Post-polio syndrome
of brain nerves and spinal cord

Polio is a serious viral infection that used to be common in the UK and worldwide. It’s rarer now because it can be prevented with vaccination.

In around 1 in 100 people, the polio virus causes paralysis, which in rare cases can be life threatening.

Cases of polio in the UK fell dramatically when routine vaccination was introduced in the mid-1950s.


In around 1 in 100 people, the polio virus causes paralysis, which in rare cases can be life threatening.

Cases of polio in the UK fell dramatically when routine vaccination was introduced in the mid-1950s.


Cases of polio in the UK fell dramatically when routine vaccination was introduced in the mid-1950s.

Symptoms

The symptoms of post-polio syndrome include:

muscle weakness shrinking of the muscles (atrophy) tight joints (contractures) pain in muscles or joints chronic fatigue including physical tiredness and brain fatigue swallowing and speech problems respiratory problems like breathlessness and sleep apnoea cramps and muscle twitching being sensitive to cold temperatures

The muscle weakness and atrophy usually affects muscles that were previously affected by polio. Sometimes it affects other muscles.

This can impact your mobility and your ability to do everyday tasks like brushing your teeth or drying your hair.

Chronic fatigue is one of the most common and troublesome symptoms of post-polio syndrome. This can be physical fatigue (tiredness) and brain fatigue. Brain fatigue can cause problems with concentration, attention and memory. MRI scans can show white spots in the brains of polio survivors which may be related to brain fatigue.

The symptoms can gradually get worse over many years. There are supportive treatments that can help with symptoms.

Although post-polio syndrome is rarely life threatening, some people can develop breathing and swallowing difficulties that can lead to serious problems like chest infections.

Some people experience a sensitivity to some types of anaesthesia causing them to take longer to recover from having anaesthesia.

Causes

Post-polio syndrome is caused by the polio virus. It only affects people who’ve had polio although it can take 15 – 40 years after the infection for it to develop. It’s not known if there’s anything that can be done to prevent it.

The exact cause behind who’ll experience post-polio syndrome after having the polio virus is unclear.

It could be because of gradual degeneration (breaking down) of nerve cells (motor neurones) in the brainstem or spinal cord that were damaged by the polio virus. This gradual change explains why it can take years for post-polio syndrome symptoms to appear.

During recovery from polio, surviving motor neurone cells grow new nerve ends to connect with other muscle fibres. This helps to regain muscle strength as someone recovers from the polio virus.

Over time, these new nerve ends put the motor neurone cell under stress. The cells slowly break down, resulting in the loss of muscle strength.

People who have had severe polio at a young age or during adolescence (teenage years) might be more likely to experience post-polio syndrome. People who had a more serious infection in early adulthood are also more likely to develop post-polio syndrome.

Post-polio syndrome is not contagious.

Diagnoses

It can be difficult to diagnose post-polio syndrome. There are no specific tests for it, and it can be mistaken for other conditions.

Your GP might suspect post-polio syndrome if:

you had polio followed by a long period of stable symptoms (usually 15 years) your symptoms have developed gradually

The symptoms of post-polio syndrome are slow and progressive. The sudden appearance of symptoms is more likely to be caused by something else. A prolonged period of bed rest as a result of another illness or serious injury can trigger post-polio syndrome symptoms.

There are some tests that can be done to rule out conditions with similar symptoms.

You might be offered blood tests and scans of your spine.

Other tests that might be offered include:

electromyography (EMG) tests – these will measure the electrical activity in your nerves and muscles and detect damage that may have been caused by having polio sleep studies – if you’re experiencing sleep apnoea or you’re feeling unusually tired tests to check your heart function and heart rate a magnetic resonance imaging (MRI) scan or computerised tomography (CT) scan of your brain, spine and muscles lung function tests like a spirometry to measure your breathing test to investigate dysphagia (swallowing problems)

Treatments

As there’s no cure for post-polio syndrome, treatment will help you manage your symptoms and quality of life.

It’s likely you’ll have a multidisciplinary team of healthcare professionals working together to care for you including:

neurologists respiratory specialists physiotherapists orthotists psychologists pain management specialists occupational therapists

They’ll discuss the most suitable plan for your care which might include a mixture of the following:

Exercise and rest Exercise can help slow down the progressive muscle weakness that post-polio syndrome causes. However, being active can become difficult because your symptoms might become worse after exercise or activity. Any exercise should be pain free because too much exercise can cause more damage. You should pace yourself to avoid becoming exhausted from exercise. Your healthcare team might suggest you try using pacing techniques. This might involve: prioritising tasks finding different ways of doing tasks which prevent pain or exhaustion getting help from others to do particularly exhausting tasks taking regular breaks and having rest periods regularly throughout your day doing some regular gentle exercise that you can gradually build up and stopping before you become exhausted Pacing can help you prevent becoming worn out. It can help to space out activities throughout the day to allow for rest periods where you can recover in between. Making effective and efficient use of your muscles and strength in this way can help them to last longer.

Painkillers Medication to relieve pain might be used in addition to pacing techniques. Your healthcare team might suggest over the counter painkillers like aspirin, paracetamol or ibuprofen. Other stronger anti-inflammatory drugs and opiates might be considered too depending on individual needs. Talk to your GP if you’re taking over the counter medicines as they shouldn’t be used long term. They can cause complications like stomach ulcers if taken over a long period of time. Your healthcare team or GP might suggest medication like gabapentin or pregabalin for your pain if over the counter medications aren’t working. When taking medication for your pain, you might not feel the damage being caused to your muscles and joints through too much activity. This means it’s important you follow your pacing routine even when you don’t feel tired or aren’t in any pain.

Mobility aids You might benefit from a mobility aid like: braces to support weakened muscles and joints, prevent falls and improve posture walking sticks to help you balance and prevent falls an electric scooter a wheelchair Your healthcare team will discuss the most suitable options for you depending on your needs. Many mobility aids are provided for free by the NHS.

Treatment of breathing problems If you have breathing problems, you might benefit from treatment or lifestyle changes. Your breathing problems will be assessed to identify the cause. For example, your breathing problems might be caused by stiff ribs, scoliosis or weak respiratory muscles. Finding the cause will help to choose the correct treatment for you. You might be offered a machine to deliver pressurised air into your lungs through a mask during sleep. This is to help stop your airways closing if you have sleep apnoea. There are exercises you can do to increase the strength of your breathing muscles. A respiratory physiotherapist will help you to find suitable and safe exercises for you. Your healthcare team might suggest you have the pneumococcal vaccination, COVID-19 vaccines and annual flu jab. This is to reduce your risk of getting chest infections which can cause further complications. If you smoke, stopping smoking can help improve your breathing too.

Healthy eating and weight control If you’re overweight, you might be putting your weakened muscles under further pressure. This can cause problems with your energy levels and overall health. Losing weight (if you’re overweight) can help improve your symptoms and general health. Your healthcare team can tell you about specific exercises suitable for you. Eating a healthy, balanced diet can help you reduce and control your weight. It’ll also improve your general health. Following a plan that includes healthy foods that provide energy that’s released slowly over time can help improve your symptoms. Read our Eatwell Guide: How to eat a healthy balanced diet

Coping with psychological factors The symptoms of post-polio syndrome can be distressing. Developing post-polio syndrome after living with the polio virus as a child can cause anxiety, isolation and stress. This can lead to depression. Speak to your GP if you’re feeling down and you no longer enjoy things you used to.

Post-traumatic stress disorder (PTSD)
of mental health

Post-traumatic stress disorder (PTSD) is an anxiety disorder caused by very stressful, frightening or distressing events.

Someone with PTSD often relives the traumatic event through nightmares and flashbacks, and may experience feelings of isolation, irritability and guilt.

They may also have problems sleeping, such as insomnia, and find concentrating difficult.

These symptoms are often severe and persistent enough to have a significant impact on the person’s day-to-day life.

Read more about the symptoms of PTSD.

Symptoms

The symptoms of post-traumatic stress disorder (PTSD) can have a significant impact on your day-to-day life.

In most cases, the symptoms develop during the first month after a traumatic event. However, in a minority of cases, there may be a delay of months or even years before symptoms start to appear.

Some people with PTSD experience long periods when their symptoms are less noticeable, followed by periods where they get worse. Other people have constant, severe symptoms.

The specific symptoms of PTSD can vary widely between individuals, but generally fall into the categories described below.


The symptoms of complex PTSD are similar to symptoms of PTSD but may include:

feelings of shame or guilt difficulty controlling your emotions periods of losing attention and concentration – this is known as dissociation physical symptoms – such as headaches, dizziness, chest pains and stomach aches cutting yourself off from friends and family relationship difficulties destructive or risky behaviour – such as self-harm, alcohol misuse or drug abuse suicidal thoughts

Causes

The type of events that can cause PTSD include:

serious road accidents violent personal assaults, such as sexual assault, mugging or robbery prolonged sexual abuse, violence or severe neglect witnessing violent deaths military combat being held hostage terrorist attacks natural disasters, such as severe floods, earthquakes or tsunamis

PTSD can develop immediately after someone experiences a disturbing event or it can occur weeks, months or even years later.

PTSD is estimated to affect about 1 in every 3 people who have a traumatic experience, but it’s not clear exactly why some people develop the condition and others don’t.

Read more about the causes of PTSD.


Post-traumatic stress disorder (PTSD) can develop after a very stressful, frightening or distressing event, or after a prolonged traumatic experience.

Types of events that can lead to PTSD include:

serious road accidents violent personal assaults, such as sexual assault, mugging or robbery prolonged sexual abuse, violence or severe neglect witnessing violent deaths military combat being held hostage terrorist attacks natural disasters, such as severe floods, earthquakes or tsunamis a diagnosis of a life-threatening condition an unexpected severe injury or death of a close family member or friend

PTSD isn’t usually related to situations that are simply upsetting, such as divorce, job loss or failing exams.

PTSD develops in about 1 in 3 people who experience severe trauma. It isn’t fully understood why some people develop the condition while others don’t. However, certain factors appear to make some people more likely to develop PTSD.

If you’ve had depression or anxiety in the past, or you don’t receive much support from family or friends, you’re more susceptible to developing PTSD after a traumatic event.

There may also be a genetic factor involved in PTSD. For example, having a parent with a mental health problem is thought to increase your chances of developing the condition.


Although it’s not clear exactly why people develop PTSD, a number of possible reasons have been suggested. These are described below.

Survival mechanism

One suggestion is that the symptoms of PTSD are the result of an instinctive mechanism intended to help you survive further traumatic experiences.

For example, the flashbacks many people with PTSD experience may force you to think about the event in detail so you’re better prepared if it happens again. The feeling of being “on edge” (hyperarousal) may develop to help you react quickly in another crisis.

However, while these responses may be intended to help you survive, they’re actually very unhelpful in reality because you can’t process and move on from the traumatic experience.

Adrenaline levels

Studies have shown that people with PTSD have abnormal levels of stress hormones.

Normally, when in danger, the body produces stress hormones such as adrenaline to trigger a reaction in the body. This reaction, often known as the “fight or flight” reaction, helps to deaden the senses and dull pain.

People with PTSD have been found to continue to produce high amounts of fight or flight hormones even when there’s no danger. It’s thought this may be responsible for the numbed emotions and hyperarousal experienced by some people with PTSD.

Changes in the brain

In people with PTSD, parts of the brain involved in emotional processing appear different in brain scans.

One part of the brain responsible for memory and emotions is known as the hippocampus. In people with PTSD, the hippocampus appears smaller in size. It’s thought that changes in this part of the brain may be related to fear and anxiety, memory problems and flashbacks.

The malfunctioning hippocampus may prevent flashbacks and nightmares from being properly processed, so the anxiety they generate doesn’t reduce over time.

Treatment of PTSD results in proper processing of the memories so, over time, the flashbacks and nightmares gradually disappear.

Treatments

It’s normal to experience upsetting and confusing thoughts after a traumatic event, but most people improve naturally over a few weeks.

You should visit your GP if you or your child are still having problems about four weeks after the traumatic experience, or if the symptoms are particularly troublesome.

If necessary, your GP can refer you to mental health specialists for further assessment and treatment.


PTSD can be successfully treated, even when it develops many years after a traumatic event.

Any treatment depends on the severity of symptoms and how soon they occur after the traumatic event. Any of the following treatment options may be recommended:

Watchful waiting – monitoring your symptoms to see whether they improve or get worse without treatment. Psychotherapy – such as trauma-focused cognitive behavioural therapy (CBT) or eye movement desensitisation and reprocessing (EMDR).  Antidepressants – such as paroxetine or mirtazapine.

Read more about treating PTSD.


It’s normal to experience upsetting and confusing thoughts after a traumatic event, but in most people these improve naturally over a few weeks.

You should visit your GP if you or your child are still having problems about four weeks after the traumatic experience, or if the symptoms are particularly troublesome.

Your GP will want to discuss your symptoms with you in as much detail as possible. They’ll ask whether you’ve experienced a traumatic event in the recent or distant past and whether you’ve re-experienced the event through flashbacks or nightmares.

Your GP can refer you to mental health specialists if they feel you’d benefit from treatment. See treating PTSD for more information.


The main treatments for post-traumatic stress disorder (PTSD) are psychotherapy and medication.

Traumatic events can be very difficult to come to terms with, but confronting your feelings and seeking professional help is often the only way of effectively treating PTSD.

It’s possible for PTSD to be successfully treated many years after the traumatic event occurred, which means it’s never too late to seek help.


One of the key symptoms of complex PTSD is losing trust in people. If possible, people with complex PTSD are recommended to slowly start doing regular activities such as:

finding friends getting a job regular exercise taking on hobbies

It’s important to try and develop some feelings of trust. It may take some time, but a trusting relationship with a therapist will help treat complex PTSD.

Treatment from a therapist may be given in three stages, described below.

Stabilisation

One of the first steps in treating complex PTSD may involve speaking with a therapist to learn how to control feelings of distrust and lose the feeling of being ‘disconnected’ from friends and family.

Certain techniques, known as ‘grounding’ techniques, may be able to help you separate an abusive or traumatic past from the present. The aim is to make the past seem less frightening and reduce the amount of flashbacks you experience.

With time, you can begin to experience less anxiety and learn to cope with daily life.

Trauma-focused therapy

Trauma-focused therapy may include:

certain types of psychotherapy cognitive behavioural therapy (CBT) eye movement desensitisation and reprocessing (EMDR)

These treatments may help you to control any distressing thoughts but must be approached carefully to avoid making the situation worse.

Reintegration

The final stage is to begin to use these skills and techniques to develop better relationships with other people.

Medication, such as antidepressants, may still be recommended if psychotherapy isn’t possible or you feel unsafe.

You can read more information about complex PTSD on the Royal College of Psychiatrists website.

Postnatal depression
of mental health

It’s a common problem, affecting more than 1 in every 10 mothers within a year of giving birth. It can also affect fathers and partners, although this is less common.

With the right support, which can include self-help strategies and therapy, most people make a full recovery.


With the right support, which can include self-help strategies and therapy, most people make a full recovery.

Symptoms

Postnatal depression affects everyone differently. It can start at any point in the first year after giving birth. It can continue from depression in pregnancy. It may develop suddenly or gradually.

Many people feel a bit down, tearful or anxious in the first week after giving birth. This is often called the ‘baby blues’ and is so common that it’s considered normal. The baby blues don’t last for more than 2 weeks after giving birth.

If your symptoms last longer or start later, you could have postnatal depression.

The main symptoms of postnatal depression include:

a persistent feeling of sadness and low mood loss of interest in the world around you no longer enjoying things that used to give you pleasure lack of energy and feeling tired all the time trouble sleeping at night feeling sleepy during the day feeling that you’re unable to look after your baby problems concentrating and making decisions loss of appetite or an increased appetite (comfort eating) feeling agitated, irritable or very apathetic (you ‘can’t be bothered’) feelings of guilt, hopelessness and self-blame difficulty bonding with your baby – feeling of indifference and no sense of enjoyment in their company frightening thoughts, for example, about hurting your baby – these can be scary, but they’re very rarely acted upon thinking about suicide and self-harm

These symptoms can affect your day-to-day life and your relationships with your baby, family and friends.

Speak to your GP or health visitor as soon as possible if: you think you have postnatal depression Don’t struggle on alone and hope the problem will go away. It can take a lot longer to feel better if it’s not addressed.

Causes

The cause of postnatal depression isn’t completely clear. Some of the factors it has been associated with include:

a history of mental health problems, particularly depression, earlier in life or during pregnancy having no close family or friends to support you a poor relationship with your partner recent stressful life events, like a bereavement experiencing the ‘baby blues’

Even if you don’t have any of these symptoms, having a baby is a life-changing event that can sometimes trigger depression.

It often takes time to adapt to becoming a new parent. Looking after a small baby can be stressful and exhausting.

Treatments

Postnatal depression can be lonely, distressing and frightening. But, support and treatments are available. With the right treatment and support, most people make a full recovery, although it can take time.

Talk to your GP about the pros and cons of different treatments so you can decide together what’s best for you.

Your GP might also want to check your physical health to see if there are any problems that may need to be addressed as well. For example, you may be anaemic after giving birth. This could add to any feelings of depression you might have.

Psychological treatments for postnatal depression

Psychological therapies are usually the first treatment recommended for postnatal depression.

Guided self-help

Guided self-help involves working through a book or an online course. You can do this on your own or with some help from a therapist.

It focusses on the issues you might be facing, with practical advice on how to deal with them.

The courses typically last 9 to 12 weeks.

Cognitive behavioural therapy

Cognitive behavioural therapy (CBT) is a type of talking therapy. It’s based on the idea that unhelpful and unrealistic thinking leads to negative behaviour.

CBT aims to break this cycle and find new ways of thinking that can help you behave in a more positive way.

CBT can be carried out either one-to-one with a therapist or in a group. Treatment will often last 3 to 4 months.

Interpersonal therapy

Interpersonal therapy (IPT) involves talking to a therapist about the problems you’re experiencing.

It aims to identify problems in your relationships with family, friends or partners. It then looks at how they might relate to your feelings of depression.

Treatment also usually lasts 3 to 4 months.

Antidepressants

Antidepressants may be recommended if:

you have moderate or severe depression you don’t want to try psychological treatment psychological treatment doesn’t help you have mild postnatal depression and a previous history of depression

They can help ease symptoms like:

low mood irritability lack of concentration sleeplessness

This helps you to function normally and helps you cope better with your new baby.

Antidepressants usually need to be taken for at least a week before the benefit starts to be felt. This means it’s important to keep taking them even if you don’t notice an improvement straight away. You’ll usually need to take them for around 6 months after you begin to feel better. If you stop too early, your depression may return.

If you’re breastfeeding, talk to your doctor about suitable medicines. Some types of antidepressants are safe to take while breastfeeding.Your doctor should explain any risks of taking antidepressants. You should be offered the type with the least risk for you and your baby.

Self-help

There are many things you can try yourself to improve your symptoms and help you cope.

Do talk to your partner, friends and family to help them understand how you’re feeling talk to your loved ones about what they can do to support you accept help from others when it’s offered ask your loved ones if they can help look after the baby and do tasks like housework, cooking and shopping make time for yourself – try to do activities that you find relaxing and enjoyable rest when you can – although it can be difficult when you’re looking after a baby, try to sleep whenever you get the chance follow good sleeping habits ask your partner to help with the night-time work exercise regularly – this has been shown to help boost mood in people with mild depression eat regular, healthy meals

Don’t do not go for long periods without eating do not drink alcohol or take drugs, as this can make you feel worse

Support groups

Ask your health visitor about support services in your area. They may be able to put you in touch with a social worker, counsellor or local support group. It can be reassuring to meet other people who are going through something similar.

Find postnatal depression support and information in your area


You might be referred to a specialist perinatal mental health team if your depression:

is very severe doesn’t respond to treatment like antidepressants, self-help or therapy

Your team might be able to offer other treatments, like:

more intensive CBT other psychological treatments, like psychotherapy therapies such as baby massage which can improve depression and help build your relationships with your baby different medications electroconvulsive therapy (ECT) where electrodes are placed on your head and pulses of electricity are sent through the brain

For a small number of people, coming into hospital can help speed up recovery.

You may be offered a place in a Mother and Baby Unit, where you can continue to look after your baby while you get the best treatment for your illness.

Ready Steady Baby!
of

Pressure ulcers
of skin hair and nails

Pressure ulcers are an injury that breaks down the skin and underlying tissue. They are caused when an area of skin is placed under pressure.

They are sometimes known as “bedsores” or “pressure sores”.

Pressure ulcers can range in severity from patches of discoloured skin to open wounds that expose the underlying bone or muscle.

Read more about the symptoms of pressure ulcers.

Symptoms

The parts of the body most at risk of developing pressure ulcers are those that are not covered by a large amount of body fat and are in direct contact with a supporting surface, such as a bed or a wheelchair.

For example, if you are unable to get out of bed, you are at risk of developing pressure ulcers on your:

shoulders or shoulder blades elbows back of your head rims of your ears knees, ankles, heels or toes spine tail bone (the small bone at the bottom of your spine)

If you are a wheelchair user, you are at risk of developing pressure ulcers on:

your buttocks the back of your arms and legs the back of your hip bone

Causes

Pressure ulcers are caused by sustained pressure being placed on a particular part of the body.

This pressure interrupts the blood supply to the affected area of skin. Blood contains oxygen and other nutrients that are needed to help keep tissue healthy. Without a constant blood supply, tissue is damaged and will eventually die.

The lack of blood supply also means that the skin no longer receives infection-fighting white blood cells. Once an ulcer has developed, it can become infected by bacteria.

People with normal mobility do not develop pressure ulcers, as their body automatically makes hundreds of regular movements that prevent pressure building up on any part of their body.

For example, you may think that you are lying still when asleep, but you may shift position up to 20 times a night.

Pressure ulcers can be caused by:

pressure from a hard surface – such as a bed or wheelchair pressure that is placed on the skin through involuntary muscle movements – such as muscle spasms moisture – which can break down the outer layer of the skin (epidermis)

The time it takes for a pressure ulcer to form will depend on:

the amount of pressure how vulnerable a person’s skin is to damage

Grade 3 or 4 pressure ulcers can develop quickly. For example, in susceptible people, a full-thickness pressure ulcer can sometimes develop in just 1 or 2 hours. However, in some cases, the damage will only become apparent a few days after the injury has occurred. 

Increased risk

There are several factors that increase the risk of developing pressure ulcers. These include:

mobility problems – anything that affects your ability to move some or all of your body poor nutrition – for your skin to remain healthy, it requires nutrients that can only be supplied by eating a nutritious diet an underlying health condition that disrupts your blood supply or makes your skin more vulnerable to injury and damage being over 70 years old urinary incontinence and/or bowel incontinence serious mental health conditions

These are discussed in more detail below.

Mobility problems

Possible reasons for having a mobility problem are:

having a spinal cord injury that causes some or all of your limbs to be paralysed brain damage caused by an event such as a stroke or severe head injury, which results in paralysis  having a condition that is causing progressive damage to the nerves your body uses to move parts of the body – such as Alzheimer’s disease, multiple sclerosis (MS) or Parkinson’s disease  having severe pain that makes it difficult to move some or all of your body having a fractured or broken bone recovering from the effects of surgery being in a coma having a condition that makes it difficult to move your joints and bones – such as rheumatoid arthritis 

Poor nutrition

Reasons that your diet may lack nutrition include:

anorexia nervosa – a mental health condition where a person has an unhealthy obsession with maintaining a low body weight   dehydration – you do not have enough fluids in your body dysphagia – difficulty swallowing food

Health conditions

Health conditions that can make you more vulnerable to pressure ulcers include:

type 1 diabetes and type 2 diabetes – the high levels of blood sugar associated with diabetes can disrupt normal blood flow peripheral arterial disease (PAD) – blood supply in the legs becomes restricted due to a build-up of fatty substances in the arteries heart failure – previous damage to the heart means it is no longer able to pump enough blood around the body kidney failure – the kidney loses most or all of its functions, which can lead to a build-up of dangerous toxins (poisons) in the blood that can cause tissue damage chronic obstructive pulmonary disease (COPD) – a collection of lung diseases; the low levels of oxygen in the blood associated with COPD can make the skin more vulnerable to damage

Ageing skin

There are several reasons why ageing skin is more vulnerable to pressure ulcers. These include:

with age, the skin loses some of its elasticity (stretchiness), which makes it more vulnerable to damage reduced blood flow to the skin, due to the effects of ageing the amount of fat under the skin tends to decrease as people get older

Incontinence

Both urinary incontinence (inability to control your bladder) and bowel incontinence (inability to control your bowels) can cause certain areas of the skin to become moist and vulnerable to infection. This can cause pressure ulcers to form.

Mental health conditions

People with severe mental health conditions such as schizophrenia (a condition where people have problems telling the difference between reality and imagination) or severe depression have an increased risk of pressure ulcers for a number of reasons. These include:

their diet tends to be poor they often have other physical health conditions, such as diabetes or incontinence they may neglect their personal hygiene, making their skin more vulnerable to injury and infection

Diagnoses

Pressure ulcers are easily diagnosed by looking at them. However, health professionals prefer to prevent ulcers developing in the first place, so it’s important to assess a person’s risk of developing them.

As part of the risk assessment process, the following will be considered:

your general health your ability to move whether you have any problems that may affect your posture whether you have any symptoms that may indicate an infection your mental health whether you have had pressure ulcers in the past whether you have urinary incontinence or bowel incontinence  your diet how well your blood circulation system is working

As part of the risk assessment, you may be referred for blood and urine tests. Blood tests can be a good way of assessing your general state of health and whether your diet is providing enough nutrition.

Urine tests can be used to check how well your kidneys are working and whether you have a urinary tract infection, which can be a cause for concern if you are incontinent or if you have had spinal damage.

Treatments

Treatment for pressure ulcers includes the use of dressings, creams and gels designed to speed up the healing process and relieve pressure. Surgery is sometimes recommended for the most serious cases.

For some people, pressure ulcers are an inconvenience that require minor nursing care. For others, they can be serious and lead to life-threatening complications, such as blood poisoning or gangrene. 

Read more about the complications of pressure ulcers.

Pressure ulcers can be unpleasant, upsetting and challenging to treat. Therefore, a range of techniques is used to prevent them developing in the first place. These include:

regularly changing a person’s position using equipment to protect vulnerable parts of the body – such as specially designed mattresses and cushions

Read about treating pressure ulcers and preventing pressure ulcers for more information.

Unfortunately, even with the highest standards of care, it’s not always possible to prevent pressure ulcers in particularly vulnerable people.


Treatment for pressure ulcers can vary, depending on the grade of the ulcer. Treatment options may include regularly changing your position, or using special mattresses and dressings to relieve pressure or protect the skin. In some cases, surgery may be needed.

Preventions

Treatment for pressure ulcers includes the use of dressings, creams and gels designed to speed up the healing process and relieve pressure. Surgery is sometimes recommended for the most serious cases.

For some people, pressure ulcers are an inconvenience that require minor nursing care. For others, they can be serious and lead to life-threatening complications, such as blood poisoning or gangrene. 

Read more about the complications of pressure ulcers.

Pressure ulcers can be unpleasant, upsetting and challenging to treat. Therefore, a range of techniques is used to prevent them developing in the first place. These include:

regularly changing a person’s position using equipment to protect vulnerable parts of the body – such as specially designed mattresses and cushions

Read about treating pressure ulcers and preventing pressure ulcers for more information.

Unfortunately, even with the highest standards of care, it’s not always possible to prevent pressure ulcers in particularly vulnerable people.


As part of your treatment plan, your care team will discuss with you the best way to prevent pressure ulcers. This will be based on your individual circumstances.

However, you may find that the general advice outlined below is helpful.

Complications

Even with the best possible medical care, complications can arise from grade 3 or grade 4 pressure ulcers and can occasionally be life-threatening.

These complications are discussed below.

Prostate cancer
of cancer, cancer types in adults

Prostate cancer is the most common cancer in men and anyone with a prostate in the UK.

Prostate cancer usually develops slowly, so there may be no signs you have it for many years.

Symptoms often only become apparent when your prostate is large enough to affect the urethra (the tube that carries urine from the bladder to the penis).

When this happens, you may notice things like an increased need to urinate, straining while urinating and a feeling that your bladder has not fully emptied.

These symptoms shouldn’t be ignored, but they do not mean you definitely have prostate cancer. It is more likely that they are caused by something else, such as benign prostatic hyperplasia (also known as BPH or prostate enlargement).

Read more about the symptoms of prostate cancer

Symptoms

Prostate cancer does not normally cause symptoms until the cancer has grown large enough to put pressure on the urethra.

This normally results in problems associated with urination. Symptoms can include:

needing to urinate more frequently, often during the night needing to rush to the toilet difficulty in starting to pee (hesitancy) straining or taking a long time while urinating weak flow feeling that your bladder has not emptied fully

Your prostate may get larger as you get older due to a non-cancerous condition known as prostate enlargement or benign prostatic hyperplasia.

Symptoms that the cancer may have spread include bone and back pain, a loss of appetite, pain in the testicles and unexplained weight loss.

Read further information:

Cancer Research UK: prostate cancer symptoms

Causes

The causes of prostate cancer are largely unknown. However, certain things can increase your risk of developing the condition.

The chances of developing prostate cancer increase as you get older. Most cases develop in men and anyone with a prostate aged 50 or older.

For reasons not yet understood, prostate cancer is more common in men and anyone with a prostate of African-Caribbean African descent. It’s less common in men and anyone with a prostate of Asian descent.

Men and anyone with a prostate who have first-degree male relatives (such as a father or brother) affected by prostate cancer are also at a slightly increased risk.

Read more about the causes of prostate cancer


It’s not known exactly what causes prostate cancer, although a number of things can increase your risk of developing the condition.

These include:

age – risk rises as you get older and most cases are diagnosed in men and anyone with a prostate over 50 years of age ethnic group – prostate cancer is more common among men and anyone with a prostate of African-Caribbean and African descent than in men and anyone with a prostate of Asian descent family history – having a brother or father who developed prostate cancer under the age of 60 seems to increase the risk of you developing it; having a close female relative who developed breast cancer may also increase your risk of developing prostate cancer obesity – there may be a link between obesity and prostate cancer exercise – men and anyone with a prostate who regularly exercises have also been found to be at lower risk of developing prostate cancer diet – research is ongoing into the links between diet and prostate cancer; a diet high in calcium is linked to an increased risk of developing prostate cancer

In addition, some research has shown that prostate cancer rates appear to be lower in men and anyone with a prostate who eat foods containing certain nutrients including lycopene, found in cooked tomatoes and other red fruit, and selenium, found in brazil nuts. However, more research is needed.

Read further information:

Prostate Cancer UK: who is at risk of prostate cancer Cancer Research UK: prostate cancer risks and causes

Diagnoses

There is no single test for prostate cancer. All the tests used to help diagnose the condition have benefits and risks, which your doctor should discuss with you.

The most commonly used tests for prostate cancer are blood tests, a physical examination of your prostate (known as a digital rectal examination or DRE) and a biopsy.

The blood test, known as a prostate-specific antigen (PSA) test, measures the level of PSA and may help detect early prostate cancer. Men and anyone with a prostate are not routinely offered PSA tests to screen for prostate cancer, as results can be unreliable.

This is because the PSA blood test is not specific to prostate cancer. PSA can be raised due to a large non-cancerous growth of the prostate (BPH), a urinary tract infection or inflammation of the prostate, as well as prostate cancer. Raised PSA levels also cannot tell a doctor whether a man has life-threatening prostate cancer or not. This means a raised PSA can lead to unnecessary tests and treatment.

However, you can ask to be tested for prostate cancer once the benefits and risks have been explained to you.

Read more about diagnosing prostate cancer and PSA screening for prostate cancer


If you have symptoms that could be caused by prostate cancer, you should visit your GP.

There is no single, definitive test for prostate cancer, so your GP will discuss the pros and cons of the various tests with you to try to avoid unnecessary anxiety.

Your doctor is likely to:

ask for a urine sample to check for infection take a blood sample to test your level of prostate-specific antigen (PSA) examine your prostate (digital rectal examination)

In 2015, the National Institute for Health and Care Excellence (NICE) published guidelines to help GPs recognise the signs and symptoms of prostate cancer and refer people for the right tests faster. To find out if you should be referred for further tests for suspected prostate cancer, read the NICE 2015 guidelines on Suspected Cancer: Recognition and Referral.


PSA is a protein produced by the prostate gland. All men and anyone with a prostate have a small amount of PSA in their blood, and it increases with age.

Prostate cancer can increase the production of PSA, and so a PSA test looks for raised levels of PSA in the blood that may be a sign of the condition in its early stages.

However, PSA testing is not a specific test for prostate cancer. Most men and anyone with a prostate who has prostate cancer will not have a raised PSA level. Most people with a raised PSA level will not have cancer, as PSA levels rise in all men and anyone with a prostate as they get older.

Read more about PSA screening for prostate cancer


If there is a significant chance the cancer has spread from your prostate to other parts of the body, further tests may be recommended.

These include:

a magnetic resonance imaging (MRI) or computerised tomography (CT) scan – these scans build a detailed picture of the inside of your body an isotope bone scan – this can tell if the cancer has spread to your bones; a small amount of radiation dye is injected into the vein and collects in parts of the bone where there are any abnormalities

Read further information:

Cancer Research UK: prostate cancer tests


There is currently no screening programme for prostate cancer in the UK. This is because it has not been proved that the benefits would outweigh the risks.


As there are many reasons why PSA levels may be high at any one time, researchers are trying to make the PSA test, or a variation of it, more accurate. This includes looking at how PSA levels change over time and comparing the PSA level to prostate size.

Researchers are also looking at whether new imaging tests, such as MRI scans, or other blood and urine tests, can be used to decide which people with an elevated PSA should have a biopsy.

Instead of a national screening programme, there is an informed choice programme called prostate cancer risk management for healthy men and anyone with a prostate aged 50 or over who ask their GP about PSA testing. It aims to give men and anyone with a prostate good information on the pros and cons of a PSA test.

If you’re aged 50 or over with a prostate and decide to have your PSA levels tested after talking to your GP, they will be able to arrange for it to be carried out for free on the NHS.

If results show you have a raised level of PSA, your GP may suggest further tests.


Because the results of the PSA test are not as reliable as doctors would like, other tests and investigations are needed to diagnose prostate cancer.

A PSA test cannot identify prostate cancer on its own, and changes in PSA levels alone are not a good reason to start treatment.

If you are thinking about asking for a PSA test, it is important that you first discuss whether it is right for you with your GP so you understand what the results might mean.

The Prostate Cancer Risk Management Programme has information on the risks and benefits of the PSA test to help you decide whether or not to have it.

Treatments

In many cases, treatment is not immediately necessary.

If the cancer is at an early stage and not causing symptoms, a policy of ‘watchful waiting’ or ‘active surveillance’ may be adopted. This involves carefully monitoring your condition.

Some cases of prostate cancer can be cured if treated in the early stages. Treatments include surgically removing the prostate, radiotherapy and hormone therapy.

Some cases are only diagnosed at a later stage when the cancer has spread. If the cancer spreads to other parts of the body, typically the bones, it cannot be cured and treatment is focused on prolonging life and relieving symptoms.

All treatment options carry the risk of significant side effects, including erectile dysfunction and urinary incontinence. For this reason, many people choose to delay treatment until there is a risk the cancer might spread.

Newer treatments, such as high-intensity focused ultrasound (HIFU) or cryotherapy, aim to reduce these side effects. Some hospitals may offer them as an alternative to surgery, radiotherapy or hormone therapy. However, the long-term effectiveness of these treatments are not yet known.

Read more about treating prostate cancer



If the cancer has reached an advanced stage, it is no longer possible to cure it. However, it may be possible to slow its progression, prolong your life and relieve symptoms.

Treatment options include:

radiotherapy hormone treatment chemotherapy

If the cancer has spread to your bones, medicines called bisphosphonates may be used. Bisphosphonates help reduce bone pain and bone loss.


There are a number of new medications that could be used if hormones and chemotherapy fail. Your medical team can tell you if these are suitable and available for you.

NICE has recently issued guidance on medications called abiraterone and enzalutamide. 

Read the NICE guidelines on:

enzalutamide for metastatic hormone-relapsed prostate cancer previously treated with docetaxel abiraterone for castration-resistant metastatic prostate cancer previously treated with a docetaxel-containing regimen


As many of the treatments above have unpleasant side effects that can affect your quality of life, you may decide against treatment. This may be especially true if you are at an age when you feel that treating the cancer is unlikely to significantly extend your life expectancy.

This is entirely your decision, and your MDT will respect it.

If you decide not to have treatment, your GP and hospital team will still give you support and pain relief. This is called palliative care. Support is also available for your family and friends.

Complications

Psoriasis
of skin hair and nails

Psoriasis is a skin condition that causes red, flaky, crusty patches of skin covered with silvery scales.

These patches normally appear on your elbows, knees, scalp and lower back, but can appear anywhere on your body. Most people are only affected with small patches. In some cases, the patches can be itchy or sore.

Psoriasis affects around 2% of people in the UK. It can start at any age, but most often develops in adults under 35 years old. The condition affects men and women equally.

The severity of psoriasis varies greatly from person to person. For some people it’s just a minor irritation, but for others it can have a major impact on their quality of life.

Psoriasis is a long-lasting (chronic) disease that usually involves periods when you have no symptoms or mild symptoms, followed by periods when symptoms are more severe.

Read more about the symptoms of psoriasis.

Psoriasis causes areas of red, flaky and crusty skin.Source: https://dermnetnz.org/

Symptoms

Psoriasis typically causes patches of skin that are dry, red and covered in silver scales. Some people find their psoriasis causes itching or soreness.

There are several different types of psoriasis. Many people have only one form of psoriasis at a time, although 2 different types can occur together. One type may change into another type, or become more severe.

Most cases of psoriasis go through cycles, causing problems for a few weeks or months before easing or stopping.

You should see your GP if you think you may have psoriasis.

Psoriasis often occurs on the elbow area.Source: https://dermnetnz.org/

Causes

People with psoriasis have an increased production of skin cells.

Skin cells are normally made and replaced every 3 to 4 weeks, but in psoriasis this process only lasts about 3 to 7 days. The resulting build-up of skin cells is what creates the patches associated with psoriasis.

Although the process isn’t fully understood, it’s thought to be related to a problem with the immune system. The immune system is your body’s defence against disease and infection, but for people with psoriasis, it attacks healthy skin cells by mistake.

Psoriasis can run in families, although the exact role that genetics plays in causing psoriasis is unclear.

Many people’s psoriasis symptoms start or become worse because of a certain event, known as a “trigger”. Possible triggers of psoriasis include an injury to your skin, throat infections and using certain medicines.

The condition isn’t contagious, so it can’t be spread from person to person.

Read more about the causes of psoriasis.


Psoriasis occurs when skin cells are replaced more quickly than usual. It’s not known exactly why this happens, but research suggests it’s caused by a problem with the immune system.

Your body produces new skin cells in the deepest layer of skin. These skin cells gradually move up through the layers of skin until they reach the outermost level. Then they die and flake off. This whole process normally takes around 3 to 4 weeks.

In people with psoriasis, this process only takes about 3 to 7 days. As a result, cells that aren’t fully mature build up rapidly on the surface of the skin, causing red, flaky, crusty patches covered with silvery scales.

Diagnoses

A GP can often diagnose psoriasis based on the appearance of your skin.

In rare cases, a small sample of skin, called a biopsy, will be sent to the laboratory for examination under a microscope. This determines the exact type of psoriasis and rules out other skin disorders, such as seborrhoeic dermatitis, lichen planus, lichen simplex and pityriasis rosea.

You may be referred to a dermatologist (a specialist in diagnosing and treating skin conditions) if your doctor is uncertain about your diagnosis, or if your condition is severe.

If your doctor suspects you have psoriatic arthritis, which is sometimes a complication of psoriasis, you may be referred to a rheumatologist (a doctor who specialises in arthritis). You may have blood tests to rule out other conditions, such as rheumatoid arthritis, and X-rays of the affected joints may be taken.

Treatments

There’s no cure for psoriasis, but a range of treatments can improve symptoms and the appearance of skin patches.

In most cases, the first treatment used will be a topical treatment, such as vitamin D analogues or topical corticosteroids. Topical treatments are creams and ointments applied to the skin.

If these aren’t effective, or your condition is more severe, a treatment called phototherapy may be used. Phototherapy involves exposing your skin to certain types of ultraviolet light.

In severe cases, where the above treatments are ineffective, systemic treatments may be used. These are oral or injected medicines that work throughout the whole body.

Read more about treating psoriasis.



Treatments are determined by the type and severity of your psoriasis and the area of skin affected. Your doctor will probably start with a mild treatment, such as topical creams (which are applied to the skin), and then move on to stronger treatments if necessary.

A wide range of treatments are available for psoriasis, but identifying which treatment is most effective can be difficult. Talk to your doctor if you feel a treatment isn’t working or you have uncomfortable side effects.

Treatments fall into 3 categories:

topical – creams and ointments that are applied to your skin phototherapy – your skin is exposed to certain types of ultraviolet light systemic– oral and injected medications that work throughout the entire body

Often, different types of treatment are used in combination.

Your treatment for psoriasis may need to be reviewed regularly. You may want to make a care plan (an agreement between you and your health professional) as this can help you manage your day-to-day health.

The various treatments for psoriasis are outlined below. You can also read a summary of the pros and cons of the treatments for psoriasis, allowing you to compare your treatment options.


Topical treatments are usually the first treatments used for mild to moderate psoriasis. These are creams and ointments you apply to affected areas. 

Some people find that topical treatments are all they need to control their condition, although it may take up to 6 weeks before there’s a noticeable effect.

If you have scalp psoriasis, a combination of shampoo and ointment may be recommended.


If your psoriasis is severe or other treatments haven’t worked, you may be prescribed systemic treatments by a specialist. Systemic treatments are treatments that work throughout the entire body.

These medications can be very effective in treating psoriasis, but they all have potentially serious side effects. All the systemic treatments for psoriasis have benefits and risks. Before starting treatment, talk to your doctor about your treatment options and any risks associated with them.

There are 2 main types of systemic treatment, called non-biological (usually given as tablets or capsules) and biological (usually given as injections). These are described in more detail below.


Biological treatments reduce inflammation by targeting overactive cells in the immune system. These treatments are usually used if you have severe psoriasis that hasn’t responded to other treatments, or if you can’t use other treatments.

Etanercept

Etanercept is injected twice a week and you’ll be shown how to do this. If there’s no improvement in your psoriasis after 12 weeks, the treatment will be stopped.

The main side effect of etanercept is a rash where the injection is given. However, as etanercept affects the whole immune system, there’s a risk of serious side effects, including severe infection. If you had tuberculosis in the past, there’s a risk it may return. You’ll be monitored for side effects during your treatment.

Adalimumab

Adalimumab is injected once every 2 weeks and you’ll be shown how to do this. If there’s no improvement in your psoriasis after 16 weeks, the treatment will be stopped.

Adalimumab can be harmful to a developing baby, so it’s important that women use contraception and don’t become pregnant while they take this drug, and for 5 months after the treatment finishes.

The main side effects of adalimumab include headaches, a rash at the injection site and nausea. However, as adalimumab affects the whole immune system, there’s a risk of serious side effects, including severe infections. You’ll be monitored for side effects during your treatment.

Infliximab

Infliximab is given as a drip (infusion) into your vein at the hospital. You’ll have 3 infusions in the first 6 weeks, then 1 infusion every 8 weeks. If there’s no improvement in your psoriasis after 10 weeks, the treatment will be stopped.

The main side effect of infliximab is a headache. However, as infliximab affects the whole immune system, there’s a risk of serious side effects, including severe infections. You’ll be monitored for side effects during your treatment.

Ustekinumab

Ustekinumab is injected at the beginning of treatment, then again 4 weeks later. After this, injections are every 12 weeks. If there’s no improvement in your psoriasis after 16 weeks, the treatment will be stopped.

The main side effects of ustekinumab are a throat infection and a rash at the injection site. However, as ustekinumab affects the whole immune system, there’s a risk of serious side effects, including severe infections. You’ll be monitored for side effects during your treatment.


It’s important to use your treatment as prescribed, even if your psoriasis improves. Continuous treatment can help to prevent flare-ups. If you have any questions or concerns about your treatment or any side effects, talk to your GP or healthcare team.

Psoriatic arthritis
of muscle bone and joints, conditions

Psoriatic arthritis is a type of arthritis that develops in some people with the skin condition psoriasis. It typically causes affected joints to become inflamed (swollen), stiff and painful.

Between 20-40% of people with psoriasis will develop psoriatic arthritis. Psoriasis affecting the skin affects around 3% of people.

In most cases, people will experience problems with their skin before they notice any symptoms affecting their joints. In a minority of cases, skin problems may develop after or at the same time as joint problems.

Like psoriasis, psoriatic arthritis is thought to be a result of the immune system mistakenly attacking healthy tissue. It’s not clear why some people with psoriasis develop psoriatic arthritis and others don’t.

Symptoms

The pain, swelling and stiffness associated with psoriatic arthritis can affect any joint in the body, but the condition often affects particular areas including the

hands feet knees elbows neck and spine

Tendons can also be involved – in some people they may be the major problem.

Symptoms usually develop slowly meaning that many people are unaware that they are developing psoriatic arthritis. In rarer cases, symptoms can develop suddenly and without warning.

The severity of the condition can vary considerably from person to person. Some people may have severe problems affecting many joints, whereas others may only notice mild symptoms in one or two joints.

There may be times when your symptoms improve and periods when they get worse (known as flare-ups or relapses). Some people may reach a point where they have no symptoms at all (known as remission).

Relapses can be very difficult to predict, but can often be managed with medication when they happen.

When to seek medical advice

You should speak to your GP if you experience constant pain, swelling or stiffness in your joints – even if you haven’t been diagnosed with psoriasis.

If you have been diagnosed with psoriasis, you should have check-ups at least once a year to monitor your condition. Make sure you let your doctor know if you’re experiencing any problems with your joints.

Diagnoses

If your doctor thinks you may have arthritis, they should refer you to a rheumatologist (a specialist in joint conditions) for an assessment.

A rheumatologist will usually be able to diagnose psoriatic arthritis if you have psoriasis and problems with your joints, and other types of arthritis – such as rheumatoid arthritis and osteoarthritis – have been ruled out.

A number of tests may be carried out to help confirm a diagnosis, including blood tests to check for signs of inflammation in your body and the presence of certain antibodies found in other types of arthritis, as well as X-rays or scans of your joints.

Treatments

The main aims of treatment will be to relieve your symptoms, slow the progression of the condition and improve your quality of life. 

For most people, this will involve trying a number of different medications, some of which can also treat the psoriasis. Ideally, you should take one medication to treat both your psoriasis and psoriatic arthritis whenever possible.

The main medications used to treat psoriatic arthritis are summarised below.

Non-steroidal anti-inflammatory drugs (NSAIDs)

Your GP may first prescribe non-steroidal anti-inflammatory drugs (NSAIDs) to see if they help relieve pain and reduce inflammation.

There are two types of NSAIDs and they work in slightly different ways:

traditional NSAIDs, such as ibuprofen, naproxen or diclofenac COX-2 inhibitors (often called coxibs), such as celecoxib or etoricoxib

Like all medications, NSAIDs can have side-effects, but your doctor will take precautions to reduce the risk of these, such as prescribing the lowest dose necessary to control your symptoms for the shortest time possible.

If side-effects do happen, they usually affect the stomach and intestines, and can include indigestion and stomach ulcers. A medication called a proton pump inhibitor (PPI) that helps protect your stomach by reducing the amount of acid it produces will therefore often be prescribed alongside NSAIDs.

If NSAIDs alone are not helpful, some of the medications below may be recommended.

Steroid medication (corticosteroids)

Like NSAIDs, corticosteroids can help reduce pain and swelling.

If you have a single inflamed or swollen joint, your doctor may inject the medication directly into the joint. This can offer rapid relief with minimal side effects, and the effect can last from a few weeks to several months.

Corticosteroids can also be taken as a tablet, or as an injection into the muscle, to help when lots of joints are inflamed. However, doctors are generally cautious about this because the medication can cause significant side effects if used in the long term, and psoriasis can flare up when you stop using it.

Disease-modifying anti-rheumatic drugs (DMARDs)

Disease-modifying anti-rheumatic drugs (DMARDs) are medications that work by tackling the underlying causes of the inflammation in your joints. They can help to ease your symptoms and slow the progression of psoriatic arthritis. The earlier you start taking a DMARD, the more effective it will be. 

Psoriatic arthritis can be treated with a variety of DMARDs including:

Methotrexate Sulphasalazine Leflunomide Cyclosporin Antimalarials (such as hydroxychloroquine) Azathioprine Apremilast

Your rheumatologist will discuss the most appropriate choice of DMARD for you.

It can take several weeks or months to notice a DMARD working. Therefore, it’s important to keep taking the medication, even if it doesn’t seem to be working at first.

DMARD therapy is monitored according to guidelines such as British Society for Rheumatology (BSR).

Biological treatments

Biological treatments are a newer form of treatment for psoriatic arthritis. You may be offered one of these treatments if:

your psoriatic arthritis has not responded to at least two different types of DMARD you are not able to be treated with at least two different types of DMARD because of other problems e.g. other diseases.

Biological drugs work by directly blocking the chemicals in the blood, skin and joints that switch the immune system on, leading it to attack the lining of your joints and your skin.

Some of the biological medicines you may be offered are adalimumab, certolizumab, etanercept, infliximab and golimumab injections. See our page on treating psoriasis for more information about these medications.  Newer biological drugs include ustekinumab.

The most common side-effect of biological treatments is a reaction in the area of skin where the medication is injected, such as redness, swelling or pain, although these reactions aren’t usually serious.

However, biological treatments can sometimes cause other side-effects, including problems with your liver, kidneys or blood count, so you’ll usually need to have regular blood or urine tests to check for these.

Biological treatments can make you more likely to develop infections, so you should tell your doctor as soon as possible if you develop symptoms of an infection, such as a sore throat, a high temperature (fever), urinary problems or diarrhoea.

Biological treatments usually take between 2 and 6 months to take effect.

If it’s effective, the medication can be continued. Otherwise, your doctor may suggest stopping the medication or swapping to an alternative biological treatment.

Complementary therapies

There isn’t enough scientific research evidence to say that complementary therapies, such as balneotherapy (bathing in water containing minerals), works in treating psoriatic arthritis.

There is also not enough evidence to support taking any kind of food supplement as treatment.

Complementary therapies can sometimes react with other treatments, so you should talk to your GP, specialist or pharmacist if you’re thinking of using any.

Managing related conditions

As with psoriasis and other types of inflammatory arthritis, you may be more likely to get some other conditions – such as cardiovascular disease (CVD) – if you have psoriatic arthritis. CVD is the term for conditions of the heart or blood vessels, such as heart disease and stroke.

Your doctor should carry out tests each year (such as blood pressure and cholesterol tests) so they can check whether you have CVD and offer additional treatment, if necessary.

You can also help yourself by:

having a good balance between rest and regular physical activity losing weight, if you’re overweight not smoking only drinking moderate amounts of alcohol

Read more about living with psoriasis and preventing CVD.

Psoriatic arthritis can also cause inflammation of the eyes, such as Conjunctivitis and Iritis.

If psoriatic arthritis affects your skin and joints, you may notice changes in your nails such as:

dents pits discolouration loosening from the nail bed

This is less common if only your skin is affected.

Your care team

As well as your GP and a rheumatologist, you may also be cared for by:

a specialist nurse – who will often be your first point of contact with your specialist care team a dermatologist (skin specialist) – who will be responsible for treating your psoriasis symptoms a physiotherapist – who can devise an exercise plan to keep your joints mobile an occupational therapist – who can identify any problems you have in everyday activities and find ways to overcome or manage these a psychologist – who can offer psychological support if you need it a podiatrist who can offer assessment and advice on foot problems if affected during the course of PSA.

Outlook

Like psoriasis, psoriatic arthritis is a long-term condition that can get progressively worse.

In severe cases, there is a risk of the joints becoming permanently damaged or deformed, which may require surgical treatment.

However, with an early diagnosis and appropriate treatment, it’s possible to slow down the progression of the condition and minimise or prevent permanent damage to the joints.

Psychosis
of mental health

Psychosis is a mental health problem that causes people to perceive or interpret things differently from those around them. This might involve hallucinations or delusions.

The two main symptoms of psychosis are:

hallucinations – where a person hears, sees and, in some cases, feels, smells or tastes things that aren’t there; a common hallucination is hearing voices delusions – where a person believes things that, when examined rationally, are obviously untrue – for example, thinking your next door neighbour is planning to kill you

The combination of hallucinations and delusional thinking can often severely disrupt perception, thinking, emotion, and behaviour.

Experiencing the symptoms of psychosis is often referred to as having a psychotic episode.

Symptoms

Someone who develops psychosis will have their own unique set of symptoms and experiences, according to their particular circumstances.

However, four main symptoms are associated with a psychotic episode. They are:

hallucinations delusions confused and disturbed thoughts lack of insight and self-awareness

These are outlined in more detail below.

Causes

Psychosis isn’t a condition in itself – it’s triggered by other conditions.

It’s sometimes possible to identify the cause of psychosis as a specific mental health condition, such as:

schizophrenia – a condition that causes a range of psychological symptoms, including hallucinations and delusions bipolar disorder – a mental health condition that affects mood; a person with bipolar disorder can have episodes of depression (lows) and mania (highs) severe depression – some people with depression also have symptoms of psychosis when they’re very depressed

Psychosis can also be triggered by traumatic experiences, stress, or physical conditions, such as Parkinson’s disease, a brain tumour, or as a result of drug misuse or alcohol misuse.

How often a psychotic episode occurs and how long it lasts can depend on the underlying cause.

For example, schizophrenia can be long term, but most people can make a good recovery and about a quarter only have a single psychotic episode. Episodes related to bipolar disorder usually resolve, but may recur.

Read more about the causes of psychosis.


The causes of psychosis have three main classifications.

They are psychosis caused by:

mental (psychological) conditions general medical conditions substances, such as alcohol or drugs

The three classifications are described in more detail below.


The following conditions have been known to trigger psychotic episodes in some people:

schizophrenia – a long-term (chronic) mental health condition that causes hallucinations and delusions bipolar disorder – a condition that affects a person’s moods, which can swing from one extreme to another (highs and lows) severe stress or anxiety severe depression – feelings of persistent sadness that last for more than six weeks, including postnatal depression, which some women experience after having a baby lack of sleep

The underlying psychological cause will often influence the type of psychotic episode someone experiences.

For example, a person with bipolar disorder is more likely to have delusions of grandeur, whereas someone with depression or schizophrenia is more likely to develop paranoid delusions.

Diagnoses

You should see your GP immediately if you’re experiencing psychotic episodes. It’s important psychosis is treated as soon as possible as early treatment usually has better long-term outcomes.

Your GP will look at your symptoms and rule out short-term causes, such as drug misuse. They may ask you some questions to help determine what’s causing your psychosis. For example, they may ask you:

whether you’re taking any medication whether you’ve been taking illegal substances how your mood has been – for example, whether you’ve been depressed how you’ve been functioning day-to-day – for example, whether you’re still working whether you have a family history of mental health conditions – such as schizophrenia about your hallucinations – such as whether you’ve heard voices about your delusions – such as whether you feel people are controlling you whether you have any other symptoms

Your GP should refer you to a mental health specialist for further assessment and treatment.

Read more about diagnosing psychosis.


You should visit your GP if you’re experiencing psychotic episodes.

It’s important to speak to your GP as soon as possible as the early treatment of psychosis usually has better long-term outcomes. 

Treatments

Treatment for psychosis involves using a combination of:

antipsychotic medication – which can help relieve the symptoms of psychosis psychological therapies – the one-to-one talking therapy cognitive behavioural therapy (CBT) has proved successful in helping people with schizophrenia; in appropriate cases, family therapy has been shown to reduce the need for hospital treatment in people with psychosis social support – support with social needs, such as education, employment, or accommodation

Most people with psychosis who get better with medication need to continue taking it for at least a year. Some people need to take medication long term to prevent symptoms recurring.

If a person’s psychotic episodes are severe, they may need to be admitted to a psychiatric hospital.

Read more about the treatment of psychosis.


Treatment for psychosis involves a combination of antipsychotic medicines, psychological therapies, and social support.


Psychological treatment can help reduce the intensity and anxiety caused by psychosis. Some possible psychological treatments are discussed below.

Cognitive behavioural therapy

Cognitive behavioural therapy (CBT) for psychosis is based on an understanding of how people make sense of their experiences and why some people become distressed by them.

The aim of CBT is to identify unhelpful thinking patterns and emotions that may be causing your unwanted feelings and behaviours. It’s then possible to learn to replace this thinking with more realistic and balanced thoughts.

A CBT therapist may encourage you to consider different ways of understanding what’s happening to you. The aim is to help you achieve goals that are meaningful and important to you, such as reducing your distress, returning to work or university, or regaining a sense of control.

Family therapy

Family therapy is known to be an effective form of treatment for people with psychosis. It’s a way of helping both you and your family cope with your condition.

After having an episode of psychosis, you may rely on your family members for care and support. While most family members are happy to help, the stress of caring for somebody can place a strain on any family.

Family therapy involves a series of informal meetings that take place over a period of six months. Meetings may include:

discussing your condition and how it might progress, plus the available treatments   exploring ways of supporting someone with psychosis  deciding how to solve practical problems caused by psychosis, such as planning how to manage future psychotic episodes 

Self-help groups

If you’re experiencing episodes of psychosis, you may benefit from being around other people who’ve had similar experiences.

Complications

People with a history of psychosis are much more likely to have drug or alcohol misuse problems, or both.

This may be because these substances can provide short-term symptom relief, although they usually make symptoms worse in the long term.

People with psychosis also have a higher than average risk of suicide. It’s estimated 1 in 5 people with psychosis will attempt to commit suicide at some point in their life, and 1 in 25 people with psychosis will kill themselves.

Side effects can also occur if someone is taking antipsychotics on a long-term basis. Weight gain is a common side effect. In rare cases, a person with psychosis may also develop type 2 diabetes.

Read more about the complications of psychosis.


Someone experiencing a psychotic episode may self-harm. Suicidal thoughts and an increased risk of suicide are also common.

Pubic lice
of sexual and reproductive

Pubic lice are not linked to poor personal hygiene.



They are spread through close body contact with someone who has them, most commonly sexual contact.

The lice crawl from hair to hair but can’t fly or jump. They need human blood to survive, so generally only leave the body to move from one person to another.

Pubic lice don’t live on other animals such as cats or dogs.

It’s also possible for pubic lice to be spread through sharing clothes, towels and bedding.

Symptoms

The most common symptom of pubic lice is itchy red spots. The itching is caused by an allergy to the louse saliva or poo.

It can take 1 to 3 weeks for itching to develop after the first infestation, and it’ll usually be worse at night.

Adult pubic lice are tiny – smaller than a match head. They’re grey-brown in colour and have 6 legs. The 2 pairs of back legs are much larger and look like the pincer claws of a crab. They use these to grasp onto your hair.

Pubic lice eggs are tiny, yellow-white ovals, which are stuck firmly to the base of your hairs.

You may also notice the following symptoms:

dark brown or black powder on your skin or in your underwear (this is louse droppings) blue spots on your skin where the lice have been, particularly on your thighs and lower stomach, caused by bites from the lice specks of blood in your underwear, if you have been scratching a lot nits (empty eggshells) that look like white oval dots attached to the base of your hairs

Diagnoses

If you think you have pubic lice, make an appointment with your GP or local sexual health services.

There is no test for lice, but you may see the lice crawling in your body hair. Your GP or sexual health clinic will look for visible evidence of the lice.

Some sexual health clinics can find the lice and look at them under a microscope.

You can also buy treatment over the counter at your local pharmacist although they will not be able to diagnose the infestation.

Treatments

Pubic lice can be treated at home with (insecticidal) lotion or cream that will kill the lice. This will usually need to be applied once and repeated after 7 days.

Everyone that you’ve had close body contact with should be treated at the same time. This includes current sexual partners and may include members of your household.

Some pubic lice can be resistant to treatment. Resistance means that the lice will not be affected by a particular treatment. If your symptoms don’t settle, you may need to try more than one type of treatment. Your GP or sexual health clinic can advise you of suitable alternatives if your initial treatment doesn’t appear to have worked.

Pubic lice can also live on the eyelashes or eyebrows. This is because the thickness of these hairs is similar to pubic hair meaning that the lice can successfully grip on. Treatment of lice in the eye area is usually different to elsewhere as certain insecticidal creams or lotions are not safe for use near the eye area. Lice here can be removed with tweezers or Vaseline can be used to suffocate the lice prior to removal.