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Anabolic Steroids: Uses, Abuse, And Side Effects
**FEATURED**
- **What is BPD?** A complex mental‑health disorder marked by unstable emotions, self‑image and relationships.
- **Why it matters:** It can affect anyone—regardless of age, gender or background—and is often linked to trauma, substance use, eating disorders and depression.
- **Key points at a glance:**
- Symptoms: intense mood swings, fear of abandonment, impulsivity, chronic emptiness, self‑harm behaviors.
- Diagnosis: requires a thorough clinical assessment; no single lab test exists.
- Treatment: evidence‑based psychotherapy (DBT, MBT, schema therapy), medications for co‑occurring conditions, and community support.
- Hope is real—people can recover, manage symptoms, and lead fulfilling lives.
---
## Frequently Asked Questions
### 1. **What exactly is Borderline Personality Disorder?**
Borderline Personality Disorder is a complex mental health condition that affects how you think, feel, and interact with others. It manifests as intense emotional swings, fear of abandonment, unstable relationships, distorted self‑image, impulsive behavior, and feelings of emptiness or boredom.
### 2. **How does BPD differ from other personality disorders?**
While all personality disorders involve patterns of thinking and behaving that deviate from cultural expectations, BPD is distinct in its:
- **Emotional volatility** – rapid shifts between extreme joy and despair.
- **Interpersonal sensitivity** – intense reactions to perceived rejection or abandonment.
- **Identity disturbance** – fluctuating self‑image and values.
- **Impulsivity** – risky behaviors such as reckless driving, binge eating, or substance abuse.
Other personality disorders may focus more on rigid patterns of cognition (e.g., paranoid) or lack of empathy (e.g., antisocial).
### 2. Core Features of BPD
| Feature | Description |
|---------|-------------|
| **Intense fear of abandonment** | Even mild separations trigger panic; often leads to clingy behavior. |
| **Unstable relationships** | Rapid oscillation between idealization and devaluation ("splitting"). |
| **Identity disturbance** | Frequent changes in self‑image, goals, or values. |
| **Impulsivity** | In at least two areas that are potentially self‑harmful (e.g., spending sprees, unsafe sex). |
| **Recurrent suicidal behavior / self‑harm** | Self‑cutting, burning, or other behaviors to cope with distress. |
| **Chronic feelings of emptiness** | Persistent sense that nothing matters; may feel "nobody exists for me." |
| **Intense anger / difficulty controlling rage** | Often directed at oneself or others. |
| **Transient stress‑related paranoid ideation or dissociation** | Not under normal circumstances, but can occur during extreme stress. |
---
## 3. How to Use These Criteria
| Step | Action |
|------|--------|
| **1. Take the History** | Ask about thoughts of self‑harm and whether you have ever actually harmed yourself. Note any patterns: "I feel it only when I’m alone or in a particular situation." |
| **2. Check for Self‑Harm Behaviors** | Confirm that you have engaged in cutting, burning, or other forms of self‑injury. |
| **3. Look at the Frequency** | If you’re seeing these thoughts *daily* and they are hard to control, this is a red flag. |
| **4. Evaluate Your Coping Strategies** | Are you using substances (alcohol, drugs) or other unhealthy tactics? |
| **5. Decide on Next Steps** | - If your thoughts are daily and overwhelming, consider seeking help right away.
- If they’re occasional but distressing, still talk to a mental‑health professional.
- If you feel safe and can manage them with coping tools, continue monitoring. |
---
## How to Find Help
| Type of Support | What It Offers | When to Seek It |
|-----------------|---------------|-----------------|
| **Therapist / Counselor** (individual or group) | Talk‑therapy, CBT, DBT, trauma work | Daily intrusive thoughts, feelings of hopelessness, emotional distress |
| **Psychiatrist** | Medication review, psychiatric assessment | Severe anxiety/depression, suicidal thoughts, medication side effects |
| **Support Groups** (online or in‑person) | Peer support, shared experiences | Need for community, feeling isolated |
| **Crisis Hotline / Helplines** (e.g., 988 Suicide & Crisis Lifeline) | Immediate emotional support, safety planning | Feeling unsafe, suicidal ideation |
| **Self‑Help Resources** (books, apps, mindfulness programs) | Structured exercises, relaxation techniques | Managing stress, building resilience |
> **Remember:** Seeking help is a sign of strength. You do not have to navigate this journey alone.
---
## 5. A Practical Self‑Care Plan for Your Journey
Below is an example plan you can adapt to your own preferences and schedule. Feel free to add or remove activities based on what feels right for you.
| Time | Activity | How It Helps |
|------|----------|--------------|
| **Morning** | 1️⃣ **Wake up at a consistent time** (e.g., 7:00 am).
2️⃣ **Hydrate** with a glass of water.
3️⃣ **Move your body** – stretch, walk, or do a short yoga flow for 10–15 min. | Sets a stable rhythm; hydration and movement boost mood and focus. |
| **Mid‑morning** | 1️⃣ **Mindful snack** (e.g., apple + almond butter).
2️⃣ **Take a 5‑minute breathing break** – inhale for 4 counts, exhale for 6. | Prevents blood‑sugar crashes; breathwork calms the nervous system. |
| **Lunch** | 1️⃣ **Balanced meal** – protein (chicken, beans), veggies, complex carb (quinoa).
2️⃣ **Serve on a plate, not in front of the screen** – savor textures and flavors. | Keeps energy steady; eating mindfully improves digestion and focus. |
| **Afternoon** | 1️⃣ **Light stretch or short walk (5‑10 min)** to reset posture.
2️⃣ **Hydrate** with water or herbal tea. | Re-oxygenates brain, reduces fatigue, prevents dehydration‑related headaches. |
| **Evening** | 1️⃣ **Prepare a calming routine** – dim lights, no screens >30 min before bed.
2️⃣ **Optional: gentle yoga or meditation (5‑10 min)** to ease the day’s tension. | Supports restful sleep and lowers cortisol that can trigger headaches. |
### Practical Tips
- **Set reminders** on phone for breaks and water intake.
- Use a **timer app** that vibrates instead of loud alarm; you’ll be less startled by it.
- Keep a small bottle of water at your desk; sip regularly.
- If your job allows, alternate between sitting and standing or walking during calls.
---
## 3. When to Seek Professional Care
While many headaches can be managed with lifestyle changes, certain situations warrant medical attention:
| Symptom | Why It Matters |
|---------|----------------|
| Headache **every day** for weeks/months | Could indicate medication‑overuse headache (MOH) or chronic migraine. |
| New‑onset headache after age 50, especially if sudden | May be a sign of a serious condition like subarachnoid hemorrhage or stroke. |
| Headache with fever, stiff neck, rash, confusion | Possible meningitis or encephalitis. |
| Visual disturbances (blurred vision, double vision) | Could signal increased intracranial pressure or optic neuritis. |
| Severe headache ("worst ever") not responding to meds | Think of aneurysm rupture. |
| Headache that worsens with coughing/standing | Might be due to orthostatic changes or a sinus infection. |
If any of these red‑flag symptoms appear, seek emergency care immediately.
---
## 3️⃣ Treatment Options (Pharmacologic & Non‑pharm)
### A. **Over‑the‑Counter (OTC) Analgesics**
| Drug | Typical dose | How it works | Pros/Cons |
|------|--------------|-------------|-----------|
| **Acetaminophen** (Tylenol) | 500 mg every 4–6 h, max 4 g/day | Reduces prostaglandin synthesis in the CNS; no GI side‑effects | Safe for most but hepatotoxic if >3.5 g/day or combined with alcohol |
| **Ibuprofen** (Advil) | 200–400 mg every 6–8 h, max 1.2 g/day | COX‑inhibitor; anti‑inflam, analgesic, antipyretic | GI irritation, renal risk; avoid if on anticoagulants |
| **Naproxen** (Aleve) | 220 mg twice daily, max 660 mg/day | Longer half‑life; good for chronic pain | Same GI/renal concerns as ibuprofen |
*Note:* For fever >38.5 °C or severe headache, paracetamol is preferred due to safety profile.
---
### 3. Anticoagulation
| Drug | Dose & Frequency | Rationale |
|------|------------------|-----------|
| **Enoxaparin (low‑molecular‑weight heparin)** | 1 mg/kg subcutaneously twice daily (adjusted for weight and renal function) | Standard prophylaxis for VTE in hospitalized patients. |
| **Oral anticoagulant** – *Apixaban* or *Rivaroxaban* if no contraindication | Apixaban: 5 mg BID; Rivaroxaban: 10 mg daily (after initial period of LMWH) | Long‑term oral therapy to reduce VTE risk, especially in patients with high DVT risk. |
**Monitoring**
- Baseline CBC, renal function, and coagulation profile.
- Periodic CBC every 3–5 days to monitor for thrombocytopenia or anemia (especially if HIT is suspected).
- Monitor creatinine; adjust doses of apixaban/rivaroxaban accordingly.
---
## 4. Anticoagulation‑Related Complications
| Potential complication | Risk factors | Management |
|------------------------|--------------|------------|
| **Bleeding** (gastrointestinal, intracranial) | High-dose LMWH/DOACs; concomitant antiplatelet agents; liver dysfunction; age >65. | Stop or reduce anticoagulant dose. Use reversal agents: protamine for LMWH, andexanet alfa (or PCC + vitamin K) for DOACs if needed. Monitor hemoglobin and coagulation parameters. |
| **Heparin‑induced thrombocytopenia (HIT)** | Exposure to unfractionated heparin >5 days; history of HIT. | Stop all heparin products. Use direct thrombin inhibitors or factor Xa inhibitors. Confirm with serotonin release assay if suspicion high. |
| **Bleeding complications** | Advanced liver disease, coagulopathy, recent surgery. | Evaluate coagulation profile (INR, aPTT), platelet count. Consider transfusion of platelets, fresh frozen plasma, cryoprecipitate as indicated. |
| **Drug interactions** | Co‑administration with CYP3A4 inhibitors/inducers, warfarin, or other anticoagulants. | Monitor for changes in INR and adjust dosing accordingly; consider therapeutic drug monitoring if available. |
---
## 5. Summary & Recommendations
- **Anticoagulation Choice:** For patients requiring oral anticoagulation in the context of advanced liver disease (Child‑Pugh B/C), a DOAC that is largely renal excreted (e.g., dabigatran) or has minimal hepatic metabolism (apixaban, rivaroxaban) should be considered over warfarin when renal function is adequate.
- **Dose Adjustment:** Renal function must guide dose reduction. For example:
- Dabigatran: reduce to 75 mg BID if CrCl < 30 mL/min; avoid if <15 mL/min.
- Apixaban: reduce to 2.5 mg BID if ≥2 of the following criteria are met: age ≥ 80 yr, weight ≤ 60 kg, serum creatinine ≥ 1.5 mg/dL.
- **Monitoring:** Regular monitoring of renal function (every 3–6 months) and liver function tests is essential, especially in patients with decompensated cirrhosis.
---
**Bottom Line**
For atrial fibrillation patients who also need anticoagulation for venous thromboembolism, the choice of a DOAC over warfarin is strongly favored. The evidence shows that rivaroxaban, apixaban, dabigatran, and edoxaban provide equal or superior efficacy with significantly lower risk of major bleeding compared to warfarin, even in those requiring treatment for VTE. Warfarin remains the drug of choice only when a DOAC is contraindicated (e.g., severe renal failure, certain drug interactions). The decision should still be individualized, taking into account patient factors such as kidney function, potential drug–drug interactions, and adherence considerations. - http://uvs2.net/index.php/user/jamlock5
