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Oppositional defiant disorder (ODD) - Diagnosis and treatment

Diagnosis

To determine whether your child has oppositional defiant disorder, the mental health professional will likely do a comprehensive psychological evaluation. Because ODD often occurs along with other behavioral or mental health problems, symptoms of ODD may be difficult to distinguish from those related to other problems.

Your child's evaluation will likely include an assessment of:

  • Overall health
  • Frequency and intensity of behaviors
  • Emotions and behavior across multiple settings and relationships
  • Family situations and interactions
  • Strategies that have been helpful — or not helpful — in managing problem behaviors
  • Presence of other mental health, learning or communication disorders

Treatment

Treatment for oppositional defiant disorder primarily involves family-based interventions, but it may include other types of psychotherapy and training for your child — as well as for parents. Treatment often lasts several months or longer. It's important to treat any co-occurring problems, such as a learning disorder, because they can create or worsen ODD symptoms if left untreated.

Medications alone generally aren't used for ODD unless your child also has another mental health disorder. If your child has coexisting disorders, such as ADHD, anxiety or depression, medications may help improve these symptoms.

The cornerstones of treatment for ODD usually include:

  • Parent training. A mental health professional with experience treating ODD may help you develop parenting skills that are more consistent, positive and less frustrating for you and your child. In some cases, your child may participate in this training with you, so everyone in your family develops shared goals for how to handle problems. Involving other authority figures, such as teachers, in the training may be an important part of treatment.
  • Parent-child interaction therapy (PCIT). During PCIT, a therapist coaches parents while they interact with their child. In one approach, the therapist sits behind a one-way mirror and, using an "ear bug" audio device, guides parents through strategies that reinforce their child's positive behavior. As a result, parents learn more-effective parenting techniques, the quality of the parent-child relationship improves, and problem behaviors decrease.
  • Individual and family therapy. Individual therapy for your child may help him or her learn to manage anger and express feelings in a healthier way. Family therapy may help improve your communication and relationships and help members of your family learn how to work together.
  • Cognitive problem-solving training. This type of therapy is aimed at helping your child identify and change thought patterns that lead to behavior problems. Collaborative problem-solving — in which you and your child work together to come up with solutions that work for both of you — can help improve ODD-related problems.
  • Social skills training. Your child may also benefit from therapy that will help him or her be more flexible and learn how to interact more positively and effectively with peers.

As part of parent training, you may learn how to manage your child's behavior by:

  • Giving clear instructions and following through with appropriate consequences when needed
  • Recognizing and praising your child's good behaviors and positive characteristics to promote desired behaviors

Although some parenting techniques may seem like common sense, learning to use them consistently in the face of opposition isn't easy, especially if there are other stressors at home. Learning these skills will require routine practice and patience.

Most important in treatment is for you to show consistent, unconditional love and acceptance of your child — even during difficult and disruptive situations. Don't be too hard on yourself. This process can be tough for even the most patient parents.

More Information

  • Family therapy

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Lifestyle and home remedies

At home, you can begin chipping away at problem behaviors of oppositional defiant disorder by practicing these strategies:

  • Recognize and praise your child's positive behaviors. Be as specific as possible, such as, "I really liked the way you helped pick up your toys tonight." Providing rewards for positive behavior also may help, especially with younger children.
  • Model the behavior you want your child to have. Demonstrating appropriate interactions and modeling socially appropriate behavior can help your child improve social skills.
  • Pick your battles and avoid power struggles. Almost everything can turn into a power struggle, if you let it.
  • Set limits by giving clear and effective instructions and enforcing consistent reasonable consequences. Discuss setting these limits during times when you're not confronting each other.
  • Set up a routine by developing a consistent daily schedule for your child. Asking your child to help develop that routine may be beneficial.
  • Build in time together by developing a consistent weekly schedule that involves you and your child spending time together.
  • Work together with your partner or others in your household to ensure consistent and appropriate discipline procedures. Also enlist support from teachers, coaches and other adults who spend time with your child.
  • Assign a household chore that's essential and that won't get done unless the child does it. Initially, it's important to set your child up for success with tasks that are relatively easy to achieve and gradually blend in more important and challenging expectations. Give clear, easy-to-follow instructions.
  • Be prepared for challenges early on. At first, your child probably won't be cooperative or appreciate your changed response to his or her behavior. Expect behavior to temporarily worsen in the face of new expectations. Remaining consistent in the face of increasingly challenging behavior is the key to success at this early stage.

With perseverance and consistency, the initial hard work often pays off with improved behavior and relationships.

Coping and support

It's challenging to be the parent of a child with oppositional defiant disorder. Ask questions and try to effectively communicate your concerns and needs to the treatment team. Consider getting counseling for yourself and your family to learn coping strategies to help manage your own distress. Also seek and build supportive relationships and learn stress management methods to help get through difficult times.

These coping and support strategies can lead to better outcomes for your child because you'll be more prepared to deal with problem behaviors.

Preparing for your appointment

You may start by seeing your child's doctor. After an initial evaluation, he or she may refer you to a mental health professional who can help make a diagnosis and create the appropriate treatment plan for your child.

When possible, both parents should be present with the child. Or, take a trusted family member or friend along. Someone who accompanies you may remember something that you missed or forgot.

What you can do

Before your appointment, make a list of:

  • Signs and symptoms your child has been experiencing, and for how long.
  • Your family's key personal information, including factors that you suspect may have contributed to changes in your child's behavior. Include any stressors and transitions that your child or close family members recently experienced, such as parental separation or divorce and differences in expectations and parenting styles.
  • Your child's school performance, including grades and patterns of academic strengths and weaknesses. Include any learning disorder assessments and any special education services.
  • Your child's key medical information, including other physical or mental health disorders with which your child has been diagnosed.
  • Any medication, vitamins, herbal products and other supplements your child is taking, including the dosages.
  • Questions to ask the doctor so that you can make the most of your appointment.

Questions to ask the doctor at your child's initial appointment include:

  • What do you believe is causing my child's symptoms?
  • Are there any other possible causes?
  • How will you determine the diagnosis?
  • Should my child see a mental health professional?

Questions to ask if your child is referred to a mental health professional include:

  • Does my child have oppositional defiant disorder or another mental health disorder?
  • Is this condition likely temporary or long lasting?
  • What factors do you think might be contributing to my child's problem?
  • What treatment approach do you recommend?
  • Does my child need to be screened for any other mental health disorders?
  • Is my child at increased risk of any long-term complications from this condition?
  • Do you recommend any changes at home or school to improve my child's behavior?
  • Should I tell my child's teachers about this diagnosis?
  • What else can my family and I do to help my child?
  • Do you recommend family therapy?

Don't hesitate to ask additional questions during your appointment.

What to expect from your doctor

Be ready to answer your doctor's questions. That way you'll have more time to go over any points you want to talk about in-depth. Here are examples of questions that your doctor may ask.

  • What are your concerns about your child's behavior?
  • When did you first notice these problems?
  • Have your child's teachers or other caregivers reported similar behaviors in your child?
  • How often over the last six months has your child had an angry and irritable mood, shown argumentative and defiant behavior, or been vindictive?
  • In what settings does your child demonstrate these behaviors?
  • Do any particular situations seem to trigger negative or defiant behavior in your child?
  • How have you been handling your child's disruptive behavior?
  • How do you typically discipline your child?
  • How would you describe your child's home and family life?
  • What stressors has the family been dealing with?
  • Has your child been diagnosed with any other medical or mental health conditions?

By Mayo Clinic Staff

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ODD Treatment for Children & Adults

How to Help a Child with ODD

Step one to treating oppositional defiant disorder (ODD) is detecting and controlling the symptoms of attention deficit disorder (ADHD or ADD) if they are present. Treatment for ADHD symptoms may include taking a daily stimulant or non-stimulant medication which can sometimes help with oppositional defiant symptoms as well.

Step two is receiving a formal evaluation for other related psychological conditions that can cause oppositional behavior.

Step three is devising a strategy to treat ODD. The preferred ODD treatment is a combination of individual and family behavioral therapy. When therapy alone does not resolve symptoms, medication for ODD can sometimes help. In addition, lifestyle changes can help some people with mild symptoms to control their explosions.

Oppositional Defiant Disorder Treatment Options

Oppositional Defiant Disorder treatment may include:

  • Cognitive-behavioral therapy
  • Parent-child interaction therapy
  • Collaborative problem solving
  • Medication in the form of a low dose, atypical neuroleptic
  • Lifestyle changes

Oppositional Defiant Disorder Treatment: Therapy

Counseling for ODD should include both the patient and his or her family members, and it should emphasize strategies that the family can use to cope with defiant behaviors.

Remember, people with ODD are neurologically hard-wired to defeat and thwart people in roles of authority. They have no intention of cooperating in any therapeutic process.

[Self-Test: Oppositional Defiant Disorder in Adults]
[Self-Test: Oppositional Defiant Disorder in Children]

Individual Cognitive-Behavioral Therapy for ODD

Individual therapy teaches people with ODD a series of techniques for managing anger, controlling emotions, and solving problems. It can provide positive alternative behaviors to replace defiant ones. This type of therapy works best when it begins early in life, when family and social interactions aren’t ingrained and difficult to change.

Family and Parent Training Programs for ODD

Parent- and family-training programs are built on the premise that children behave badly when they realize that doing so gets them what they want. Say your child throws a fit when you ask him to turn off a video game; if you give in even once, he learns that he will sometimes succeed. Parent training teaches caregivers what to do in these stressful, exhausting moments to avoid setting a precedent that will encourage more bad behavior.

Parents learn to change their reactions to a child’s behavior – good and bad. They learn to demonstrate and define their expectations, and then give well-defined rewards and praise when their child behaves accordingly – or consistent consequences when the child doesn’t. Most effective parenting programs are built around these four core principles:

1. Reinforce good behavior with a reward system – like stars on a chart, or extending a special privilege.

2. Discourage negative behavior by ignoring it. Kids often use bad behavior to get attention.

3. Take away a privilege if negative behavior is too serious to ignore.

4. Remove common triggers of bad behavior.

[Free Download: 4 Parent-Child Therapies for Better Behavior]

A therapist will also work with a parent and child together to solve specific challenges. The plan should start with a key, narrow behavior – like no swearing. Parents learn how to give instructions in an authoritative way, use time-outs effectively, praise children, and create rewards systems.

The goal is to incrementally teach a child new ways of behaving and to break the cycle of defiance. By focusing on and rewarding desired behaviors, a parent can help their child experience success, which encourages the child to behave that way again.

The three most common types of parent- and family-training programs are:

1. Parent-Child Interaction Therapy (PCIT) – PCIT is a program that looks beyond bad behavior to examine troubled relationships – and how changing them can improve daily life. It helps parents become better at managing their child’s behavior with real-time coaching. It is most effective for children ages two to seven, and is offered in university-based centers and by individual therapists.

Participating family members interact while listening to advice from therapists behind a one-way mirror, so the child associates the parenting skills with her parent, not the therapist.

2. Collaborative Problem Solving (CPS) – CPS is a program created by Ross W. Green, Ph.D., for defiant teens who have outgrown time-outs. The program focuses on giving kids the problem-solving skills they lack rather than using a reward-and-punishment system.

The first step in CPS is to identify and understand the child’s concern about a problem (completion of homework or chores), and reassure him that the problem will be resolved by the child and the adult together. The second step is to identify the adult’s concerns about the same problem. The third step invites the child to brainstorm solutions with the adult, and to find a plan that is mutually satisfactory.

3. Vive – This is an intensive family therapy program for parents of older kids with behavioral problems. It uses the principles of parent management training, but involves two separate therapists: a “mentor” for the struggling teen, and a “coach” for the parents. The program can help kids become more reflective about problems, and help families recognize patterns in the ways they react to each other. This technique is geared toward families in crisis who can devote a substantial amount of time and money. Fees can be up to $3,000 a month.

Oppositional Defiant Disorder Treatment: Medication

If therapies prove ineffective, medication can sometimes help to “re-wire” oppositional behaviors. No medications are FDA-approved for the treatment of ODD in the U.S. Nonetheless, clinical experience has shown that the majority of children and adolescents with ODD do show signs of improvement with a low dose of atypical neuroleptics – arippirazole (Abilify) and risperidone (Risperidal), for example.

Oppositional Defiant Disorder Treatment: Lifestyle Changes

Families can use many of the techniques taught in behavioral therapy to improve everyday life with defiant behavior while working to diminish it. These techniques include the following:

  • Always build on positives: Praise your child and offer positive reinforcement when he shows flexibility or cooperation. Recognize the “little victories” with enthusiasm.
  • Learn to control yourself: Take a time-out or break if you suspect you are about to make the conflict with your child worse, not better.
  • Pick your battles: Since a child with ODD has trouble avoiding power struggles, prioritize the demands you put on your child.
  • Provide structure: Bad behavior tends to escalate when a child has unsupervised free time and unclear expectations. A daily routine, on the other hand, lets a child know what to expect.
  • Position behavioral issues as problems she can solve: Explain to your child that ignoring an alarm clock doesn’t help her get to school on time, and ask what she can do to avoid being tardy again.
  • Set up reasonable, age-appropriate limits and enforce consequences consistently: Resist the temptation to rescue the child from naturally occurring consequences.
  • Don’t go it alone: Work with and get support from the other adults (teachers, coaches, and spouse) who interact with your child. Look for local support groups and/or parenting classes for parents of difficult children.
  • Avoid burnout: Maintain interests other than your child so that managing her behavior doesn’t sap all of your time and energy. Manage your own stress with exercise and relaxation. Use respite care as needed.

Additionally, supplements may improve certain symptoms of ODD. Be sure to consult with a physician before trying any of the alternative therapies below.

  • Omega-3 Fatty Acids to regulate mood and emotions
  • Vitamin E to help absorb Omega-3s
  • Melatonin to help normalize sleep patterns
  • Zinc to help neutralize brain chemicals that can lead to hyperactivity and impulsivity

For adults, reading about ODD can be an asset. Taking Charge of Anger, a book by W. Robert Nay, Ph.D., gives practical advice that may benefit an adult with the condition.

[Back From the Brink: Two Families’ Stories of Oppositional Defiant Disorder]

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10 drugs with the strangest side effects Most often, people are interested in when and in what quantities to take the medicine, and almost no one pays attention to the item in which all side effects are prescribed.

Compounds of chemicals in each individual drug, when interacting with the human body, can cause not only nausea or dizziness, but also other, extremely unusual sensations.

We have compiled a list of drugs that can trigger the most bizarre reactions in the body.

1. Capecitabine. No fingerprints

A few years ago, a man from Singapore was detained in America. The tourist got to the station for one simple reason: the police could not get fingerprints from him. As it turned out later, the man took the drug, which in rare cases leads to a change in the skin of the hands and feet, up to the disappearance of fingerprints. As practice shows, after stopping this medication, the skin is restored.

2. Ropinirole. Gambling and Sex Cravings

GlaxoSmithKline, the manufacturer of this drug, warns consumers of all possible side effects. In 2011, a resident of France sued drug manufacturers due to the fact that he began to feel sexual attraction to males and ceased to control himself during gambling. Now you can read all the warnings regarding cravings for games and sex on the insert for the pills.

3. Amitriptyline. Blue staining of urine

A person who is accustomed to the yellow color of urine will obviously be surprised when one day it changes color to blue. The fact is that the chemical composition of the shells of some drugs includes dyes that can provoke a change in the color of biological fluids in the body. These drugs also include the anesthetic indomethacin and the anesthetic propofol.

4. Zolpidem. Desire to eat or cook while sleeping

Many patients who have tried the drug have become concerned about their safety. The fact is that there have been several cases of driving a car in a state of increased drowsiness. In addition, several people have noted strange symptoms such as a strong desire to eat or cook food while sleeping.

5. Voriconazole. Auditory and visual hallucinations

In 2004, the journal Infection published an article about the antifungal drug voriconazole. The man who used the medicine claimed to have "heard" popular songs for five days in complete silence. A year later, an article appeared in another magazine stating that 12 people who took the drug had visual hallucinations.

6. Vasoket. Inability to smell

This drug, like many others, has a wide range of side effects. There may be problems with all five senses. However, the most strange thing can be called a change in smell. A side effect can manifest itself both in minor deviations and in the complete inability of a person to smell.

7. Clomipramine. Irresistible desire to yawn and involuntary orgasm

The drug, aimed at the treatment of depression and numerous phobias, increases the concentration of the neurotransmitter serotonin in the brain. Patients taking this medicine often cannot control certain processes. For example, throughout the day a person feels an irresistible desire to yawn, even if he does not want to sleep and is not tired. Cases of involuntary orgasm have been reported among patients taking this drug.

8. Mefloquine. Suicide attempts

A drug used to treat malaria has several side effects. Frequent complaints of patients about hallucinations, mental problems are not the saddest results of taking the medicine. In some cases, the drug influenced people's desire to commit suicide.

9. Bimatoprost. Increasing the growth rate of eyelashes

The drug for glaucoma is available in the form of eye drops. Manufacturers warn that after using the medicine, an improvement in the structure of the eyelashes and their active growth can be observed. Soon the American company Allergan released a cosmetic product based on bimatoprost, the side effect of which has now become the main advantage. Anyone who wants to accelerate the growth of eyelashes and improve their quality can buy Allergan cosmetic products.

10. Sodium valproate. Curling straight hair

Among the many side effects of this remedy, the most harmless and perhaps the most unusual is the drug's ability to make straight hair frizzy. Scientists claim that this is due to a decrease in the concentration of certain substances that affect hair growth and quality. When therapy is stopped, the hair becomes straight again.

See also:
From cocaine to worms: the wildest ways to lose weight in the last century,
10 Incredible Facts About the Placebo Effect,
The Thalidomide Tragedy, or How “Miracle Pills” Destroyed People's Bodies and Destinies

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The sinister paracetamol and other pills: how they change our personality

  • Zaria Gorvette
  • BBC Future

to help you understand the events.

Image copyright Getty Images

They have been associated with road rage, pathological gambling, and complicated cases of fraud. Some of them make us less neurotic, others can even affect our relationships with people.

It turns out that many conventional drugs affect not only our body, but also the way our brain works. How does it work and why is it not warned by warning labels on the packages?

"Patient #5" was well into his 50s when seeing a doctor changed his life.

He had diabetes and agreed to participate in a study to see if statins, a cholesterol-lowering drug, would help him.

At first everything went well. But shortly after starting the drug, his wife began to notice ominous changes.

A previously quite sane person, he began to experience fits of anger, and, it is not clear why, began to behave aggressively while driving.

Once he even told his family members to stay away from him if they didn't want to go to the hospital.

Fearing that something terrible would happen, "Patient #5" stopped driving. But his behavior in the car as a passenger was such that his wife was often forced to turn back halfway.

In such cases, she would sit him alone in front of the TV to calm him down. And she began to fear for her own safety.

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And then one day it dawned on "patient No. 5". "It suddenly dawned on him that all these problems began after I started participating in the study," says Beatrice Golom, who leads the team of scientists at the University of California (San Diego).

Anxious husband and wife turned to the organizers of the study for clarification. "They were very hostile. They said it couldn't be related to the medication and the man should continue taking it and remain one of the study participants," Golom says.

For better or for worse, but by that time the patient's character had already changed so much towards grumpiness that he simply ignored these doctors' advice. Two weeks later, his old personality returned to him.

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Antidepressants may not only improve mood, they can affect overall behavior, research shows

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But others weren't so lucky. Over the years, Golom has been collecting patient stories from all over the United States - of broken marriages, ruined careers, of a surprisingly large number of men who were on the verge of killing their own wife.

And in almost every one of these cases, the threatening symptoms appeared after people started taking statins. And they immediately disappeared as soon as they stopped drinking this medicine. One man even quit five times and started again until he realized that statins were the reason for what was happening to him.

According to Golom, this is all quite typical: in her experience, most patients cannot recognize the changes that are taking place in their character, let alone associate them with the drug they have started taking.

In some cases, this understanding comes too late: the researcher was contacted by many relatives of such people, including an internationally renowned scientist and a former editor of a legal publication who committed suicide.

We know that psychedelics distort consciousness. But it turns out that perfectly ordinary drugs are also capable of this.

From paracetamol to histamines, from antidepressants to statins to asthma medications, more and more research shows they can make us overly impulsive, short-tempered or restless.

They can reduce empathy for strangers and even manipulate fundamental aspects of our character, our personality, such as how neurotic we are.

Image copyright, Getty Images

Image caption,

We don't always have information about the effects of taking a drug

For most people, these changes are barely noticeable. But for some, they can be significant.

In 2011, a French father of two sued the pharmaceutical company GlaxoSmithKline, alleging that a drug he was taking for Parkinson's disease turned him into a gambler and gay sex addict, and that it was this that caused him to risky behavior that led to him being raped.

In 2015, a man who was stalking young girls online resorted to a similar line of defense: he claimed that an obesity drug had reduced his ability to control his impulses and desires.

Again and again we find that killers try to blame sedatives or antidepressants for what they have done.

  • Antidepressants make shrimp forget predators

If these claims are true, the consequences could be serious. The list of potential culprits includes some of the world's most widely used drugs. Which means: even if at the level of an individual the effect of such drugs is insignificant, nevertheless they change the personality of millions of people.

Research into this influence is very welcome. Our world is in an over-medication crisis. In the US alone, up to 49,000 tons of paracetamol are bought each year (about 298 paracetamol tablets per person), and the average American consumes $1,200 worth of prescription drugs per year.

As the world's population ages, our addiction to drugs will get more and more out of control. For example, already in the UK, one in ten older people over 65 take eight different medications every week.

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Image caption,

More than 49,000 tons of paracetamol are consumed in the United States every year - an average of 298 tablets per person

How do all these drugs affect our brains? And isn't it time to start putting warning labels on packages?

Golome initially believed that the link between statin use and personality changes could have been discovered a couple of decades ago, after a series of frightening discoveries that people with low cholesterol were more likely to die violent deaths.

But one day, in a casual conversation with a cholesterol expert about such a potential connection, he dismissed her arguments as obvious nonsense.

"And then I said to myself: how do we know this?" Golom says. She began to carefully study the scientific and medical literature on this topic. "I found an amazing amount of evidence - more than I could have imagined," she says.

For starters, there are studies of primates that were put on a low cholesterol diet and became more aggressive.

A potential mechanism has even been described: lowering cholesterol in animals seems to affect levels of serotonin, an important neurotransmitter, the "mood hormone" involved in regulating behavior.

Even fruit flies start fighting if you change their serotonin levels. And it also affects people in a bad way - studies have linked this to a tendency to violence, impulsiveness, suicide and murder.

Image copyright Getty Images

Image caption,

Drosophila flies became more aggressive when their serotonin levels were altered.

If statins affect the human brain, this is probably a direct consequence of their ability to lower cholesterol levels.

In recent years there have been many new testimonies to this. Several studies have supported the hypothesis of a potential link between irritability and statin use, including in Gol's more than 1,000 randomized controlled trials (RCTs), which are considered the gold standard for generating scientific evidence for new medical interventions.

Golom's RCT showed that the drug increased aggression in post-menopausal women, but, strangely, had no effect on the behavior of men.

In 2018, one study found a similar effect in fish - the mechanism that links cholesterol levels and aggression seems to have been around for millions of years.

Golom continues to believe that low cholesterol and, as a result, statins can cause behavioral changes in both women and men, but the depth of influence can vary greatly from person to person.

But the most embarrassing discovery that Golom has made is that it is not at all possible that ordinary drugs can affect our personality. This is a general lack of interest in such exposure.

"The emphasis is on things that doctors can easily check," she explains. For a long time, research on the side effects of statins has focused on the muscles and liver, she says, because any problems with these organs can be detected with standard blood tests.

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Image caption,

Certain medications can affect your driving behavior

Ohio University researcher Dominic Miszkowski noticed this too. "We know a lot about the physiological effects of drugs," he says, "but we don't understand how they affect human behavior."

Miszkowski's own research found ominous side effects from taking paracetamol. Scientists have long known that this drug reduces physical pain by reducing activity in certain areas of the brain, such as the insula, which plays an important role in our emotions.

These areas are involved in creating a sense of interpersonal and social problems, and paracetamol can surprisingly alleviate our psychological pain, for example, if we are rejected.

Recent studies have shown another interesting thing: in our brain, pain centers are also centers of empathy, empathy with the emotional state of another person.

For example, scanning with fMRI (functional magnetic resonance imaging) showed that the same areas become active in the brain during pain and the so-called positive empathy (joy for another person).

Based on this finding, Mishkovsky wondered if painkillers weaken our ability to empathize with others.

Together with colleagues from Ohio, he recruited volunteers from university students and divided them into two groups. One group was given a standard dose of paracetamol (1000 mg) and the other was given a placebo.

Then they were asked to read various inspiring stories from other people's lives - for example, about the luck of a certain Alex, who finally mustered up the courage and asked the girl for a date (and she agreed).

Image copyright, Getty Images

Image caption,

Levodopa is the most effective drug for Parkinson's disease, but it has unexpected side effects

The result was that paracetamol significantly reduced our ability to be happy for others - now think about how this a drug can affect relationships in millions of people around the world on a daily basis.

"I'm no longer a novice researcher," says Mishkovsky, "and to be honest, the results of these experiments are the most disturbing I've come across. Especially because I have a good idea of ​​what a huge number of people are exposed to such an effect. When you give somebody a medicine, you don't just give it to an individual, you give it to a social system, and we don't really understand the impact of these medicines in a larger context."

Empathy isn't just about being a good person or crying when you watch a sad movie.

This emotion has many practical advantages, among which are a more stable relationship with a loved one, children more adapted to life, a more successful career.

Some scientists have even suggested that empathy is the reason for the success of man as a biological species.

All this involuntarily makes one wonder what consequences a decline in the ability to experience empathy will have for the whole of humanity.

Technically, paracetamol does not change our character, since the effect of taking it lasts for only a few hours and few of us take it constantly.

But, as Miszkowski points out, we need to be informed about how it affects us, which will help us make sound decisions about its use.

"Just as we know not to drive when we're drunk, we shouldn't take paracetamol if we're going to be in a situation where we're going to need an emotional response, like having a serious conversation with a partner or colleague. ".

One of the reasons drugs have such a psychological effect is that our body is not just a sack of various organs bathed in bodily fluids and chemicals. It is a system in which different processes are closely interconnected.

For example, scientists already knew that taking asthma medication sometimes affects the behavior of patients and sometimes leads to the development of attention deficit hyperactivity disorder. And recently, one study found that there is a mysterious connection between these two diseases: having one of them, you increase the risk of getting sick with the other by 45-53%.

Nobody knows why. There is an idea that asthma medications cause attention deficit hyperactivity disorder (ADHD) by altering levels of serotonin, or chemicals that cause inflammation.

Image copyright, Getty Images

Image caption,

There are many reports of statin use causing major personality changes.

Sometimes the connection is easy to see. In 2009, a team of psychologists from Northwestern University (Illinois) decided to test whether antidepressants affect our character.

In particular, scientists were especially interested in neuroticism - one of the character traits that manifests itself in anxiety, fear, jealousy, envy and guilt.

For their study, the researchers recruited a group of adults suffering from moderate to severe depression. One third of the participants received the antidepressant paroxetine (a selective serotonin reuptake inhibitor), another third received a placebo, and another third received psychological therapy.

The scientists then checked how the mood and character of the volunteers changed from the beginning to the end of the 16-week experiment.

"We found that the drug caused a major change in neuroticism. Placebo and therapy had almost no effect on this trait," says Robert Derubais, one of the researchers. "It was amazing."

The big surprise for the scientists was that although the antidepressants made the participants less depressed, the reduction in neuroticism was much more severe, and the effect of the drugs on depression was not related to the effect on neuroticism. In addition, those who received antidepressants began to score higher in the surveys on the extraversion scale.

It is important to understand, however, that this was a relatively small study, and no one has yet attempted to replicate the results, so they may not be completely reliable. But what is intriguing is that antidepressants can directly affect neuroticism.

According to one hypothesis, this personality trait (neuroticism) is associated with the level of serotonin in the brain, which changes under the influence of antidepressants.

While becoming less neurotic sounds appealing, not all is well with this news.

This aspect of our personality is a double-edged sword. Yes, neuroticism brings us many unpleasant moments in life, not to mention the fact that it can cause earlier deaths.

But at the same time, it is believed that excessive anxiety and a tendency to worry all the time can serve us well in some situations - for example, to avoid unnecessary risk. Or even improve work efficiency.

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Cholesterol-lowering drugs save thousands of lives every year, so check with your doctor before stopping them. it is customary to worry," Derubais emphasizes. If so, should patients be warned that drugs can change their personality?

"If my friend were to ask me for advice, I would definitely warn him, in the same way that they warn about such well-known side effects from drugs, such as possible weight gain," says Derubais.

And here it should be emphasized that no one is calling for people to stop drinking their medicines.

Despite their subtle effects on brain function, antidepressants have saved people from suicide more than once, cholesterol-lowering drugs save tens of thousands of lives every year, and paracetamol is on the United Nations List of Essential Medicines for its ability to relieve pain.

But it is also important that people are informed of any potential psychological side effects.

This question looks much more serious if we take into account the fact that some changes in character can be quite radical.

There is evidence that the drug L-dopa (levodopa), which is prescribed to treat Parkinson's disease, increases the risk of impulsive personality disorder. (A person with impulse control disorder is often unable to resist a sudden, violent urge to do something that may violate the rights of others or cause conflict with social norms. - Note Translator .)

Therefore, taking this drug can have devastating consequences for the lives of some patients who suddenly begin to take unnecessary risks in everything - they may experience pathological gambling, shopping or become a sexaholic.

In 2009, the media reported on a drug with similar qualities, after a man with Parkinson's disease accused the drug of completely changing his character and even causing him to commit fraud - he sold tickets on eBay to non-existent rock concerts, thus gaining £45,000 ($60,000).

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Image caption,

We'll still take our pills. But it's important to make sure we understand what we're getting into.

The association of such a drug with impulsive behavior is quite understandable because it supplies the brain with extra dopamine (important in Parkinson's disease). And this hormone is involved in creating sensations of pleasure and reward.

Experts agree that levodopa is the most effective treatment for many of the symptoms of Parkinson's disease. Every year it is prescribed to thousands of people across the United States - despite the long list of possible side effects. This list specifically mentions the risk of having unusually strong desires - for example, to play in a casino or have sex.

Both Derubais, Golom, and Mishkovsky are of the opinion that the drugs they studied will continue to be used by people, regardless of psychological side effects.

"We are human beings," says Mishkovsky. "We do and take a lot of things that are not necessarily useful in different circumstances. I always cite alcohol as an example, which can also be painkillers, like paracetamol."

But in order to minimize any unwanted effects and make the most of the amazing amount of drugs we take every day, we need to know more about them, Miszkowski emphasizes.

Because at the moment, he says, it remains largely a mystery how exactly they affect individuals and society as a whole.

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