126-436: Herpes simplex , often known simply as herpes , is a viral infection caused by the herpes simplex virus . Herpes infections are categorized by the area of the body that is infected. The two major types of herpes are oral herpes and genital herpes , though other forms also exist. Oral herpes involves the face or mouth. It may result in small blisters in groups, often called cold sores or fever blisters, or may just cause
252-404: A latent infection in sensory and autonomic ganglia of the nervous system. The double-stranded DNA of the virus is incorporated into the cell physiology by infection of the nucleus of a nerve's cell body . HSV latency is static; no virus is produced; and is controlled by a number of viral genes, including latency-associated transcript . Many HSV-infected people experience recurrence within
378-766: A meta-analysis , but this association disappeared after correction for multiple testing . On the other hand, two polymorphisms in TPH2 were identified as being associated with bipolar disorder. Due to the inconsistent findings in a genome-wide association study , multiple studies have undertaken the approach of analyzing SNPs in biological pathways. Signaling pathways traditionally associated with bipolar disorder that have been supported by these studies include corticotropin-releasing hormone signaling, cardiac β-adrenergic signaling, phospholipase C signaling, glutamate receptor signaling, cardiac hypertrophy signaling, Wnt signaling , Notch signaling , and endothelin 1 signaling. Of
504-411: A byproduct of serotonin , are present in the cerebrospinal fluid of persons with bipolar disorder during both the depressed and manic phases. Increased dopaminergic activity has been hypothesized in manic states due to the ability of dopamine agonists to stimulate mania in people with bipolar disorder. Decreased sensitivity of regulatory α 2 adrenergic receptors as well as increased cell counts in
630-457: A consequence of substance use. In November 2018, Cyberpsychology published a systematic review and meta-analysis of 5 studies that found evidence for a relationship between problematic smartphone use and impulsivity traits. In October 2020, the Journal of Behavioral Addictions published a systematic review and meta-analysis of 40 studies with 33,650 post-secondary student subjects that found that
756-439: A definitive diagnosis. Neurologic diseases such as multiple sclerosis , complex partial seizures , strokes, brain tumors, Wilson's disease , traumatic brain injury , Huntington's disease , and complex migraines can mimic features of bipolar disorder. An EEG may be used to exclude neurological disorders such as epilepsy , and a CT scan or MRI of the head may be used to exclude brain lesions. Additionally, disorders of
882-415: A depressive episode, or vice versa, remain poorly understood. Also known as a manic episode, mania is a distinct period of at least one week of elevated or irritable mood, which can range from euphoria to delirium . The core symptom of mania involves an increase in energy of psychomotor activity . Mania can also present with increased self-esteem or grandiosity , racing thoughts , pressured speech that
1008-524: A diagnosis— disruptive mood dysregulation disorder —that covers children with long-term, persistent irritability that had at times been misdiagnosed as having bipolar disorder, distinct from irritability in bipolar disorder that is restricted to discrete mood episodes. Bipolar on average, starts during adulthood. Bipolar 1, on average, starts at the age of 18 years old, and Bipolar 2 starts at age 22 years old on average. However, most delay seeking treatment for an average of 8 years after symptoms start. Bipolar
1134-481: A diagnostically specific causal agent for bipolar, does place genetically and biologically vulnerable individuals at risk for a more severe course of illness. Longitudinal studies have indicated that full-blown manic stages are often preceded by a variety of prodromal clinical features, providing support for the occurrence of an at-risk state of the disorder when an early intervention might prevent its further development and/or improve its outcome. The aim of management
1260-642: A few days. Some evidence indicates genetics play a role in the frequency of cold sore outbreaks. An area of human chromosome 21 that includes six genes has been linked to frequent oral herpes outbreaks. An immunity to the virus is built over time. Most infected individuals experience fewer outbreaks and outbreak symptoms often become less severe. After several years, some people become perpetually asymptomatic and no longer experience outbreaks, though they may still be contagious to others. Immunocompromised individuals may experience longer, more frequent, and more severe episodes. Antiviral medication has been proven to shorten
1386-449: A few weeks to a few months. Symptoms of the depressive phase of bipolar disorder include persistent feelings of sadness, irritability or anger, loss of interest in previously enjoyed activities , excessive or inappropriate guilt , hopelessness , sleeping too much or not enough , changes in appetite and/or weight, fatigue , problems concentrating, self-loathing or feelings of worthlessness, and thoughts of death or suicide. Although
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#17328847414891512-426: A herpes simplex infection and the other does not, the use of antiviral medication, such as valaciclovir , in conjunction with a condom, further decreases the chances of transmission to the uninfected partner. Topical microbicides that contain chemicals that directly inactivate the virus and block viral entry are being investigated. Antivirals may reduce asymptomatic shedding; asymptomatic genital HSV-2 viral shedding
1638-442: A history of childhood abuse and long-term stress . The condition is classified as bipolar I disorder if there has been at least one manic episode, with or without depressive episodes, and as bipolar II disorder if there has been at least one hypomanic episode (but no full manic episodes) and one major depressive episode. It is classified as cyclothymia if there are hypomanic episodes with periods of depression that do not meet
1764-549: A hospital admission, support services available can include drop-in centers , visits from members of a community mental health team or an Assertive Community Treatment team, supported employment , patient-led support groups , and intensive outpatient programs . These are sometimes referred to as partial-inpatient programs. Compared to the general population, people with bipolar disorder are less likely to frequently engage in physical exercise. Exercise may have physical and mental benefits for people with bipolar disorder, but there
1890-455: A job, leading to trouble with healthcare access, leading to more decline in their mental health due to not receiving treatment such as medicine and therapy. Bipolar disorder is uncommon in older patients, with a measured lifetime prevalence of 1% in over 60s and a 12-month prevalence of 0.1–0.5% in people over 65. Despite this, it is overrepresented in psychiatric admissions, making up 4–8% of inpatient admission to aged care psychiatry units, and
2016-523: A manic episode usually lasts three to six months. In severe manic episodes, a person can experience psychotic symptoms, where thought content is affected along with mood. They may feel unstoppable, persecuted , or as if they have a special relationship with God, a great mission to accomplish, or other grandiose or delusional ideas. This may lead to violent behavior and, sometimes, hospitalization in an inpatient psychiatric hospital . The severity of manic symptoms can be measured by rating scales such as
2142-434: A medical work-up to rule out other causes. Caregiver-scored rating scales, specifically from the mother, have shown to be more accurate than teacher and youth-scored reports in identifying youths with bipolar disorder. Assessment is usually done on an outpatient basis; admission to an inpatient facility is considered if there is a risk to oneself or others. The most widely used criteria for diagnosing bipolar disorder are from
2268-406: A microbicidal vaginal gel, was reported to reduce herpes virus sexual transmission by 51%. Condoms offer moderate protection against HSV-2 in both men and women, with consistent condom users having a 30%-lower risk of HSV-2 acquisition compared with those who never use condoms. A female condom can provide greater protection than the male condom, as it covers the labia. The virus cannot pass through
2394-718: A mild to moderate effect . The risk of bipolar disorder is nearly ten-fold higher in first-degree relatives of those with bipolar disorder than in the general population; similarly, the risk of major depressive disorder is three times higher in relatives of those with bipolar disorder than in the general population. Although the first genetic linkage finding for mania was in 1969, linkage studies have been inconsistent. Findings point strongly to heterogeneity, with different genes implicated in different families. Robust and replicable genome-wide significant associations showed several common single-nucleotide polymorphisms (SNPs) are associated with bipolar disorder, including variants within
2520-604: A mixed state may have manic symptoms such as grandiose thoughts while simultaneously experiencing depressive symptoms such as excessive guilt or feeling suicidal. They are considered to have a higher risk for suicidal behavior as depressive emotions such as hopelessness are often paired with mood swings or difficulties with impulse control . Anxiety disorders occur more frequently as a comorbidity in mixed bipolar episodes than in non-mixed bipolar depression or mania. Substance (including alcohol ) use also follows this trend, thereby appearing to depict bipolar symptoms as no more than
2646-399: A neurological condition or injury including stroke, traumatic brain injury , HIV infection , multiple sclerosis , porphyria , and rarely temporal lobe epilepsy . The precise mechanisms that cause bipolar disorder are not well understood. Bipolar disorder is thought to be associated with abnormalities in the structure and function of certain brain areas responsible for cognitive tasks and
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#17328847414892772-421: A one-year span. Rapid cycling is usually temporary but is common amongst people with bipolar disorder and affects 25.8–45.3% of them at some point in their life. These episodes are separated from each other by a remission (partial or full) for at least two months or a switch in mood polarity (i.e., from a depressive episode to a manic episode or vice versa). The definition of rapid cycling most frequently cited in
2898-446: A partner having a genital infection during the last trimester of pregnancy. Mothers infected with HSV are advised to avoid procedures that would cause trauma to the infant during birth (e.g. fetal scalp electrodes, forceps, and vacuum extractors) and, should lesions be present, to elect caesarean section to reduce exposure of the child to infected secretions in the birth canal. The use of antiviral treatments, such as aciclovir, given from
3024-522: A review of HSV-1/HSV-2 prevalence and incidence studies worldwide, see Smith and Robinson 2002). As many as one in seven Canadians aged 14 to 59 may be infected with herpes simplex type 2 virus and more than 90 per cent of them may be unaware of their status, a new study suggests. In the United States, it is estimated that about 1,640,000 HSV-2 seroconversions occur yearly (730,000 men and 910,000 women, or 8.4 per 1,000 persons). In British Columbia in 1999,
3150-737: A role in HSV-1 reactivation. Concurrent infections, such as viral upper respiratory tract infection or other febrile diseases, can cause outbreaks. Reactivation due to other infections is the likely source of the historic terms 'cold sore' and 'fever blister'. Other identified triggers include local injury to the face, lips, eyes, or mouth; trauma; surgery; radiotherapy ; and exposure to wind, ultraviolet light , or sunlight. The frequency and severity of recurrent outbreaks vary greatly between people. Some individuals' outbreaks can be quite debilitating, with large, painful lesions persisting for several weeks, while others experience only minor itching or burning for
3276-556: A role in bipolar disorder are the mitochondria and a sodium ATPase pump . Circadian rhythms and regulation of the hormone melatonin also seem to be altered. Dopamine , a neurotransmitter responsible for mood cycling, has increased transmission during the manic phase. The dopamine hypothesis states that the increase in dopamine results in secondary homeostatic downregulation of key system elements and receptors such as lower sensitivity of dopaminergic receptors. This results in decreased dopamine transmission characteristic of
3402-646: A significant decrease in the individual's ability to socialize or work, lacks psychotic features such as delusions or hallucinations , and does not require psychiatric hospitalization. Overall functioning may actually increase during episodes of hypomania and is thought to serve as a defense mechanism against depression by some. Hypomanic episodes rarely progress to full-blown manic episodes. Some people who experience hypomania show increased creativity, while others are irritable or demonstrate poor judgment. Hypomania may feel good to some individuals who experience it, though most people who experience hypomania state that
3528-583: A sore throat. Genital herpes involves the genitalia . It may have minimal symptoms or form blisters that break open and result in small ulcers . These typically heal over two to four weeks. Tingling or shooting pains may occur before the blisters appear. Herpes cycles between periods of active disease followed by periods without symptoms. The first episode is often more severe and may be associated with fever, muscle pains, swollen lymph nodes and headaches. Over time, episodes of active disease decrease in frequency and severity. Herpetic whitlow typically involves
3654-473: A synthetic condom, but a male condom's effectiveness is limited because herpes ulcers may appear on areas not covered by it. Neither type of condom prevents contact with the scrotum, anus, buttocks, or upper thighs, areas that may come in contact with ulcers or genital secretions during sexual activity. Protection against herpes simplex depends on the site of the ulcer; therefore, if ulcers appear on areas not covered by condoms, abstaining from sexual activity until
3780-412: A type of HSV can reduce the odds of reinfection with the same virus type. In a monogamous couple, a seronegative female runs a greater than 30% per year risk of contracting an HSV infection from a seropositive male partner. If an oral HSV-1 infection is contracted first, seroconversion will have occurred after 6 weeks to provide protective antibodies against a future genital HSV-1 infection. Herpes simplex
3906-405: A weak-to-moderate positive association between mobile phone addiction and impulsivity. People with bipolar disorder often have other co-existing psychiatric conditions such as anxiety (present in about 71% of people with bipolar disorder), substance abuse (56%), personality disorders (36%) and attention deficit hyperactivity disorder (10–20%) which can add to the burden of illness and worsen
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4032-547: Is a double-stranded DNA virus . Herpes simplex virus is divided into two types. However, each may cause infections in all areas. Primary orofacial herpes is readily identified by examination of persons with no previous history of lesions and contact with an individual with known HSV infection. The appearance and distribution of sores is typically presents as multiple, round, superficial oral ulcers, accompanied by acute gingivitis . Adults with atypical presentation are more difficult to diagnose. Prodromal symptoms that occur before
4158-530: Is a lack of research. Psychotherapy aims to assist a person with bipolar disorder in accepting and understanding their diagnosis, coping with various types of stress, improving their interpersonal relationships, and recognizing prodromal symptoms before full-blown recurrence. Cognitive behavioral therapy (CBT), family-focused therapy , and psychoeducation have the most evidence for efficacy in regard to relapse prevention, while interpersonal and social rhythm therapy and cognitive-behavioral therapy appear
4284-568: Is a recurrent or initial herpes simplex infection affecting primarily the hair follicle . Although the exact cause of Bell's palsy —a type of facial paralysis —is unknown, it may be related to the reactivation of HSV-1. This theory has been contested, however, since HSV is detected in large numbers of individuals having never experienced facial paralysis, and higher levels of antibodies for HSV are not found in HSV-infected individuals with Bell's palsy compared to those without. Antivirals may improve
4410-441: Is an HSV infection in an infant. It is a rare but serious condition, usually caused by vertical transmission of HSV-1 or -2 from mother to newborn. During immunodeficiency, herpes simplex can cause unusual lesions in the skin. One of the most striking is the appearance of clean linear erosions in skin creases, with the appearance of a knife cut. Herpetic sycosis is a recurrent or initial herpes simplex infection affecting primarily
4536-410: Is associated with "classic mania", to dysphoria and irritability . Psychotic symptoms such as delusions or hallucinations may occur in both manic and depressive episodes; their content and nature are consistent with the person's prevailing mood. In some people with bipolar disorder, depressive symptoms predominate, and the episodes of mania are always the more subdued hypomania type. According to
4662-399: Is believed to occur on 20% of days per year in patients not undergoing antiviral treatment, versus 10% of days while on antiviral therapy. The risk of transmission from mother to baby is highest if the mother becomes infected around the time of delivery (30% to 60%), since insufficient time will have occurred for the generation and transfer of protective maternal antibodies before the birth of
4788-539: Is characterized by intermittent episodes of mania , commonly (but not in every patient) alternating with bouts of depression, with an absence of symptoms in between. During these episodes, people with bipolar disorder exhibit disruptions in normal mood , psychomotor activity (the level of physical activity that is influenced by mood)—e.g. constant fidgeting during mania or slowed movements during depression— circadian rhythm and cognition. Mania can present with varying levels of mood disturbance, ranging from euphoria , which
4914-504: Is classified as a sexually transmitted infection . It may be spread to an infant during childbirth. After infection, the viruses are transported along sensory nerves to the nerve cell bodies, where they reside lifelong . Causes of recurrence may include: decreased immune function , stress, and sunlight exposure. Oral and genital herpes is usually diagnosed based on the presenting symptoms. The diagnosis may be confirmed by viral culture or detecting herpes DNA in fluid from blisters. Testing
5040-454: Is contracted through direct contact with an active lesion or body fluid of an infected person. Herpes transmission occurs between discordant partners; a person with a history of infection (HSV seropositive) can pass the virus to an HSV seronegative person. Herpes simplex virus 2 is typically contracted through direct skin-to-skin contact with an infected individual, but can also be contracted by exposure to infected saliva, semen, vaginal fluid, or
5166-407: Is crucial to establishing a treatment plan where these comorbidities exist. Children of parents with bipolar disorder more frequently have other mental health problems. In the 1920s, Kraepelin noted that manic episodes are rare before puberty. In general, bipolar disorder in children was not recognized in the first half of the twentieth century. This issue diminished with an increased following of
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5292-413: Is difficult to interrupt, decreased need for sleep, disinhibited social behavior, increased goal-oriented activities and impaired judgement, which can lead to exhibition of behaviors characterized as impulsive or high-risk, such as hypersexuality or excessive spending . To fit the definition of a manic episode, these behaviors must impair the individual's ability to socialize or work. If untreated,
5418-537: Is effective in acute manic and depressive episodes, especially with psychosis or catatonia . Admission to a psychiatric hospital may be required if a person is a risk to themselves or others; involuntary treatment is sometimes necessary if the affected person refuses treatment. Bipolar disorder occurs in approximately 2% of the global population. In the United States, about 3% are estimated to be affected at some point in their life; rates appear to be similar in females and males. Symptoms most commonly begin between
5544-416: Is estimated to be between 1-5% of the world's popluation. While the causes of this mood disorder are not clearly understood, both genetic and environmental factors are thought to play a role. Many genes, each with small effects, may contribute to the development of the disorder. Genetic factors account for about 70–90% of the risk of developing bipolar disorder. Environmental risk factors include
5670-402: Is higher in those with an adult diagnosis of bipolar spectrum disorder than in those without, particularly events stemming from a harsh environment rather than from the child's own behavior. Acutely, mania can be induced by sleep deprivation in around 30% of people with bipolar disorder. Less commonly, bipolar disorder or a bipolar-like disorder may occur as a result of or in association with
5796-453: Is made, while substance/medication-induced bipolar and related disorder is used if a medication is thought to have triggered the condition. Most people who meet criteria for bipolar disorder experience a number of episodes, on average 0.4 to 0.7 per year, lasting three to six months. Rapid cycling , however, is a course specifier that may be applied to any bipolar subtype. It is defined as having four or more mood disturbance episodes within
5922-423: Is more common than HSV-2, with rates of both increasing as people age. HSV-1 rates are between 70% and 80% in populations of low socioeconomic status and 40% to 60% in populations of improved socioeconomic status. An estimated 536 million people or 16% of the population worldwide were infected with HSV-2 as of 2003 with greater rates among women and in those in the developing world. Rates of infection are determined by
6048-643: Is no cure. Paracetamol (acetaminophen) and topical lidocaine may be used to help with the symptoms. Treatments with antiviral medication such as aciclovir or valaciclovir can lessen the severity of symptomatic episodes. Worldwide rates of either HSV-1 or HSV-2 are between 60% and 95% in adults. HSV-1 is usually acquired during childhood. Since there is no cure for either HSV-1 or HSV-2, rates of both inherently increase as people age. Rates of HSV-1 are between 70% and 80% in populations of low socioeconomic status and 40% to 60% in populations of improved socioeconomic status. An estimated 536 million people worldwide (16% of
6174-577: Is not required for a diagnosis , though blood tests or medical imaging can rule out other problems. Mood stabilizers , particularly lithium , and certain anticonvulsants , such as lamotrigine , valproate , and carbamazepine , as well as atypical antipsychotics, including quetiapine , cariprazine , and aripiprazole , are the mainstay of long-term pharmacologic relapse prevention. Antipsychotics are additionally given during acute manic episodes as well as in cases where mood stabilizers are poorly tolerated or ineffective. In patients where compliance
6300-401: Is of concern, long-acting injectable formulations are available. There is some evidence that psychotherapy improves the course of this disorder. The use of antidepressants in depressive episodes is controversial: they can be effective but have been implicated in triggering manic episodes. The treatment of depressive episodes, therefore, is often difficult. Electroconvulsive therapy (ECT)
6426-435: Is often dependent on the genetics of the infected person. In all cases, HSV is never removed from the body by the immune system . Following a primary infection, the virus enters the nerves at the site of primary infection, migrates to the cell body of the neuron, and becomes latent in the ganglion . As a result of primary infection, the body produces antibodies to the particular type of HSV involved, which can help reduce
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#17328847414896552-443: Is often misdiagnosed with other psychiatric disorders. There is no definitive association between race, ethnicity, or Socioeconomic status (SES). Adults with Bipolar report having a lower quality of life, even outside of a manic or depressive episode. Bipolar can put strain on marriage and other relationships, having a job, and everyday functioning. Bipolar is associated with having higher rates of unemployment. Most have trouble keeping
6678-518: Is the nature of the mood swings; in contrast to the sustained changes to mood over days to weeks or longer, those of the latter condition (more accurately called emotional dysregulation ) are sudden and often short-lived, and secondary to social stressors . Although there are no biological tests that are diagnostic of bipolar disorder, blood tests and/or imaging are carried out to investigate whether medical illnesses with clinical presentations similar to that of bipolar disorder are present before making
6804-527: Is to treat acute episodes safely with medication and work with the patient in long-term maintenance to prevent further episodes and optimise function using a combination of pharmacological and psychotherapeutic techniques. Hospitalization may be required especially with the manic episodes present in bipolar I. This can be voluntary or (local legislation permitting) involuntary . Long-term inpatient stays are now less common due to deinstitutionalization , although these can still occur. Following (or in lieu of)
6930-612: Is weaker. A number of topical antivirals are effective for herpes labialis, including aciclovir, penciclovir, and docosanol . Evidence is insufficient to support use of many of these compounds, including echinacea , eleuthero , L-lysine , zinc , monolaurin bee products, and aloe vera . While a number of small studies show possible benefit from monolaurin, L-lysine, aspirin , lemon balm, topical zinc, or licorice root cream in treatment, these preliminary studies have not been confirmed by higher-quality randomized controlled studies . Following active infection, herpes viruses establish
7056-471: The herpesviridae family such as herpes zoster (also known as shingles), which is caused by varicella zoster virus . The differential diagnosis includes hand, foot and mouth disease due to similar lesions on the skin. Lymphangioma circumscriptum and dermatitis herpetiformis may also have a similar appearance. As with almost all sexually transmitted infections, women are more susceptible to acquiring genital HSV-2 than men. On an annual basis, without
7182-587: The American Psychiatric Association 's (APA) Diagnostic and Statistical Manual of Mental Disorders , Fifth Edition (DSM-5) and the World Health Organization 's (WHO) International Statistical Classification of Diseases and Related Health Problems , 10th Edition (ICD-10). The ICD-10 criteria are used more often in clinical settings outside of the U.S. while the DSM criteria are used within
7308-581: The Bipolar spectrum diagnostic scale , Mood Disorder Questionnaire , the General Behavior Inventory and the Hypomania Checklist . The use of evaluation scales cannot substitute a full clinical interview but they serve to systematize the recollection of symptoms. On the other hand, instruments for screening bipolar disorder tend to have lower sensitivity . Bipolar disorder is classified by
7434-450: The DSM-5 criteria, mania is distinguished from hypomania by the duration: hypomania is present if elevated mood symptoms persist for at least four consecutive days, while mania is present if such symptoms persist for more than a week. Unlike mania, hypomania is not always associated with impaired functioning. The biological mechanisms responsible for switching from a manic or hypomanic episode to
7560-504: The International Classification of Diseases as a mental and behavioural disorder . Mental disorders that can have symptoms similar to those seen in bipolar disorder include schizophrenia , major depressive disorder, attention deficit hyperactivity disorder (ADHD), and certain personality disorders, such as borderline personality disorder . A key difference between bipolar disorder and borderline personality disorder
7686-504: The Young Mania Rating Scale , though questions remain about the reliability of these scales. The onset of a manic or depressive episode is often foreshadowed by sleep disturbance . Manic individuals often have a history of substance use disorder developed over years as a form of "self-medication". Hypomania is the milder form of mania, defined as at least four days of the same criteria as mania, but which does not cause
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#17328847414897812-839: The bipolar spectrum has been estimated at 0.71. Twin studies have been limited by relatively small sample sizes but have indicated a substantial genetic contribution, as well as environmental influence. For bipolar I disorder, the rate at which identical twins (same genes) will both have bipolar I disorder (concordance) is around 40%, compared to about 5% in fraternal twins . A combination of bipolar I, II, and cyclothymia similarly produced rates of 42% and 11% (identical and fraternal twins, respectively). The rates of bipolar II combinations without bipolar I are lower—bipolar II at 23 and 17%, and bipolar II combining with cyclothymia at 33 and 14%—which may reflect relatively higher genetic heterogeneity . The cause of bipolar disorders overlaps with major depressive disorder. When defining concordance as
7938-1140: The endocrine system such as hypothyroidism , hyperthyroidism , and Cushing's disease are in the differential as is the connective tissue disease systemic lupus erythematosus . Infectious causes of mania that may appear similar to bipolar mania include herpes encephalitis , HIV, influenza , or neurosyphilis . Certain vitamin deficiencies such as pellagra ( niacin deficiency), vitamin B 12 deficiency , folate deficiency , and Wernicke–Korsakoff syndrome ( thiamine deficiency ) can also lead to mania. Common medications that can cause manic symptoms include antidepressants, prednisone , Parkinson's disease medications, thyroid hormone , stimulants (including cocaine and methamphetamine), and certain antibiotics . Bipolar spectrum disorders include: bipolar I disorder, bipolar II disorder, cyclothymic disorder and cases where subthreshold symptoms are found to cause clinically significant impairment or distress. These disorders involve major depressive episodes that alternate with manic or hypomanic episodes, or with mixed episodes that feature symptoms of both mood states. The concept of
8064-513: The hippocampus , dorsal anterior cingulate cortex, and other parts of the prefrontal cortex. The model hypothesizes that bipolar disorder may occur when the ventral system is overactivated and the dorsal system is underactivated. Other models suggest the ability to regulate emotions is disrupted in people with bipolar disorder and that dysfunction of the ventricular prefrontal cortex is crucial to this disruption. Meta-analyses of structural MRI studies have shown that certain brain regions (e.g.,
8190-706: The lingual gyrus compared to people without bipolar disorder. In contrast, they demonstrate decreased activity in the inferior frontal cortex during manic episodes compared to people without the disorder. Similar studies examining the differences in brain activity between people with bipolar disorder and those without did not find a consistent area in the brain that was more or less active when comparing these two groups. People with bipolar have increased activation of left hemisphere ventral limbic areas—which mediate emotional experiences and generation of emotional responses—and decreased activation of right hemisphere cortical structures related to cognition—structures associated with
8316-469: The locus coeruleus indicated increased noradrenergic activity in manic people. Low plasma GABA levels on both sides of the mood spectrum have been found. One review found no difference in monoamine levels, but found abnormal norepinephrine turnover in people with bipolar disorder. Tyrosine depletion was found to reduce the effects of methamphetamine in people with bipolar disorder as well as symptoms of mania, implicating dopamine in mania. VMAT2 binding
8442-593: The 16 genes identified in these pathways, three were found to be dysregulated in the dorsolateral prefrontal cortex portion of the brain in post-mortem studies: CACNA1C , GNG2 , and ITPR2 . Bipolar disorder is associated with reduced expression of specific DNA repair enzymes and increased levels of oxidative DNA damages . Psychosocial factors play a significant role in the development and course of bipolar disorder, and individual psychosocial variables may interact with genetic dispositions. Recent life events and interpersonal relationships likely contribute to
8568-513: The 1980s serological tests for antibodies to HSV were rarely useful to diagnosis and not routinely used in clinical practice. The older IgM serologic assay could not differentiate between antibodies generated in response to HSV-1 or HSV-2 infection. However, a glycoprotein G-specific (IgG) HSV test introduced in the 1980s is more than 98% specific at discriminating HSV-1 from HSV-2. It should not be confused with conditions caused by other viruses in
8694-410: The 36th week of pregnancy, limits HSV recurrence and shedding during childbirth, thereby reducing the need for caesarean section. Aciclovir is the recommended antiviral for herpes suppressive therapy during the last months of pregnancy. The use of valaciclovir and famciclovir, while potentially improving compliance, have less-well-determined safety in pregnancy. No method eradicates herpes virus from
8820-568: The DSM criteria in the last part of the twentieth century. The diagnosis of childhood bipolar disorder, while formerly controversial, has gained greater acceptance among childhood and adolescent psychiatrists. American children and adolescents diagnosed with bipolar disorder in community hospitals increased 4-fold reaching rates of up to 40% in 10 years around the beginning of the 21st century, while in outpatient clinics it doubled reaching 6%. Studies using DSM criteria show that up to 1% of youth may have bipolar disorder. The DSM-5 has established
8946-457: The DSM-5 criteria for diagnosing unipolar and bipolar episodes are the same, some clinical features are more common in the latter, including increased sleep, sudden onset and resolution of symptoms, significant weight gain or loss, and severe episodes after childbirth. The earlier the age of onset, the more likely the first few episodes are to be depressive. For most people with bipolar types 1 and 2,
9072-480: The HSV-2 virus are still contagious. In many infections, the first symptom people will have of their own infections is the horizontal transmission to a sexual partner or the vertical transmission of neonatal herpes to a newborn at term. Since most asymptomatic individuals are unaware of their infection, they are considered at high risk for spreading HSV. In October 2011, the anti-HIV drug tenofovir , when used topically in
9198-586: The U.S. and are the prevailing criteria used internationally in research studies. The DSM-5, published in 2013, includes further and more accurate specifiers compared to its predecessor, the DSM-IV-TR . This work has influenced the eleventh revision of the ICD, which includes the various diagnoses within the bipolar spectrum of the DSM-V. Several rating scales for the screening and evaluation of bipolar disorder exist, including
9324-402: The ages of 20 and 25 years old; an earlier onset in life is associated with a worse prognosis. Interest in functioning in the assessment of patients with bipolar disorder is growing, with an emphasis on specific domains such as work, education, social life, family, and cognition. Around one-quarter to one-third of people with bipolar disorder have financial, social or work-related problems due to
9450-489: The appearance of herpetic lesions help differentiate HSV symptoms from the similar symptoms of other disorders, such as allergic stomatitis . When lesions do not appear inside the mouth, primary orofacial herpes is sometimes mistaken for impetigo , a bacterial infection . Common mouth ulcers ( aphthous ulcer ) also resemble intraoral herpes, but do not present a vesicular stage. Genital herpes can be more difficult to diagnose than oral herpes, since most people have none of
9576-744: The bipolar spectrum is similar to that of Emil Kraepelin 's original concept of manic depressive illness. Bipolar II disorder was established as a diagnosis in 1994 within DSM IV; though debate continues over whether it is a distinct entity, part of a spectrum, or exists at all. The DSM and the ICD characterize bipolar disorder as a spectrum of disorders occurring on a continuum. The DSM-5 and ICD-11 lists three specific subtypes: When relevant, specifiers for peripartum onset and with rapid cycling should be used with any subtype. Individuals who have subthreshold symptoms that cause clinically significant distress or impairment, but do not meet full criteria for one of
9702-410: The blood for antibodies against the virus can confirm a previous infection but will be negative in new infections. The most effective method of avoiding genital infections is by avoiding vaginal, oral, manual, and anal sex. Condom use decreases the risk. Daily antiviral medication taken by someone who has the infection can also reduce spread. There is no available vaccine and once infected, there
9828-482: The body, but antiviral medications can reduce the frequency, duration, and severity of outbreaks. Analgesics such as ibuprofen and paracetamol (acetaminophen) can reduce pain and fever. Topical anesthetic treatments such as prilocaine , lidocaine , benzocaine , or tetracaine can also relieve itching and pain. Several antiviral drugs are effective for treating herpes, including aciclovir (acyclovir), valaciclovir , famciclovir , and penciclovir . Aciclovir
9954-478: The child. In contrast, the risk falls to 3% if the infection is recurrent, and is 1–3% if the woman is seropositive for both HSV-1 and HSV-2, and is less than 1% if no lesions are visible. Women seropositive for only one type of HSV are only half as likely to transmit HSV as infected seronegative mothers. To prevent neonatal infections, seronegative women are recommended to avoid unprotected oral-genital contact with an HSV-1-seropositive partner and conventional sex with
10080-629: The classical symptoms. Further confusing diagnosis, several other conditions resemble genital herpes, including fungal infection , lichen planus , atopic dermatitis , and urethritis . Laboratory testing is often used to confirm a diagnosis of genital herpes. Laboratory tests include culture of the virus, direct fluorescent antibody (DFA) studies to detect virus, skin biopsy , and polymerase chain reaction to test for presence of viral DNA. Although these procedures produce highly sensitive and specific diagnoses, their high costs and time constraints discourage their regular use in clinical practice. Until
10206-538: The co-twins having either bipolar disorder or major depression, then the concordance rate rises to 67% in identical twins and 19% in fraternal twins. The relatively low concordance between fraternal twins brought up together suggests that shared family environmental effects are limited, although the ability to detect them has been limited by small sample sizes. Behavioral genetic studies have suggested that many chromosomal regions and candidate genes are related to bipolar disorder susceptibility with each gene exerting
10332-487: The condition slightly when used together with corticosteroids in those with severe disease. HSV-1 has been proposed as a possible cause of Alzheimer's disease . In the presence of a certain gene variation ( APOE -epsilon4 allele carriers), HSV-1 appears to be particularly damaging to the nervous system and increases one's risk of developing Alzheimer's disease. The virus interacts with the components and receptors of lipoproteins , which may lead to its development. Herpes
10458-398: The criteria for major depressive episodes. If these symptoms are due to drugs or medical problems, they are not diagnosed as bipolar disorder. Other conditions that have overlapping symptoms with bipolar disorder include attention deficit hyperactivity disorder , personality disorders , schizophrenia , and substance use disorder as well as many other medical conditions. Medical testing
10584-449: The depressive episodes are much longer than the manic or hypomanic episodes. Since a diagnosis of bipolar disorder requires a manic or hypomanic episode, many affected individuals are initially misdiagnosed as having major depression and incorrectly treated with prescribed antidepressants. In bipolar disorder, a mixed state is an episode during which symptoms of both mania and depression occur simultaneously. Individuals experiencing
10710-520: The depressive phase. The depressive phase ends with homeostatic upregulation potentially restarting the cycle over again. Glutamate is significantly increased within the left dorsolateral prefrontal cortex during the manic phase of bipolar disorder, and returns to normal levels once the phase is over. Medications used to treat bipolar may exert their effect by modulating intracellular signaling, such as through depleting myo- inositol levels, inhibition of cAMP signaling , and through altering subunits of
10836-440: The dopamine-associated G-protein. Consistent with this, elevated levels of G αi , G αs , and G αq/11 have been reported in brain and blood samples, along with increased protein kinase A (PKA) expression and sensitivity; typically, PKA activates as part of the intracellular signalling cascade downstream from the detachment of G αs subunit from the G protein complex. Decreased levels of 5-hydroxyindoleacetic acid ,
10962-450: The elevated mood is severe or associated with psychosis , it is called mania ; if it is less severe and does not significantly affect functioning, it is called hypomania . During mania, an individual behaves or feels abnormally energetic, happy, or irritable, and they often make impulsive decisions with little regard for the consequences; there is usually also a reduced need for sleep during manic phases. During periods of depression,
11088-552: The fingers or thumb, herpes simplex keratitis involves the eye, herpesviral encephalitis involves the brain, and neonatal herpes involves any part of the body of a newborn, among others. There are two types of herpes simplex virus, type 1 (HSV-1) and type 2 (HSV-2). HSV-1 more commonly causes infections around the mouth while HSV-2 more commonly causes genital infections. They are transmitted by direct contact with body fluids or lesions of an infected individual. Transmission may still occur when symptoms are not present. Genital herpes
11214-583: The first year of infection. Prodrome precedes development of lesions. Prodromal symptoms include tingling ( paresthesia ), itching, and pain where lumbosacral nerves innervate the skin. Prodrome may occur as long as several days or as short as a few hours before lesions develop. Beginning antiviral treatment when prodrome is experienced can reduce the appearance and duration of lesions in some individuals. During recurrence, fewer lesions are likely to develop and are less painful and heal faster (within 5–10 days without antiviral treatment) than those occurring during
11340-671: The fluid from herpetic blisters. To infect a new individual, HSV travels through tiny breaks in the skin or mucous membranes in the mouth or genital areas. Even microscopic abrasions on mucous membranes are sufficient to allow viral entry. HSV asymptomatic shedding occurs at some time in most individuals infected with herpes. It can occur more than a week before or after a symptomatic recurrence in 50% of cases. Virus enters into susceptible cells by entry receptors such as nectin-1, HVEM and 3-O sulfated heparan sulfate. Infected people who show no visible symptoms may still shed and transmit viruses through their skin; asymptomatic shedding may represent
11466-635: The former group present with milder manic episodes, more prominent cognitive changes and have a background of worse psychosocial functioning, while the latter present more commonly with mixed affective episodes, and have a stronger family history of illness. Older people with bipolar disorder experience cognitive changes, particularly in executive functions such as abstract thinking and switching cognitive sets, as well as concentrating for long periods and decision-making. Attempts at prevention of bipolar disorder have focused on stress (such as childhood adversity or highly conflictual families) which, although not
11592-597: The frequency and duration of outbreaks. Outbreaks may occur at the original site of the infection or in proximity to nerve endings that reach out from the infected ganglia. In the case of a genital infection, sores can appear at the original site of infection or near the base of the spine, the buttocks, or the back of the thighs. HSV-2-infected individuals are at higher risk for acquiring HIV when practicing unprotected sex with HIV-positive persons, in particular during an outbreak with active lesions. Worldwide rates of either HSV-1 and/or HSV-2 are between 60 and 95% in adults. HSV-1
11718-434: The general population. Substance use disorder is a common comorbidity in bipolar disorder; the subject has been widely reviewed. The causes of bipolar disorder likely vary between individuals and the exact mechanism underlying the disorder remains unclear. Genetic influences are believed to account for 73–93% of the risk of developing the disorder indicating a strong hereditary component. The overall heritability of
11844-445: The genes CACNA1C , ODZ4 , and NCAN . The largest and most recent genome-wide association study failed to find any locus that exerts a large effect, reinforcing the idea that no single gene is responsible for bipolar disorder in most cases. Polymorphisms in BDNF , DRD4 , DAO , and TPH1 have been frequently associated with bipolar disorder and were initially associated in
11970-429: The hair follicles. Eczema herpeticum is an infection with herpesvirus in patients with chronic atopic dermatitis may result in spread of herpes simplex throughout the eczematous areas. Herpetic keratoconjunctivitis , a primary infection, typically presents as swelling of the conjunctiva and eyelids ( blepharoconjunctivitis ), accompanied by small white itchy lesions on the surface of the cornea . Herpetic sycosis
12096-438: The illness. Bipolar disorder is among the top 20 causes of disability worldwide and leads to substantial costs for society. Due to lifestyle choices and the side effects of medications, the risk of death from natural causes such as coronary heart disease in people with bipolar disorder is twice that of the general population. Late adolescence and early adulthood are peak years for the onset of bipolar disorder. The condition
12222-428: The incidence of mood disorders is increasing overall with the aging population. Depressive episodes more commonly present with sleep disturbance, fatigue, hopelessness about the future, slowed thinking, and poor concentration and memory; the last three symptoms are seen in what is known as pseudodementia . Clinical features also differ between those with late-onset bipolar disorder and those who developed it early in life;
12348-441: The individual may experience crying, have a negative outlook on life, and demonstrate poor eye contact with others. The risk of suicide is high; over a period of 20 years, 6% of those with bipolar disorder died by suicide, while 30–40% engaged in self-harm . Other mental health issues, such as anxiety disorders and substance use disorders , are commonly associated with bipolar disorder. The global prevalence of bipolar disorder
12474-482: The infected partner will be seropositive but symptom-free by about 50%. Condom use also reduces the transmission risk significantly. Condom use is much more effective at preventing male-to-female transmission than vice versa . Previous HSV-1 infection may reduce the risk for acquisition of HSV-2 infection among women by a factor of three, although the one study that states this has a small sample size of 14 transmissions out of 214 couples. However, asymptomatic carriers of
12600-465: The left rostral anterior cingulate cortex , fronto-insular cortex , ventral prefrontal cortex, and claustrum ) are smaller in people with bipolar disorder, whereas other regions are larger ( lateral ventricles , globus pallidus , subgenual anterior cingulate , and the amygdala). Additionally, these meta-analyses found that people with bipolar disorder have higher rates of deep white matter hyperintensities . Functional MRI findings suggest that
12726-467: The levels in non-manic people, suggesting that ventricular prefrontal cortex activity is an indicator of mood state. However, while pharmacological treatment of mania reduces amygdala hyperactivity, it remains more active than the amygdala of those without bipolar disorder, suggesting amygdala activity may be a marker of the disorder rather than the current mood state. Manic and depressive episodes tend to be characterized by dysfunction in different regions of
12852-447: The literature (including the DSM-V and ICD-11) is that of Dunner and Fieve: at least four major depressive, manic, hypomanic or mixed episodes during a 12-month period. The literature examining the pharmacological treatment of rapid cycling is sparse and there is no clear consensus with respect to its optimal pharmacological management. "Ultra rapid" and "ultradian" have been applied to faster-cycling types of bipolar disorder. People with
12978-559: The most common form of HSV-2 transmission. Asymptomatic shedding is more frequent within the first 12 months of acquiring HSV. Concurrent infection with HIV increases the frequency and duration of asymptomatic shedding. Some individuals may have much lower patterns of shedding, but evidence supporting this is not fully verified; no significant differences are seen in the frequency of asymptomatic shedding when comparing persons with one to 12 annual recurrences to those with no recurrences. Antibodies that develop following an initial infection with
13104-539: The nucleus. This group of analysts defined multiple categories of virus. Groups: The clinical characteristics of viruses may differ substantially among species within the same family: Vertical and sexual Varicella : Zoster : Varicella : Zoster : Bipolar disorder Bipolar disorder , previously known as manic depression or manic depressive disorder , is a mental disorder characterized by periods of depression and periods of abnormally elevated mood that each last from days to weeks. If
13230-589: The odds of subsequent infection of that type at a different site. In HSV-1-infected individuals, seroconversion after an oral infection helps prevent additional HSV-1 infections such as whitlow, genital herpes, and herpes of the eye. Prior HSV-1 seroconversion seems to reduce the symptoms of a later HSV-2 infection, although HSV-2 can still be contracted. Many people infected with HSV-2 display no physical symptoms—individuals with no symptoms are described as asymptomatic or as having subclinical herpes. However, infection with herpes can be fatal. Neonatal herpes simplex
13356-541: The onset and recurrence of bipolar mood episodes, just as they do for unipolar depression. In surveys, 30–50% of adults diagnosed with bipolar disorder report traumatic/abusive experiences in childhood, which is associated with earlier onset, a higher rate of suicide attempts, and more co-occurring disorders such as post-traumatic stress disorder . Subtypes of abuse, such as sexual and emotional abuse, also contribute to violent behaviors seen in patients with bipolar disorder. The number of reported stressful events in childhood
13482-428: The population) were infected with HSV-2 as of 2003 with greater rates among women and those in the developing world. Most people with HSV-2 do not realize that they are infected. The name is from Ancient Greek : ἕρπης herpēs , which is related to the meaning 'to creep', referring to spreading blisters. The name does not refer to latency. HSV infection causes several distinct medical disorders . Common infection of
13608-504: The presence of antibodies against either viral species . In the US , 58% of the population is infected with HSV-1 and 16% are infected with HSV-2. Among those HSV-2-seropositive, only 19% were aware they were infected. During 2005–2008, the prevalence of HSV-2 was 39% in black people and 21% in women. The annual incidence in Canada of genital herpes due to HSV-1 and HSV-2 infection is not known (for
13734-455: The primary infection. Subsequent outbreaks tend to be periodic or episodic, occurring on average four or five times a year when not using antiviral therapy. The causes of reactivation are uncertain, but several potential triggers have been documented. A 2009 study showed the protein VP16 plays a key role in reactivation of the dormant virus. Changes in the immune system during menstruation may play
13860-421: The processing of emotions. A neurologic model for bipolar disorder proposes that the emotional circuitry of the brain can be divided into two main parts. The ventral system (regulates emotional perception) includes brain structures such as the amygdala , insula , ventral striatum , ventral anterior cingulate cortex , and the prefrontal cortex . The dorsal system (responsible for emotional regulation) includes
13986-419: The prognosis. Certain medical conditions are also more common in people with bipolar disorder as compared to the general population. This includes increased rates of metabolic syndrome (present in 37% of people with bipolar disorder), migraine headaches (35%), obesity (21%) and type 2 diabetes (14%). This contributes to a risk of death that is two times higher in those with bipolar disorder as compared to
14112-655: The rapid cycling or faster-cycling subtypes of bipolar disorder tend to be more difficult to treat and less responsive to medications than other people with bipolar disorder. The diagnosis of bipolar disorder can be complicated by coexisting ( comorbid ) psychiatric conditions including obsessive–compulsive disorder , substance-use disorder , eating disorders , attention deficit hyperactivity disorder , social phobia , premenstrual syndrome (including premenstrual dysphoric disorder ), or panic disorder . A thorough longitudinal analysis of symptoms and episodes, assisted if possible by discussions with friends and family members,
14238-472: The regulation of emotions. Neuroscientists have proposed additional models to try to explain the cause of bipolar disorder. One proposed model for bipolar disorder suggests that hypersensitivity of reward circuits consisting of frontostriatal circuits causes mania, and decreased sensitivity of these circuits causes depression. According to the "kindling" hypothesis, when people who are genetically predisposed toward bipolar disorder experience stressful events,
14364-484: The result of a cross-species transmission event from gibbons, orangutans, or gorillas. Viral disease A viral disease (or viral infection ) occurs when an organism's body is invaded by pathogenic viruses , and infectious virus particles (virions) attach to and enter susceptible cells. Examples are the common cold , gastroenteritis and pneumonia . Basic structural characteristics, such as genome type, virion shape and replication site, generally share
14490-452: The same features among virus species within the same family. Human-infecting virus families offer rules that may assist physicians and medical microbiologists / virologists . As a general rule, DNA viruses replicate within the cell nucleus while RNA viruses replicate within the cytoplasm . Exceptions are known to this rule: poxviruses replicate within the cytoplasm and orthomyxoviruses and hepatitis D virus (RNA viruses) replicate within
14616-536: The seroprevalence of HSV-2 antibody in leftover serum submitted for antenatal testing revealed a prevalence of 17%, ranging from 7% in women 15–19 years old to 28% in those 40–44 years. In Norway, a study published in 2000 found that up to 70–90% of genital initial infections were due to HSV-1. In Nova Scotia, 58% of 1,790 HSV isolates from genital lesion cultures in women were HSV-1; in men, 37% of 468 isolates were HSV-1. Herpes originated and evolved in Africa and could be
14742-600: The skin or mucosa may affect the face and mouth (orofacial herpes), genitalia (genital herpes), or hands ( herpetic whitlow ). More serious disorders occur when the virus infects and damages the eye ( herpes keratitis ), or invades the central nervous system, damaging the brain (herpes encephalitis). People with immature or suppressed immune systems, such as newborns, transplant recipients, or people with AIDS, are prone to severe complications from HSV infections. HSV infection has also been associated with cognitive deficits of bipolar disorder , and Alzheimer's disease , although this
14868-483: The stress of the experience is very painful. People with bipolar disorder who experience hypomania tend to forget the effects of their actions on those around them. Even when family and friends recognize mood swings , the individual will often deny that anything is wrong. If not accompanied by depressive episodes, hypomanic episodes are often not deemed problematic unless the mood changes are uncontrollable or volatile. Most commonly, symptoms continue for time periods from
14994-422: The stress threshold at which mood changes occur becomes progressively lower, until the episodes eventually start (and recur) spontaneously. There is evidence supporting an association between early-life stress and dysfunction of the hypothalamic-pituitary-adrenal axis leading to its overactivation, which may play a role in the pathogenesis of bipolar disorder. Other brain components that have been proposed to play
15120-411: The three subtypes may be diagnosed with other specified or unspecified bipolar disorder. Other specified bipolar disorder is used when a clinician chooses to explain why the full criteria were not met (e.g., hypomania without a prior major depressive episode). If the condition is thought to have a non-psychiatric medical cause, the diagnosis of bipolar and related disorder due to another medical condition
15246-410: The ulcers are fully healed is one way to limit risk of transmission. The risk is not eliminated, however, as viral shedding capable of transmitting infection may still occur while the infected partner is asymptomatic. The use of condoms or dental dams also limits the transmission of herpes from the genitals of one partner to the mouth of the other (or vice versa ) during oral sex . When one partner has
15372-436: The use of antivirals or condoms, the transmission risk of HSV-2 from infected male to female is about 8–11%. This is believed to be due to the increased exposure of mucosal tissue to potential infection sites. Transmission risk from infected female to male is around 4–5% annually. Suppressive antiviral therapy reduces these risks by 50%. Antivirals also help prevent the development of symptomatic HSV in infection scenarios, meaning
15498-405: The ventricular prefrontal cortex regulates the limbic system , especially the amygdala. In people with bipolar disorder, decreased ventricular prefrontal cortex activity allows for the dysregulated activity of the amygdala, which likely contributes to labile mood and poor emotional regulation. Consistent with this, pharmacological treatment of mania returns ventricular prefrontal cortex activity to
15624-442: The ventricular prefrontal cortex. Manic episodes appear to be associated with decreased activation of the right ventricular prefrontal cortex whereas depressive episodes are associated with decreased activation of the left ventricular prefrontal cortex. These disruptions often occur during development linked with synaptic pruning dysfunction. People with bipolar disorder who are in a euthymic mood state show decreased activity in
15750-400: Was found to be increased in one study of people with bipolar mania. Bipolar disorder is commonly diagnosed during adolescence or early adulthood, but onset can occur throughout life. Its diagnosis is based on the self-reported experiences of the individual, abnormal behavior reported by family members, friends or co-workers, observable signs of illness as assessed by a clinician, and ideally
15876-414: Was the first discovered and is now available in generic . Valaciclovir is also available as a generic and is slightly more effective than aciclovir for reducing lesion healing time. Evidence supports the use of aciclovir and valaciclovir in the treatment of herpes labialis as well as herpes infections in people with cancer . The evidence to support the use of aciclovir in primary herpetic gingivostomatitis
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