Antipsychotic Medications

A person who is psychotic is out of touch with reality. People with psychosis may hear "voices" or have strange and illogical ideas (for example, thinking that others can hear their thoughts, or are trying to harm them, or that they are the President of the United States or some other famous person). They may get excited or angry for no apparent reason, or spend a lot of time by themselves, or in bed, sleeping during the day and staying awake at night. The person may neglect appearance, not bathing or changing clothes, and may be hard to talk to--barely talking or saying things that make no sense. They often are initially unaware that their condition is an illness.

These kinds of behaviors are symptoms of a psychotic illness such asschizophrenia. Antipsychotic medications act against these symptoms. These medications cannot "cure" the illness, but they can take away many of the symptoms or make them milder. In some cases, they can shorten the course of an episode of the illness as well.

There are a number of antipsychotic (neuroleptic) medications available. These medications affect neurotransmitters that allow communication between nerve cells. One such neurotransmitter, dopamine, is thought to be relevant to schizophrenia symptoms. All these medications have been shown to be effective for schizophrenia. The main differences are in the potency--that is, the dosage (amount) prescribed to produce therapeutic effects-and the side effects. Some people might think that the higher the dose of medication prescribed, the more serious the illness; but this is not always true.

The first antipsychotic medications were introduced in the 1950s. Antipsychotic medications have helped many patients with psychosis lead a more normal and fulfilling life by alleviating such symptoms as hallucinations, both visual and auditory, and paranoid thoughts. However, the early antipsychotic medications often have unpleasant side effects, such as muscle stiffness, tremor, and abnormal movements, leading researchers to continue their search for better drugs.

The 1990s saw the development of several new drugs for schizophrenia, called "atypical antipsychotics." Because they have fewer side effects than the older drugs, today they are often used as a first-line treatment. The first atypical antipsychotic, clozapine (Clozaril), was introduced in the United States in 1990. In clinical trials, this medication was found to be more effective than conventional or "typical" antipsychotic medications in individuals with treatment-resistant schizophrenia (schizophrenia that has not responded to other drugs), and the risk of tardive dyskinesia (a movement disorder) was lower. However, because of the potential side effect of a serious blood disorder--agranulocytosis (loss of the white blood cells that fight infection)-patients who are on clozapine must have a blood test every 1 or 2 weeks. The inconvenience and cost of blood tests and the medication itself have made maintenance on clozapine difficult for many people. Clozapine, however, continues to be the drug of choice for treatment-resistant schizophrenia patients.

Several other atypical antipsychotics have been developed since clozapine was introduced, they are risperidone (Risperdal), aripiprazole (Abilify), olanzapine (Zyprexa), quetiapine (Seroquel), and ziprasidone (Geodon). Each has a unique side effect profile, but in general, these medications are better tolerated than the earlier drugs. Click on the links above to each drug for more information about side effects.

All these medications have their place in the treatment of schizophrenia, and doctors will choose among them. They will consider the person's symptoms, age, weight, and personal and family medication history.

Dosages and side effects. Some drugs are very potent and the doctor may prescribe a low dose. Other drugs are not as potent and a higher dose may be prescribed.

Unlike some prescription drugs, which must be taken several times during the day, some antipsychotic medications can be taken just once a day. In order to reduce daytime side effects such as sleepiness, some medications can be taken at bedtime. Some antipsychotic medications are available in "depot" forms that can be injected once or twice a month.

Bogra My Home Town

This article is about the city. For the district, see Bogra District. For the cantonment, see Bogra Cantonment. For the former Prime Minister of Pakistan, see Mohammad Ali Bogra

Bogra বগুড়া Bogra,Rajshahi, Bangladesh
Coordinates: 24°51′N 89°22′E
Country	Bangladesh
Division	Rajshahi Division
District	Bogra District
Population (2001)
- Total	210,038
Time zone	Bangladesh Time (UTC+6)
Calling code	051
Website	http://www.dcbogra.gov.bd

Bogra (Bengali: বগুড়া) is a town, and one of the oldest towns in northern Bangladesh. It is a centre of commerce and trade within the Bogra District and located under the Rajshahi Division. Bogra is sometimes described as the nerve centre of Northern Bangladesh. Amongst many notable activities, it has been hosting cricket test matches in Shaheed Chandu Stadium. Bogra is also the battle honour of 5/11 Gorkha Rifles of Indian Army which fought a fierce battle with Pakistani army here during the Liberation war of Bangladesh in 1971 along with Muktibahni.

Bogra town also has an importance in terms of transport in northern Bangladesh, as it's situated at the centre. Very close to the town there is a place called Mahasthangarh which was the earliest capital city of Bangladesh, formerly known as Pundravardhana. This place is considered to be sacred by Buddhists, Muslims and Hindus alike and is visited by tourists from all over Bangladesh throughout the year.

Former president of Bangladesh Ziaur Rahman and Muhammad Ali Bogra a former Prime Minister of Pakistan both were born in the district.

History

The history says it was the oldest city of Bengal in the Great Emperor Ashoka's India. He conquered the Bengal (Bongo) and founded this old city called Pundra Bardhan. It was famously written in famous ancient travellers of that time. An ancient engraved stone believed to be of Gupta era was discovered from the bank of a pond near Sura Masjid at Ghoraghat Upazila in Dinajpur in October 2008.

In the Bangladesh Liberation War, the area witnessed a fierce battle - Battle of Bogra - between the allied troops of Mitro Bahini and Indian Army (together/combined) which defeated the Pakistan Army.

Geography

Ramparts of Mahasthangarh citadel, few miles away from Bogra town

Bagura or Bogra was a town and district of British India, in the Rajshahi division of eastern Bengal and Assam. The town is situated on the right bank of the river Karatoya. But the present District Of Bogra, was first formed in 1821. It contains an area of 1359 mi² (3,520 km²). In 1901 the population of the town was 3,094 and of the district (on a reduced area) was 854,533, showing an increase of 11% in the decade. The district stretches out in a level plain, intersected by numerous streams and dotted with patches of jungle. The Karatoya flows from north to south, dividing it into two portions, possessing very distinct characteristics. The eastern tract consists of rich alluvial soil, well watered, and subject to fertilizing inundations, yielding heavy crops of coarse rice, oil-seeds and jute. The western portion of the district is high-lying and produces the finer qualities of rice.

The principal rivers are formed by the different channels of the Brahmaputra, which river here bears the local names of the Konai, the Daokoba and the Jamuna, the last forming a portion of the eastern boundary of the district. Its bed is studded with alluvial islands. The Brahmaputra and its channels, together with three minor streams, the Bangali, Karatoya and Atrai, afford admirable facilities for commerce, and render every part of the district accessible to native cargo boats of large burden. The rivers swarm with fish. The former production of indigo is extinct, and the industry of silk-spinning is decaying.

 There is no town with as many as 10,000 inhabitants, trade being conducted at riverside marts. Nor are there any metalled roads. Several lines of railway (the Eastern Bengal, &c.), however, serve the district.

Economy

In the recent years there has been a significant development in town infrastructure. with new advanced urban planning. The town roads have been restructured and widened and telecommunications have greatly improved within the city. Gas connection through buried pipes has been set up. In recent years, red chili production in Bogra has taken a large shape, for which many companies like Square, Acme, BD Food are collecting chili from as many as 12 centers of Bogra. The business turnover has crossed 100 crore Banking in Bogra has significantly expanded with the branch expansion of private and specialized banks such as Standard Chartered Bank, Dutch Bangla Bank, BRAC Bank and so on.

Furthermore, online banking, ATM and modern banking facilities have been introduced. Bogra is undergoing industrialization and urbanization. There are many IT and software, technology and computer services companies in Bogra and more companies are launching business here. Grameen Group and Groupe Danone, a French company, entered into a joint venture named Grameen Danone and set up a nutritious yogurt project in Bogra in 2008. 

The project aims to produce 500,000 pots of yogurt by the end of 2009. Bogra is home to country's largest foundry industry. Irrigation pump, tube-well and other metal castings produced in Bogra are exported to West Bengal, Assam, Meghalaya, Bihar, Bhutan and the amount of export is increasing. Most of the city's workforce is involved in agriculture (29.95%), agricultural (12.53%), commerce (18.11%), service (15.62%), transport (6.66%), wage laborer (2.2%) and others (14.93%).

Tourism

Mahasthangarh, the earliest urban archaeological site so far discovered in Bangladesh is located in Bogra. The village Mahasthan in Shibganj thana of Bogra District contains the remains of an ancient city which was called Pundranagara or Paundravardhanapura in the territory of Pundravardhana. 

This place is considered to be sacred by Buddhists, Muslims and Hindus alike. Another tourist attraction is the Goku Medh, an excavated mound in the village of Gokul under Bogra Sadar Upazila, about two kilometres southwest of mahasthan citadel. Excavations in 1934-36 by NG Majumdar revealed a gigantic shrine or sputa plinth built in the terraced cellular style of construction. "Behular Bashor Ghar" which is very near to Mahasthangar is a popular place for the tourists. Tourists from all over Bangladesh visit this place throughout the year. Nawab Palace (called Neelkuthi during the British period) and Jaina Temple are two eminent archaeological sights located in Bogra. The only 4 star hotel in Rajshahi division, Hotel Naz Garden, is situated at the heart of Bogra city.

Culture

Bogra has a strong cultural affinity to Baul, Marfati, Lalon and Sufi music. There are a number of local newspapers and journals in Bogra. The Daily Korotoa and Daily Aaj O Agamikal are two main local newspapers.

Education

Bogra contains numerous educational institutes, Bogra Zilla School is the most famous among them. Eastablished in 1853, Bogra Zilla School is situated at the centre of Bogra. It also contains the Govt. Girls' High School (famous as Victoria Memorial or VM School) girls high school which is government owned. Govt. Azizul Haque College is under the National University. A large medical college and hospital named Shaheed Ziaur Rahman Medical College and Hospital, equipped with advanced facilities has been started recently. Bogra also contains the largest English college in the North Bengal region named "Millenium Scholastic School & College, which was established in 1998, the Bogra Polytechnic institute and Institute of Information Technology Bogra.

Notable people from Bogra

• Khademul Bashar, Air Vice-Marshal, Sector Commander and Chief, Bangladesh Airforce
• Akhteruzzaman Elias, famous novelist and short story writer
• Muhammad Ali Bogra, former Prime Minister of Pakistan, 1953–1955
• M. R. Akhtar Mukul, author
• Ziaur Rahman, former president of Bangladesh
• Shimul Zaman, Singer
• Prafulla Chaki (1888–1908) - Bengali revolutionary
• Mushfiqur Rahim, Cricketer
• Shafiul Islam, Cricketer

Excessive Use and Misuse of Antibiotics

In a very wide variety of complaints, doctors may prescribe antibiotics without a clear indication of a "bug" that is susceptible to antibiotics - "just in case". Worse yet, people without proper medical training may push antibiotics or misguided persons may "self-medicate" with them. What's wrong with the the "just in case" approach? No doubt you've heard already that "bugs will become resistant to antibiotics". Perhaps that sounds a bit "theoretical" to you; not something that will have an impact for years to come - well, think again.

First of all, there is a well-documented explosion in the prevalence of antibiotic resistant strep . This is an obvious problem today, not in the future. US Public Health Service (USPHS) and the Center for Disease Control (CDC) have publicly pleaded against the overuse of antibiotics. Each year, the bacteria are developing resistances to our "best" antibiotics and persons succumb to various illnesses needlessly because the medication is now ineffective.

But isn't it still true true that for a single patient there is no negative effect of taking antibiotics "just in case"? Answer: -think again.

In a recent article in Archives of Internal Medicine 252 adults with sinusitis were studied. In this blind study, some were given a placebo and others were given a common, expensive, highly recommended sinus antibiotic. Patients took their medication twice a day for 6 days. There was no observable difference in the recovery of the patients that took the antibiotic over those taking the placebo. However, with the antibiotic there was diarrhea and upset stomach among the users. This research is similar to another study published in Lancet that reached a similar conclusion. This study is of major importance to the 37 million people treated for sinusitis each year in US. Side effects vary in severity and with antibiotic and condition treated: in addition to diarrhea, secondary vaginal and oral thrush infections occur with antibiotics. Your body depends on many types of "good bacteria" living within it to keep you free of infection. These secondary infections occur because antibiotics kill off the good bacteria as well as the bad. Antibiotics can be life-saving miracles, but these and other side effects should bring home the point that they certainly "mess" with your body!

Pulsatile irrigation is an excellent alternative to treating sinusitis with antibiotics. Nasal and sinus cilia are the body's natural defense against sinus disease. These consist of millions of microscopic oar-like "hairs" that propel the infected mucus out of the nose and sinuses. When they work well, the body stays healthy. But after smog or diesel fumes or an infection, they may slow down and allow bacteria to grow. Pulsatile irrigation, however, has been shown in dozens of articles to restore healthy function to the nasal and sinus cilia - to actually heal the body's own defenses. Introducing salt water into the nose can be helpful in "cleaning", but only pulsatile irrigation, pulsating in harmony with the cilia's natural motion, has been shown clinically to be extremely effective in returning the cilia to their healthy function. I recommend pulsatile irrigation as the best way to recover from a sinus condition - without antibiotics.

One part of the problem with over subscribing antibiotics is that patients want something tangible for their money and trouble for an office visit. Some of you may recall the wonderful "Doctor" series with Dick Beggared. In one scene he is trying to explain to an obese female why she does not need a shot of vitamins (she is quite sufficiently nourished). Patiently he explains why. Finally she calls her husband in and says, "Honey, he won't give me medicine!" and her husband joins in on insisting on the vitamin shot and again the poor doctor tries to explain - to deaf ears - why she doesn't need it. In the case of sinusitis or any other "-itis" where patients have heard of friends or relatives getting antibiotics, patients frequently demand them. Many think their doctor is withholding care if they don't. In this case the doctor can write them a prescription in three minutes, or spend 20 minutes patiently explaining why it is better for medicine to be "withheld" from the patient. I have even overheard patients going out to the receptionist to ask to see another doctor in the same clinic - this time to get antibiotic. So, it is as important for the patient to be receptive to fewer antibiotics as it is for the doctor to make this recommendation.

If you think an infection is coming on: First and foremost, rest, plenty of hot liquids - tea, lemon and honey. Drink a lot of liquids; the urine should turn light. Avoid overuse of pills and nose sprays. Relax. Let the body do the work. Despite the constant barrage of commercials, you aren't going to perish by just taking it easy and not rushing to the medicine chest. Relaxed, positive people get well the fastest (reference 2). Grab your CDs and play some happy music. Avoid getting chilled. Warm compresses to the sinus area helps too.

Occasional use of a nose drop or spray to open the nose can give a lot of relief - but take care you don't overuse these products.

Of course, there is a place for antibiotics and medications. Always follow your doctor's instructions. But these research conclusions should make you pause. Think HOT TEA, rest, and pulsatile irrigation first, before you go running for antibiotics! Over the last 25 years of clinical practice I have seen patient after patient who received three courses of antibiotics, but who were still sick because the antibiotics did nothing to restore the natural movement of their nasal / sinus system of cilia. —And during these 25 years I have seen these supposedly "difficult" cases respond well to methods of restoring the cilia, including adequate fluids, tea, compresses, rest and pulsatile irrigation. It just makes me wonder why they didn't try it in the first place!

An Outbreak of Deadly Anthrax in Bangladesh

Bangladesh has now issued a red alert in the country as the cases of deadly anthrax continue to climb. So far, according to the latest report, 327 people have been infected with anthrax just since the middle of August. Anthrax was first detected in Bangladesh on August 20 in Sirajganj district, about 90 miles (150 km) north-west of Dhaka (capital of Bangladesh). Despite efforts by the local government to contain the infection, the disease has now spread to two more districts in the north and east, taking the total of the number of districts affected to six. Close to 150 cows have died thus far due to the infection. Anthrax bacterium is naturally found in the soil and it usually infects the livestock via inhalation or ingestion of spores while grazing. Without prompt treatment, an anthrax infection is often fatal in both humans and cattle. The WHO explains: "Humans generally acquire the disease directly or indirectly from infected animals, or occupational exposure to infected or contaminated animal products. Control in livestock is therefore the key to reduced incidence. There are no documented cases of person to person transmission. The disease's impact on animal and human health can be devastating. 

There are 3 types of anthrax in humans: cutaneous anthrax, acquired when a spore enters the skin through a cut or an abrasion; gastrointestinal tract anthrax, contracted from eating contaminated food, primarily meat from an animal that died of the disease; and pulmonary (inhalation) anthrax from breathing in airborne anthrax spores. The cutaneous form accounts for 95% or more of human cases globally. All 3 types of anthrax are potentially fatal if not treated promptly.

Vaccines (for prevention) are available for animals and humans. However in humans their use should be confined to high-risk groups, such as those occupationally exposed, in some military settings and in situations where known or suspected inhalation of anthrax spores has taken place. Patient isolation is not required and there are no quarantine requirements. 

Antibiotic therapy usually results in dramatic recovery of the individual or animal infected with anthrax if given before onset or immediately after onset of illness. Late-stage inhalation anthrax is often fatal despite the use of antibiotics. Antibiotic therapy may be also used for prophylaxis in asymptomatic patients believed to have been exposed to anthrax spores, possibly in conjunction with vaccination. Anthrax spores may remain in the lungs for as long as 100 days prior to germination.

Accordingly, in cases where known or suspected inhalation of anthrax spores has taken place, it is prudent to consider the administration of an anthrax vaccine simultaneously with antibiotic treatment. The antibiotic treatment should be continued for 60 days to allow for development of adequate vaccine induced immunity. Following the first detection of anthrax in a herd, the remaining animals should be removed immediately from the field and checked regularly for signs of illness. In endemic areas, or if there is concern that the outbreak may spread, the herd should be vaccinated."

All of the cases detected in Bangladesh so far have been of the cutaneous variety. Bangladesh has ordered half a million ampoules of the vaccine for the cattle, which are in the process of being distributed right now. Mosaddek Hossain, a Bangladeshi official said to the AFP, "This is the biggest outbreak of anthrax in the country's history. We are very concerned. The government has set up surveillance teams in all the affected areas so that the disease cannot spread to other places. We are battling hard to contain the disease. Still, we are receiving reports of new infections in almost every day".