation, which has been experienced on a large scale in parts of Africa, the Baltic States, many East European countries, certain American cities and in areas of the developing world.
XDR-TB, is an abbreviation for extensively drug-resistant tuberculosis (TB) (this form of TB is resistant to at least four of the core anti-TB drugs).
MDR-TB involves resistance to the two most powerful anti-TB drugs, isoniazid and rifampicin. MDR-TB and XDR-TB both take much longer to treat than ordinary TB, and require the use of anti-TB drugs, which are more expensive and have more side effects than the normal TB drugs.
If there are problems with patients not taking their medicines, it may be necessary to arrange supervision either in a hospital or at home with a nurse. This programme is known as DOTS (directly observed treatment, short-course) and is recommended by the World Health Organisation (WHO).

How can treatment be controlled?

An undetected infectious TB victim will, on average, infect another 10 cases in a year, each of whom could transmit the disease in turn.
According to the WHO and the international tuberculosis union IUATLD, all countries should have a national tuberculosis programme and authorities should also be notified about patients who have been diagnosed with TB.
The treatment itself is prescribed under the supervision of chest clinics where they make sure that the patient has correctly taken a curative course of treatment.
Negative culture from sputum in 6 to 12 months from the moment of the diagnosis indicates a cure.
The clinics make sure that the environment in which the patient lives is also carefully examined. All family members will be required to undergo chest X-rays. Sometimes, the patient's workplace will also be examined.

What are the world's highest-risk regions?

Infection is possible anywhere, but tuberculosis is especially prevalent in sub-Saharan Africa and in Southeast Asia.
The disease is more common in Eastern Europe than Western Europe, and Scandinavia has the lowest number of cases in the world.

Is HIV/AIDS associated with tuberculosis?

Yes. In certain African countries and many parts of Southeast Asia, HIV is becoming more and more endemic.
Where tuberculosis is also endemic among the population, a weakened immune system will increase the risk of getting tuberculosis.
This is an extremely worrying situation and the WHO and the IUATLD are doing all they can to prevent the disease from spreading.

Can tuberculosis be prevented?

TB is reduced with better housing and less over-crowding.
The most important step is to find, isolate and treat all disease carriers until they are no longer an infective risk to others.
It is always advisable not to get too close to people who are coughing; equally, people with a cough should be aware of those around them and try not to cough or spit near them.

Good advice

If you travel in countries where tuberculosis is a problem, get travel health advice about BCG vaccination and avoid socialising with people who have a persistent cough.
Make sure that you eat well and enjoy plenty of sunlight and exercise.
Seek medical attention:

• if you develop a cough that persists for more than three weeks
• if you see blood in your sputum
• if you have unexplained weight loss or unexplained night sweats.

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