Anxiety Attacks Solution

Panic Away End Anxiety and Panic Attacks

The program is designed to tackle the general anxiety (Gad) by releasing calm into your body through specific exercises. This part of the program uses holistic techniques that are focused on acceptance and visualization. The exercises described in this stage are mental exercises and physical exercises that are easily done in chunks of time and are not overwhelming. The eBook course has been broken down to simple steps with clear information on how to get rid of panic attacks and anxiety. You may go through the entire course in a few hours and start implementing very soon. If you have the fear of public speaking, fear of driving, or encounter panic disorders due to leaving your home than you may especially be fond of the segment dedicated to applying the One Move method to these particular problems. This Panic away technique is said to successfully fight the general anxiety disorder. Read more...

Panic Away Summary


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Author: Barry McDonagh
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Highly Recommended

I started using this book straight away after buying it. This is a guide like no other; it is friendly, direct and full of proven practical tips to develop your skills.

As a whole, this book contains everything you need to know about this subject. I would recommend it as a guide for beginners as well as experts and everyone in between.

Generalized Anxiety Disorder

Generalized anxiety disorder (GAD) is characterized by excessive and uncontrollable worry lasting weeks or months, with restlessness, fatigue, muscular tension, poor concentration, irritability, and insomnia. Patients usu Approximately two-thirds of patients with GAD have a concurrent psychiatric disorder, and over 90 percent of patients with a lifetime diagnosis of GAD have at least one other lifetime psychiatric diagnosis. The most common comorbid illnesses include phobias, panic disorder, and depressive disorders. Controversy exists as to whether GAD is an independent entity, a prodrome to another disorder, or a residual form of a previous illness. Regardless of the actual nature of GAD, patients who have the condition report a five-year duration of symptoms on average and significant interference with their daily activities. A third receive some type of public assistance, and only half work full-time. As with all severe anxiety disorders, patients have a high probability of...

Excluding Medical Disorders That Can Mimic Anxiety Disorders

Just as anxiety disorders can mimic or complicate medical disorders, medical disorders can mimic or complicate anxiety disorders. Patients who complain of persistent or intermittent nervousness, with or without somatic symptoms, should therefore be evaluated for conditions such as hyperthy-roidism, hypoglycemia, anemia, hypoparathyroidism, cardiac arrhythmias, and pheochromocytoma. electrocardiogram (ECG). Other investigations (e.g., urinary or plasma catecholamines) should be performed when specific conditions (e.g., pheochromocytoma) are suspected. Although mitral valve prolapse is sometimes found on echocardiogram in patients with panic disorder, the relationship is almost certainly coincidental.

Screening for Anxiety Disorders and Psychosocial Problems

When patients report both anxiety and somatic complaints, it is easy to assume that their apprehensiveness is a result of their medical condition. That is often true, of course, but sometimes the opposite relationship holds. Even when a medical disorder is present, not all anxiety is normal. Anxiety disorders are significantly more common in patients with chronic medical illnesses than in those without. Furthermore, anxiety disorders can provoke, maintain, or worsen certain medical conditions (e.g., hypertension, gastroesophageal reflux, myofascial pain). Whether or not a patient has a medical disorder, then, nervousness or worry should prompt a search for an anxiety disorder. Screening for psychiatric disorders is important in the evaluation of any patient, and specific methods exist for the detection of anxiety disorders in the primary care setting. The use of such questionnaires and brief interviews during routine office visits improves the recognition of psychiatric disorders and...

The Treatment of Anxiety Disorders in Primary Care

Once the primary care physician has made the diagnosis of an anxiety disorder, treatment can begin. The first step is not to prescribe a medication or refer the patient to a psychiatrist or psychologist, but to reinforce the doctor-patient relationship. The physician should review the key elements that went into making the diagnosis this review will clarify the fact that an anxiety disorder is not a diagnosis of exclusion or of last resort, made only because the physician has no other explanation for the patients complaints. Next, the physician should educate the patient about the existence of effective treatments, including medications, psychotherapy, and behavior therapy. Finally, the physician should outline an initial treatment plan. This will reassure patients that their physician will not abandon them, will continue

Benzodiazepines Glucuronidation and Its Impact on Drug Screening

Benzodiazepines (e.g., Valium (diazepam) and Librium (chlordiazepoxide)) are commonly prescribed minor tranquilizers, sedatives, and anticonvulsants. They are a large class of compounds and also undergo extensive metabolism, with glucuronida-tion often being the last step in the biotransformation. Most immunoassays for benzodiazepines involve antibodies raised against a common benzodiazepine metabolite, oxazepam. However, because most oxazepam excreted into the urine is actually oxazepam glucuronide, the immunoassay does not always perform well. The antibody has less reactivity with the oxazepam glucuronide, the actual metabolite present in urine. Some research has shown that pretreatment of the urine specimen with glucuronidase, which liberates the metabolite from binding with glucuronide, improves the sensitivity of the method.

Anger Anxiety Conflicts

Dollard and Miller thought that anger-anxiety conflict was sufficiently important to add it, as a fourth critical training period, to those that correspond to Freud's first three psy-chosexual stages. Because childhood produces many frustrations including those that come from childhood dependency, mental limitations, and sibling rivalry children must learn to deal with anger. When children express their anger overtly, perhaps by hitting or throwing things, they are punished. In this way, they learn to be anxious about anger. To some extent this is a necessaiy and desirable result because it helps the child to learn self-control. It can be overdone, however, eliminating even appropriately assertive behavior.

Empirical evidence of whether information increases anxiety

One area that has been the subject of study is whether giving information increases anxiety, and what is the psychological physiological effect of giving information to patients for the purposes of seeking their consent. King's 1986 review looked at some studies of this. Her conclusion was that it depends upon the patient, the condition, and the way in which information is given. There is certainly some evidence that information about side effects of treatment can lead to those side effects being experienced (e.g. Cairns et al., 1985). There is also evidence, however, that giving information can improve patients' recovery (Wallace, 1984, 1986). Kerrigan and others (1993) observed that 'detailed information did not increase patient anxiety' in men undergoing elective inguinal hernia repair. However, in Chee Saw et al.'s study (1994) referred to above, 54 of respondents did not want detailed explanations, trusting in the doctor to give them the right treatment.

Benzodiazepines and GABAa Receptor Heterogeneity

As reviewed elsewhere in this book, GABAA receptors have received considerable attention as the site of action for drugs that act not only as anxiolytics, but also as sedatives, anticonvulsants, and muscle relaxants. All of these clinically beneficial effects are exhibited by the benzodiazepine-type drugs, which act by allosterically binding to GABAA receptors and enhancing the ability of GABA to increase chloride conductance. Many studies over the past decades have revealed the existence of multiple subtypes of the GABAa receptor (for e.g., see ref. 8), and research with transgenic mice and subtype-selective ligands has postulated that the diverse behavioral effects of benzodiazepine-type drugs may reflect action at different subtypes of GABAa receptors (9-12). The GABAA receptors in the central nervous system are pentamers constituted from structurally distinct proteins, with each protein family consisting of different subunits. The majority of GABAA receptors consist of a-, P-, and...

Benzodiazepines A Question of Abuse vs Therapeutic

As will be discussed in subsequent sections, the idea that the abuse potential of benzodiazepine-type drugs may be less than other abused drugs has empirical, in addition to regulatory support. This notion has generated lively debate beyond the Valium scare era of the 1970s (for e.g., see refs. 4,5,7). Based in large part on epidemiological findings at the time, Woods and colleagues (5,20,21) concluded that the vast majority of benzodiazepine use was appropriate and, combined with human laboratory data, the classification of benzodiazepine-type drugs as addictive drugs or drugs of abuse was perhaps erroneous, or at the very least, overstated. An important consequence of this classification might be that benzodiazepine-type drugs are, in fact, underpre-scribed with many patients going untreated owing to a general reluctance to prescribe and use these drugs (5,22). Another perspective is that classifying benzodiazepine-type drugs as abused drugs reflects a reactionary response by...

Basic Hostility and Basic Anxiety

Unfortunately, a multitude of adverse influences may interfere with these favorable conditions. Primary among these is the parents' inability or unwillingness to love their child. Because of their own neurotic needs, parents often dominate, neglect, overprotect, reject, or overindulge. If parents do not satisfy the child's needs for safety and satisfaction, the child develops feelings of basic hostility toward the parents. However, children seldom overtly express this hostility as rage instead they repress their hostility toward their parents and have no awareness of it. Repressed hostility then leads to profound feelings of insecurity and a vague sense of apprehension. This condition is called basic anxiety, which Homey (1950) defined as a feeling of being isolated and helpless hi a world conceived as potentially hostile (p. 18). Earlier, she gave a more graphic description, calling basic anxiety a feeling of behig small, insignificant, helpless, deserted endangered in a world that...

The Four Systems Anxiety Questionnaire

Falih Koksal of the University of Stirling in Scotland. For more information see F. Koksal, and D. G. Power (1990). Four Systems Anxiety Questionnaire (FSAQ) A Self-Report Measure of Somatic, Cognitive, Behavioral, and Feeling Components. Journal of Personality Assessment, 54, 534-45.

About the Four Systems Anxiety Questionnaire

Psychologists have known for several decades that anxiety is a multifaceted concept. While all of us would acknowledge having experienced anxiety, the reality is that our experience of feeling anxious is probably quite different from how others experience this emotion. Nearly thirty years ago, psychologist Peter Lang proposed three ways in which anxiety can be experienced. The first can be called the cognitive component what people say to themselves or what they report to others. A man with a dog phobia, for instance, might say I'm terrified when he sees a Rotweiller running toward him. The second component is the physiological or somatic reaction. In our example, the dog-phobic man may experience a pounding heart or a knot in his stomach when he spots the Rotweiller. The third component of anxiety is behavioral what our man does when he spots the dog. If he turns to run away, we can be safe in concluding that he is exhibiting a behavioral sign of anxiety. What makes this concept so...

R Adjustments to Basic Anxiety

To solve conflicts over basic anxiety, an individual adopts defense mechanisms, including many of the defense mechanisms that previous analysts had described, such as repression, and Horney's expanded list of defensive maneuvers. All neurotics use some mixture of four major strategies for resolving the basic conflict between helplessness and hostility. These strategies do not solve the conflict or lead to growth, but they may allow a person to adapt sufficiently to cope with daily life.

The Prognosis of Anxiety Disorders

Although most patients with anxiety disorders improve with treatment, many need long-term follow-up. The primary care physician should decrease or discontinue medications after patients have been asymptomatic for six months but should vigorously reinstitute treatment at the first sign of relapse. Patients with panic disorder have been found to be symptomatic for 16 percent of their lives after the onset of their illness. For panic disorder with agoraphobia, the figure is 29 percent. Despite this relatively good prognosis, the relapse rate in panic disorder is 80 percent within two years after stopping treatment, and up to 20 percent of patients are chronically ill. Patients with agoraphobia, major depression, substance abuse, or personality disorders have poorer treatment outcomes, as do those who discontinue their medications without their physicians advice. Rates of suicide attempts by patients with panic disorder have been as high as 20 percent.

Benzodiazepine Receptor Agonists

Agonists are drugs that bind to a receptor site on a cell and cause an action to occur. Benzodiazepine receptor agonists work by increasing the efficiency of gamma-aminobutryric acid (GABA), a neurotransmitter that reduces how often neurons fire alertness-promoting messages to each other. The drugs attach themselves to receptor sites on nerve cell molecules, changing the shape of the site slightly, so it's more attractive to GABA molecules. The binding of GABA opens pores in the cell, allowing chloride ions to flow into the cell, which makes the cell less likely to react. Depending on the cell's location, GABA binding can lead to sedation, muscle relaxation, decreased anxiety, and antiseizure effects. Until recently, benzodiazepines which have been available since the 1960s were the only prescription drugs specifically approved for insomnia. This class of medications is proven effective in making people fall asleep faster, wake up less often, and sleep longer overall. There are two...

Separation Anxiety Disorder

Children with separation anxiety disorder have intense anxiety about being away from home or caregivers to the point where social or school functioning is affected. Such children have a great need to stay at home or close to their parents. When they are apart, these children may worry excessively about their parents, and when they are together, the children may cling to parents, refuse to go to school, or be afraid to go to sleep. Repeated nightmares about separation and physical symptoms such as stomachaches and headaches are also common.

Normal Anxiety

No one can escape the effects of anxiety. To grow and to change one's values means to experience constructive or normal anxiety. May (1967) defined normal anxiety as that which is proportionate to the tlneat, does not involve repression, and can be confronted constructively on the conscious level (p. 80). As people grow from infancy to old age, then values change, and with each step, they experience normal anxiety. All growth consists of the anxiety-creating surrender of past values (May, 1967, p. 80). Normal anxiety is also experienced during those creative moments when an artist, a scientist, or a philosopher suddenly achieves an insight that leads to a recognition that one's life, and perhaps the lives of countless others, will be permanently changed. For example, scientists who witnessed the first atomic bomb tests in Alamogordo, New Mexico, experienced normal anxiety with the realization that, from that moment forward, everything had changed (May, 1981).


Severe anxiety, formally known as generalized anxiety disorder, is a mental illness that causes a person to have persistent, nagging feelings of worry, apprehension, or uneasiness. These feelings are unusually intense and out of proportion to the person's actual troubles. People with generalized anxiety disorder tend to be hyperalert and frequently have trouble falling and staying asleep, and they often do not feel rested when they awake. A combination of psychotherapy and antianxiety medication (including benzodiazepines and antidepressants) can ease anxiety, leading to better sleep.

Subsyndromal Anxiety

In the primary care setting, patients sometimes complain of anxiety symptoms that do not meet diagnostic criteria for an anxiety disorder. These patients usually report brief or intermittent anxiety in the setting of stresses such as bereavement, serious illness, marital discord, or financial embarrassment. The patients are often anxiety-prone individuals and describe themselves as worriers at baseline. Treatment of subsyndromal anxiety includes emotional support and medications to control symptoms (see below).

Neurotic Anxiety

Normal anxiety, the type experienced during periods of growth or of threat to ones values, is experienced by everyone. It can be constructive provided it remains proportionate to the threat. But anxiety can become neurotic or sick. May (1967) defined neurotic anxiety as a reaction which is disproportionate to the tlneat, involves repression and other forms of intrapsychic conflict, and is managed by various kinds of blocking-off of activity and awareness (p. 80). Whereas normal anxiety is felt whenever values are threatened, neurotic anxiety is experienced whenever values become transformed into dogma. To be absolutely right in ones beliefs provides temporary security, but it is security bought at the price of surrendering ones opportunity for fresh learning and new growth (May, 1967, p. 80). Philip's neurotic anxiety was evident in his attachment to unpredictable and crazy women, an attachment that began in early childhood. During the first 2 years of his life, his world was...

Where Did the Time Go

A registered nurse who graduated from nursing school in the early 1990s remembers learning the textbook methods of giving back rubs, making beds, and turning and bathing patients. Accordingly, clinical experiences, at least the fundamental ones, required mastery of these and other skills involved in taking care of people and making them feel better. But when she emerged onto the cardiac step-down unit for the first time as a registered nurse, she salvaged very little time for these niceties. I spent almost half of my time documenting, she recalls, and a good deal of that was done after reporting off to the next shift. Time with patients was confined to the minutes required to do a head-to-toe assessment at the beginning of the shift, medication rounds every two hours, and confirmation that intravenous pumps and other equipment were running smoothly. If I spent extra time with a patient, she says, it was because that patient called me. If there was a problem that wasn't quick to solve,...

Why Is the Need So Critical

Most people would not deny that health care is one of the most emotionally charged of all occupational fields. No one coming into the health care system is immune from at least some form of vulnerability. Patients do not always know what is going to happen, despite what their doctors have told them. Diagnostic tests are foreign to most patients, even if they know someone else who had one or received detailed descriptions beforehand of what was going to happen. Lack of control pervades the thought processes of those undergoing medical procedures, as though they were a passenger flying in a commercial airliner for the first time. No matter how prepared passengers are for the mechanical sequence of events such as takeoff and landing, emotions such as anxiety and the feeling of someone else being in control and responsible for getting them back on the ground are more difficult to prepare for in advance.

Psychology And The Psychology Of Science

Cemed with perception, concept formation, learning, memory, problem solving, and creativity, it has the most obvious possible connection with a psychology of science. The only subdiscipline I do not take up in the book is clinical psychology, simply because there is little to no empirical work directly related to scientific thought and behavior. The one fascinating clinical topic that has garnered some empirical attention and could justify including a clinical subdivision in the psychology of science in the future would be the extent to which particular mental disturbances (for example, autism, manic-depression, or obsessive-compulsive disorder) help or hinder interest or creative achievement in science. For example, as I discuss in the chapters on development and evolution, Simon Baron-Cohen and his colleagues have found a connection between high functioning autism (Asperger's Syndrome) and scientific interest and talent. Is creative achievement helped or hindered by certain mental...

Obsessive Compulsive Disorder

Children with obsessive-compulsive disorder have frequent and uncontrollable thoughts ( obsessions ) and or perform routines or rituals ( compulsions ), usually to get rid of the thoughts. This disorder often involves repeating behaviors to avoid some imagined consequence, so that a child might constantly wash hands because of a fear of germs. other common compulsions include counting, repeating words silently, and rechecking completed tasks. The obsessions and or compulsions may take up a lot of time and cause a child much anxiety. Typically, this disorder begins in adolescence. Children who experience a physical or emotional trauma, such as witnessing a shooting, surviving physical or sexual abuse, or being in a car accident, may develop post-traumatic stress disorder (PTSD). Children are more easily traumatized than adults An event that may not be traumatic to an adult might be to a child, such as a turbulent plane ride. As a result of the trauma, a child may reexperi-ence the...

Few Words about Norms

One last concept and then the statistics lesson is over. In the process of developing a test, psychologists give it to a group of people in order to establish the norms. This group of people is called the normative sample, and it is important to know something about the sample to understand what your test score means. For instance, scoring at the 85th percentile on a test of anxiety would mean something quite different if the normative sample consisted of typical college students rather than hospitalized psychiatric patients. In the first case, you are at the high end of the normal population. In the second case, your anxiety level would represent a much more serious problem. It is very important that you keep in mind that all of the norms presented in this book were based on typical people. In most cases, the normative sample consisted of college students, and for the other tests, the normative sample consisted of typical adults without any known psychological disorders. So, even if...

Selective Serotonin Reuptake Inhibitors

Potential side effects include nausea, anorexia, more frequent or loose stools, anxiety, restlessness, sleep disturbance (insomnia or hypersomnia), headache, diminished sexual drive, orgasmic dysfunction, and apathy. Sinus bradycardia is an uncommon side effect but is rarely symptomatic. Most of these adverse effects are mild or transient, and thus most patients tolerate SSRIs well in the short term. Over the long haul, however, up to 20 percent of patients will discontinue these drugs because of persistent changes in sexual drive or function, and a smaller number will discontinue use because of apathy, gastrointestinal disturbance, or sleep disturbance. Sertra-line hydrochloride is most likely to cause diarrhea, and paroxetine hy-drochloride to cause hypersomnia.

Books on management theory and the MBA

Bookshops, especially those at airports and stations, have large sections devoted to books about management The Way to Win, Think and Grow Rich, The Foundations of Corporate Success, A Passion for Excellence, The One Minute Manager, and so on, including helpful titles such as Who Moved my Cheese About 750 million worth of books about business is sold every year in the USA alone, and Americans are less addicted to them than the British. Many of these titles have made their authors into millionaires, but it is claimed very few are read from end to end. Managers' anxiety not to be outflanked by a new idea continues to sell these books, whereas faddism and a lack of objective ways of judging their worth guarantees a steady flow of new books. If you are minded to buy one first see

Symptoms and Treatment

The toxins affect the central nervous system (CNS). Symptoms start within twenty minutes and may last for two to four hours, but peak hallucinogenic activity rarely lasts for more than one hour. Symptoms include anxiety and tension, visual effects such as blurring, euphoria, increased color perception with closed eyes, but also headache and fatigue. The overall sensation is usually described as pleasant. Treatment is infrequently required. Severe agitation, anxiety, and aggressive behavior respond to diazepam, for example. Rest in a dark, quiet room is sufficient for the majority of the cases.

Symptomatic Relief Left Ventricular Assist Devices Versus Resynchronization Therapy

Normal work, social, and leisure activities. Anxiety and depression are frequent and have a profound effect on patients' mental as well as physical health. These effects on patients' physical, cognitive, and emotional functioning may explain why ratings of physical and emotional QOL closely relate to their New York Heart Association (NYHA) classifications 4 . Because of this association, in the Heart Failure Society of America 2006 Comprehensive Heart Failure Guideline, improving symptoms and QOL is listed among the clinician's top priorities, along with slowing the progression of cardiac and peripheral dysfunction and reducing mortality, when treating patients who have HF and left ventricular systolic dysfunction.

Center for Hyperactive Child Information A

Central nervous system depressants A group of drugs that cause sedation or diminish brain activity. These drugs include alcohol, aminoglutethimide, anesthetics, anticonvulsants, antidepressants, anti-dyskinetics (except amantadine), antihistamines, apomorphine, baclofen, barbiturates, benzodiazepines, buclizine, carbamazepine, chloral hydrate, chlorzoxazone, clonidine, cyclizine, difenoxin and atropine, diphenoxylate and atropine, disulfiram, dronabinol, ethchlorvynol, ethinamate, etomidate, fenfluramine, flavoxate, glutethimide, guanabenz, guanfacine, haloperidol, hydroxyzine, interferon, loxapine, magnesium sulfate, matprotiline, mecli-zine, meprobamate, methyldopa, methyprylon, metoclopramide, metyrosine, mitotane, molin-done, opiod (narcotic) analgesics, oxybutynin, par-aldehyde, paregoric, pargyline, phenothiazines, pimozide, procarbazine, promethazine, propi-omazine, rauwolfia, scopolamine, skeletal muscle relaxants, thioxanthenes, trazodone, trimeprazine, and trimethobenzamide....

Good Communication Is the Key for Surviving the Couples Match Intact

Dency training may be the first significant compromise they have had to reach. Whether the issue is location, program, hospital, or even specialty, both partners must be flexible and open to negotiation. Without excellent communication throughout the entire process, the outcome on Match Day may elicit feelings of disappointment or resentment. But participating in the Couples Match can be a stress-free, even enjoyable, experience. Remember, the final decision on the ranked list of paired programs does not occur until February. Every couple can allay much anxiety by pushing the strategizing and compromising until the end. By doing so, medical student couples will prevent the Match process from creating any rifts in their relationship.

Chlorpromazine Trade name Thorazine A

Major tranquilizer and antipsychotic drug that is used to treat schizophrenia and mania and to control severe anxiety and nausea or vomiting. Chlor-promazine also enhances the effects of painkillers and is used to treat terminally ill patients and those undergoing anesthesia. Chlorpromazine works primarily by blocking dopaminergic receptors.

Referral to Mental Health Professionals

Several types of mental health professionals are available, including psychiatrists, psychologists, social workers, and nurse therapists. The nature of the clinical problem should determine which of these is most appropriate to treat an anxious patient. For example, prompt referral to a psychiatrist is indicated if the patient has severe symptoms that impair daily functioning or are associated with suicidal thoughts. A psychiatrist should also be selected when there is diagnostic uncertainty when advice is needed about medications when the patient has complicated medical comorbidity when another psychiatric condition, such as major depression, substance abuse, or personality disorder, is present and when the anxiety is due to OCD or posttraumatic stress disorder. In addition, psychiatrists should be able to design pharmacologic treatments for patients whose disorder has failed to respond completely to initial medication trials by primary care physicians. Psychological treatments are...

Differential Diagnosis

Similar to many endocrine conditions, the individual differential diagnoses of weight loss, tachycardia, loose stools and behavioral changes are very broad. Considerations in cases of weight loss include cancer, malnutrition, malabsorption, infectious, autoimmune and inflammatory disorders, or any significant focal or systemic disease. Tachycardia can result from exercise, pain, anxiety, hypovolemia, anemia, cardiac arrhythmias, or heart

Why Exercise Enhances Sleep

The benefit of regular exercise to people who have trouble sleeping probably occurs because it reduces stress and anxiety, factors that impede sleep. A good workout leaves you feeling relaxed and in a good mood, so later on you're more likely to fall asleep and stay asleep.

Technological Advances in Health Care

Feel enslaved as instant response becomes more and more possible and expected. Pagers and cellular telephones are available to keep us close to work no matter where we are. This feeling of constantly being monitored, known as techno stress, has been shown to contribute to anxiety and anger in the workplace (Helge, 2001).

The Treatment of Delirium

Illusions, hallucinations, and delusions are often frightening to patients and can lead to dangerous behavior. If they do not abate rapidly with reversal of the underlying cause of the delirium, they are best treated with neu-roleptic drugs. Haloperidol, 0.5 mg po or im q2-4h, or risperidone, 0.5-1 mg po q4h, is often effective. Patients should be monitored for extrapyramidal side effects such as rigidity and tremor. Patients who are agitated or aggressive may require higher doses of neuroleptics or benefit from a fast-acting agent such as droperidol, 0.5-2 cc im, to initiate therapy. Benzodiazepines should be given when alcohol or benzodiazepine withdrawal is suspected, but they will not reverse hallucinations and delusions, as neuroleptics do. Parenterally administered short-acting benzodiazepines such as midazolam hydrochloride or intermediate-acting agents such as lo-razepam are, however, useful for rapid sedation of delirious patients whose behavior is dangerous and for whom...

The Treatment of Noncognitive Symptoms

In general, benzodiazepines are not recommended for the treatment of aggressive or disinhibited behavior. Their role in the treatment of concomitant anxiety is not clear. Recent small studies support the use of the anti-convulsants carbamazepine and divalproex sodium for the treatment of aggressive behavior. Buspirone hydrochloride and trazodone hydrochloride are occasionally beneficial in treating physical aggression. Trazodone, 50-100 mg po qhs, can be used for isolated sleep disorder.

Using Emotion and the Need to Effectively Communicate

At a nurse manager's meeting, suppose a colleague suggests that a nurse be transferred to your unit in order to avoid laying her off. You are aware that this proposal evokes anxiety in you, so you discuss your concerns about an unpleasant encounter you had with that particular nurse in the past (Vitello-Cicciu, 2002). As a result, you and your colleague are able to reach an understanding about not only what is best for the staff member but what is best for you as well. Further, if the nurse eventually transfers to your unit, this preliminary discussion with your management colleague may have served to calm any unresolved reservations you had about the employee, which will ultimately promote better relations between you and that staff member. It is easy to see how perception of emotion and the effective use of emotion to facilitate thought were key ingredients in this interaction. Suppose you had ignored the warning that your emotions were sending when you became anxious about the...

Psychic Defense Mechanisms

Klein (1955) suggested that, from very early infancy, children adopt several psychic defense mechanisms to protect their ego agahist the anxiety aroused by their own destructive fantasies. These intense destructive feelings orighiate with oral-sadistic anxieties concerning the breast the dreaded, destructive breast on the one hand and the satisfyhig, helpful breast on the other. To control these anxieties, infants use several psychic defense mechanisms, such as introjection, projection, splitting, and projective identification.

Proteins That Regulate Endocytosis and Endocytic Recycling of GABAa Rs

GABAA Rs expressed on the cell surface of neurons are subject to constitutive and protein kinase C (PKC)-stimulated endocytosis (2,57,148,149). Therefore, changes in the rate of receptor insertion and endocytosis allow for dynamic physiological adaptation in inhibitory transmission but are also implicated in the etiology of neurological disorders. For example, excessive rates of endocytosis might explain loss of surface expression of GABAA Rs and phar-macoresistance to benzodiazepine treatment observed in rodents and patients during prolonged status epilepticus (5,19,20). Whereas both clathrin-dependent and -independent endocytosis mechanisms have been described in heterologous cells (150), evidence from brain and cultured neurons suggests that GABAA Rs are endocytosed through clathrin-coated pits (2,15,57,148,149,151). GABAA Rs associate directly with the endocytic machinery by binding of receptor-P and Y-subunits to the 2-subunit of the clathrin adaptor AP2 (2,15,116). Consistent...

The Doctorpatient Relationship

The preoperative consultation, a key interaction, involves more than taking medical histories and performing physical examinations. This quality time is spent answering questions about the planned anesthetic care and allaying patients' anxiety. Anesthesiologists need excellent interpersonal skills to comfort patients who are terrified of surrendering control of their lives under general anesthesia. They help patients emotionally who are undergoing one of the most stressful episodes in their lives. The best anesthesiologists are compassionate, sensitive, and supportive. Because of the specialty's emphasis on procedures, they must recognize that often one has to hurt somebody a little to help a lot. At all times, anesthesiologists are quick with a smile or a hand on the shoulder to foster comfort with their nervous patients. In most cases, empathy and compassion have a more lasting effect than premedication. Patient interactions, therefore, are always positive.

What Is Sunday Insomnia

It is not unusual for people to have trouble falling asleep on Sunday nights. While anxiety about work or school on Monday is a potential cause, another important factor is often weekend changes in sleep habits. When someone stays up later Friday night and sleeps in Saturday morning, he or she is primed to stay up even later Saturday night and sleep in the next day. By Sunday evening, the body's clock is programmed to stay up late. People who have developed a pattern of Sunday insomnia may feel their anxiety mount as they anticipate a difficult night ahead. The solution to the Sunday blues is to maintain your weekday rising schedule on the weekends. Then on Sunday night, if you have stayed on schedule, you should have no problem getting to sleep. If you have stayed up a bit later on Friday and Saturday, the sleep deprivation should help you get to sleep easily. In either case and especially if getting anxious about the coming week interferes with getting to sleep make sure to use the...

Researching Druginduced Amnesia

Anticholinergic Drugs and Benzodiazepines Interest in the effects of benzodiazepines (BDZs) on memory initially stemmed from clinical considerations in anesthesiology (cf. Ghoneim & Mewaldt, 1990). Anaesthetists value drugs that ensure a sufficient period and depth of anterograde amnesia, so that even if a patient regained consciousness during an operation, he she would not remember doing so. In this respect, BDZs proved to be ideal drugs. BDZs such as diazepam (trade name Valium), alprazolam (Xanax), lorazepam (Ativan) and 30 or more similar compounds all act via specific benzodiazepine receptors to facilitate the transmission of GABA (Y-aminobutyric acid), the major inhibitory neurotransmitter in the brain. BDZs act as agonists at the GABAa-BDZ receptor (the single term BDZ used here refers to these full agonists). The BDZ receptor can be blocked by a BDZ antagonist, such as flumazenil. Compounds also exist which have opposite effects to BDZs at the same receptor, e.g. j-carbolines...

Dideoxycytidine ddC See zalcitabine dideoxyinosine ddl See didanosine

People with HIV are usually advised to take a multiple vitamin-mineral supplement that supplies the basic level of nutrients most important to body function. Many nutritionists believe that additional supplements are necessary. Symptoms that may be related to nutrient deficiencies and may be reversible with appropriate supplementation include serious fatigue, memory loss or other cognitive dysfunction, skin problems, neuropathy, weight loss, loss of the senses of smell or taste, appetite loss, muscle pain or cramps, digestive problems, night blindness, canker sores, constipation, depression anxiety, menstrual cramps, and menopausal problems. Many other symptoms in people living with HIV may be related to nutrient deficiencies.

Federation for Children with Special Needs 107

There are four stages of the disease, beginning with a progressive insomnia that develops over about four months and includes a collection of psychiatric problems such as panic attacks and bizarre phobias. The second stage includes hallucinations, panic, agitation, and sweating, and lasts about five months. The third stage lasts about three months and involves total insomnia with weight loss. Individuals at this point look much older than they are and may experience incontinence. The fourth stage lasts about six months and is recognized as dementia with total insomnia it ends with sudden death.

Monitoring health outcomes

The effects of case mix routinely frustrate interpretation, except in rare instances of sophisticated systems, such as those used for predicting the survival of ITU patients. Studies on treatments that are, or could be, multimodal show that even quite wide ranges of quality in the application of these treatments have minimal effects on measurable outcome in the short term.21 Purchasers' measures of effectiveness and government league tables which ignore case mix and statistics are worse than useless, giving spurious honour to those whom population bias, case selection and statistical serendipity have thrust to the top of the list. For the government so often to use meaningless league tables in a widely publicised naming and shaming exercise is not simply an unfortunate reflection on their intellectual credulity but a tragedy when all it does is seed widespread anxiety into the very populations for whom they are claiming to act.

Interview and History

The PSD patient often has a history of other conversion disorders and prior psychological stress unrelated to the symptom (Pincus and Tucker, 1974). PSD onset is sudden and tends to be linked to a specific traumatic event (e.g., surgery) or painful emotional experiences (e.g., death of a family member). In the patient interview, the speech-language pathologist determines what the patient might gain from the presenting speech disorder. Primary gain refers to the reduction of anxiety, tension, and conflict provided by the speech disorder. This could be related to a breakdown in communication between the patient and some person of importance, such as a spouse, a boss, or parent. Here the speech problem constitutes a lesser dilemma for the individual than the interpersonal problems from which it arose. Secondary gain refers to those benefits received by the individual from the external environment. This could take the form of monetary compensation, attention, and sympathy from others over...

Presentation of the Diagnosis and Treatment Plan to the Patient

If a psychiatric disorder is diagnosed after thorough workup of a patient with unexplained physical complaints, the first step is the presentation to the patient of the diagnosis and its implications for treatment. This is usually done by the primary care physician, sometimes together with the consulting psychiatrist. It may be of help to have family members present when this summing up takes place, to avoid any miscommunication. The physician should explain that the patients complaints do, indeed, have a cause stress, anxiety, depression, or whatever term is most accurate and acceptable to the patient. The physician may wish to reiterate that there is no doubt of the patient's suffering despite the absence of a medical or surgical disorder to explain it. Many patients with psychiatric disorders who initially cannot be reassured about their health are best treated by their own physicians.

Obstructive Sleep Apnea OSA

People with effectively treated OSA consistently describe a rediscovered sense of rejuvenation, awakening refreshed and energized in a way they didn't believe was possible. They are less prone to depression and anxiety although findings have been mixed, some studies report that cognitive function and memory performance are also improved.

Menopause and Insomnia

Menopause is a time of major hormonal, physical, and psychological changes, and sleep disturbance is one of the hallmark symptoms. More than half of women complain of difficulty falling asleep, less restorative sleep, and daytime sleepiness during this life stage, and these sleep problems are frequently accompanied by depression and anxiety.

The Nature Of Personality

Over the last sixty years, the field of personality psychology has debated the question of both the number and the structure of fundamental dimensions of personality.1 That is, what are the universal dimensions of personality and how many are there Although, as with every academic debate, there is some disagreement concerning the answers to these questions, during the last fifteen years a surprisingly clear answer has begun to emerge. It has been labeled the Big-Five or Five-Factor Model. According to this model, there are five major dimensions to human personality anxiety (neuroticism), extroversion, openness, agreeableness, and conscientiousness. Moreover, each dimension is both bipolar and normally distributed in the population. That is, for instance, anxiety is one pole of the dimension, with emotional stability being its opposite. Everyone falls somewhere on the continuum from extremely anxious to extremely emotional stable, with most people falling in between. In addition, just...

Incidence of Mental Illness

In 1996, a large-scale nationwide mental health and substance abuse epidemiological study was conducted by researchers from the University of Antioquia and the University CES of Medellin. Funded by the Ministry of Health and working with a national team of more than 100 interviewers, the researchers interviewed a random sample of 15,046 individuals older than 12 years of age across the country, using the Clinical Diagnostic Inventory II questionnaire, which is based on the DSM-IV classification. This is the most comprehensive mental health study ever conducted in Colombia. The lifetime prevalence of diagnosable disorders was as follows nicotine dependency, 28 major depression, 19.3 alcohol abuse and dependency (combined), 16.6 posttraumatic stress disorder, 4.5 somatization, 4.3 generalized anxiety, 3.8 and schizophrenia, 1.4 . The lifetime use of marijuana was 7.8 and of cocaine 2.5 (Torres and Montoya 1997). Suicide is also a public health problem in 1995, a total of 58,830 suicides...

Federal Rehabilitation Act 181

Physicians suggest that individuals be encouraged to develop their own methods of coping with fatigue, including pacing their daily lives, altering activity-rest patterns, taking frequent rest breaks, and delegating activities to others. Working out at the gym or jogging is a form of natural psychological and physical stimulation, but more moderate exercise such as walking can be helpful, too. People have found such meditative exercise forms as yoga, tai chi, or chi gong very restorative even when their physical capacity is limited by disease. Massage, therapeutic touch, acupuncture, and other alternative therapies that claim to restore the body's energy balance also may have a role to play, if only for their meditative aspects, which may relieve mental tension and depression. Finally, psychosocial counseling and support groups can be important for helping the individual to cope with emotional stress or anxiety. occupational therapy can also be a valuable strategy for

Genetics and Personality

QTL research has begun to uncover some of the many genetic markers involved in basic nonpathological personality traits, such as novelty- or thrill-seeking, neuroticism anxiety, and indirect genetic markers in potentially pathological levels of aggression, sexuality, impulsivity, or lack of constraint.6 To take just one example thrill seeking appears to be associated with long repeating sequences of base pairs (rather than short sequences) in an allele for a dopamine receptor (DRD4) on chromosome 11. Having a short form of the allele appears to result in a more efficient method for binding dopamine, and hence having a long repeating sequence rather than short repeating sequence results in a dopamine deficiency. This deficiency in turn is associated with a greater need for thrill seeking, such as riding roller coasters or playing the stock market. Dopamine appears to be related to the experience of pleasure, and those with low baseline levels would then naturally seek experiences that...

Acculturation and Mental Health Symptoms

While investigating Colombians in New York, Correa (1992) found that ac-culturative stressors were better predictors of anxiety and depression than were general life stressors and also found that individuals who were more psy-chosocially competent used more active (problem-solving) coping strategies and experienced fewer symptoms of distress.

Human factors in functional neuroimaging

Another concern is that the neuroimaging environment itself may change performance of the task and other physiological measures. Changes may be due to anxiety about the scanning environment, changes in temperature (many scanner rooms are chilly), changes in posture that induce physiological changes (lying down reduces orthostatic load), practice, a response to the medical context presented by imaging suites, or other variables. It is advisable to test paradigms outside the scanner, and use objective measures of performance and other behaviors whenever possible.

Dependence on Alcohol or Drugs

Although substance use disorders are mostly self-inflicted, they can be initiated or sustained through the well-intentioned treatment of a variety of common complaints (e.g., anxiety, headaches, insomnia, chronic pain). For most front-line practitioners, few days go by without repeated requests for more or stronger psychoactive medications. Once a substance use disorder has become established, it brings its own cargo of medical and psychiatric problems.

Habits vs Mental Problems

In rare instances, a habit may be due to a physical or psychological problem. For example, a child who picks his nose may do so because he has stuck an object in his nose. A child who constantly sucks her thumb might be feeling extremely anxious. Most habits are harmless, but they can sometimes lead to injury. For example simple hair twirling is a common habit, but a child who pulls her hair out in patches may have trichotillomania, a more serious condition in which a child intentionally pulls out her hair. Habits that affect a child's social relationships or interfere with daily life are considered obsessive behaviors, such as those seen in obsessive-compulsive disorder. When a person imposes some control over an obsessive behavior, he begins to feel increasing anxiety until he displays the behavior again.

Introduction to examples

However, there are difficulties with the process of obtaining consent, which were identified in Chapter Four. Chapter Eight gives those difficulties substance by reference to a number of empirical studies, such as the one which showed considerable confusion about the concept of randomization amongst parents of neonates in a research project. Other empirical studies discussed investigate whether seeking consent gives rise to greater anxiety, which if true would be a duty-based reason for being wary of seeking consent. Yet more studies indicate that the consent process reduces recruitment rates of subjects for research, which threatens research. This, of course, is a goal-based concern, and provides a goal-based reason for being reluctant to take the consent process seriously. These threats to the claim of right-based morality, that seeking consent is of paramount importance, are not inconsiderable, which is why it is necessary to be able to give substance and weight to the principle...

Aphasia Treatment Pharmacological Approaches

The role of the inhibitory transmitter g-aminobutyric acid (GABA) has been investigated in several studies. Intracortical infusion of GABA exacerbates the hemi-paresis produced by a small motor cortex lesion in rats (Schallert et al., 1992). The short-term administration of diazepam, a benzodiazepine and indirect GABA agonist, can permanently impede sensory cortical recovery. Furthermore, phenobarbital, which may have some GABA agonist effects, also impedes recovery (Hernandez and Holling, 1994). An early study of aphasia pharmacotherapy with methylphenidate (similar to amphetamine) and chlor-diazepoxide (a benzodiazepine) revealed no effects (Darley, Keith, and Sasanuma, 1977). A recent prospective double-blind study of motor recovery with methylphenidate found a significant difference in motor and depression scores on some measures but not others (Grade et al., 1998). Methylphenidate may play a role in the treatment of post-stroke depression (Lazarus et al., In a formal...

The Acquisition of Increased Tolerance

Patients with a high tolerance to alcohol, for example, readily develop similar tolerance to benzodiazepines, barbiturates, and anesthetic agents. A relationship exists between alcohol and opioids such that acetaldehyde, alcohols first metabolite, has been linked to increased production of endogenous opiates in the brain, which may explain the increased affinity for opioids observed among alcoholic persons and the frequency with which chronic pain patients develop alcoholism. Not all cross-tolerance is complete, however a fact with important implications for the treatment of withdrawal states.

Jerome S Schwartz Phillip Song and Andrew Blitzer Introduction

Headaches are one of the most common patient complaints to primary care physicians in the United States. The debilitating nature of many headache disorders often results in significant loss of productivity, social engagement, and quality of life. Although the overwhelming majority of headache disorders are benign in nature, patients often fear the worst case scenario, such as an aneurysm or brain tumor. To compound the situation, physicians, particularly those who are unfamiliar with headache management, often needlessly resort to extensive diagnostic examinations in search of organic pathology, thereby creating additional anxiety and financial burden.

Motor system disease See motor neuron disease

Tremors are disorders that involve abnormal involuntary movement. They can involve the arms, legs, head, or body. They may be most evident when a person is resting or trying to make fine, coordinated movements. Physiological tremor can affect anyone and may occur with too much caffeine intake or during periods of anxiety.

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Phenobarbital can be detected in the urine for well over a week, while shorter-acting barbiturates such as butalbital disappear much more rapidly. Benzodiazepines with long half-lives (e.g., diazepam, chlordiazepoxide hydrochloride, and clonazepam) can persist for well over a week, especially in elderly patients. Shorter-acting benzodiazepines (e.g., alprazolam, triazo-lam) often escape detection in the urine except when used in large doses.


TTHs may be difficult to distinguish from migraine headache on initial presentation. They have been recently subcategorized according to the frequency of episodes as infrequent episodic TTH (ETTH), frequent episodic headache, and chronic TTH (12). Infrequent ETTH is the most prevalent subtype, presenting as a constant, pressing, mild to moderate, bilateral headache lasting between 30 minutes and several days for less than 1 day per month (

Factors Contributing to Consistency in Personality

There are increasing levels of depression and anxiety in recent decades, along with increases in self-esteem (based on self-reports), extraversi n, and (among women) as-sertiveness. Cultural pressures toward individualism, along with declines in social support and changes in gender roles, may account for these changes. While such studies don't address the question of consistency of an individual's personality, they do point out that individuals develop their personality in a social context, which personality theories have generally neglected, focusing instead on causes in the family and (more recently) in biology.

Implementation of the Plan

Many patients will seek detoxification simply to gain temporary relief from their withdrawal misery, but not every patient should necessarily be detoxified simply because of an expressed desire to do so. Any patient who has never undergone medical detoxification should be given the opportunity as quickly as possible, as should anyone active in treatment who relapses. Medical detoxification should always be undertaken whenever a patient's alcohol or drug use significantly compromises the treatment of any other disorder (e.g., epilepsy, diabetes, cardiovascular dysfunction, anxiety and depressive disorders). Otherwise, detoxification should be undertaken only when part of a broader, mutually agreed-upon, long-range treatment strategy in order to deter poorly motivated patients from employing revolving door detoxification as a stopgap measure (e.g., when their drug supply has been temporarily interrupted). A bit of clinical skepticism should be exercised with kindness. Alcohol. A history...

Insertive anal intercourse See anal intercourse

Insomnia The inability to sleep, or to get enough sleep. The difficulty may be either in falling asleep or remaining asleep, or both. This sleep disorder may be primary or secondary to some other illness, condition, or circumstance. Primary insomnia exists when there are no signs or symptoms of a mental or physical condition that would account for the disorder. Secondary insomnia is usually readily explained by the existence of a condition that causes anxiety, stress, or pain or by the use of a drug that interferes with sleep. The causes of insomnia may be mental or physical. A great variety of drugs are available for primary insomnia, including over-the-counter medications. Their use on a short-term basis might be advisable, but all prescription drugs may have undesired side effects, such as overdose, habituation, tolerance, addiction, daytime drowsiness, lethargy, or amnesia. In secondary insomnia, treatment consists of determining the condition causing the insomnia and

Why the Study of Emotional Intelligence in Teams Is So Important

One factor that was desirable for some but not necessarily all members of the team was a high IQ. Introversion and extroversion were also defining characteristics for those in various team roles, as were a tendency toward anxiety, a sense of urgency, and emotionality. If a person were an emotional, dominant, impulsive extrovert, for example, he might best be placed in the role of shaper for the team. Finishers were anxious, introverted individuals who might worry excessively about follow-through. Team leaders were described as stable, dominant extroverts who concentrated on objectives and made sure people were focused on their areas of greatest ability (Johnson, Scholes, and Sexty, 1989, p. 123). Attempts such as these to define teams and the personalities or abilities of team members continued well into the 1990s. Such delineations as supervisors work in the system and team leaders work on the system (Fisher, 1993, p. 126) and relationship roles such as encourager, harmonizer and...

Mental Health of Adults with Epilepsy

Summary Mental Health of Adults With Epilepsy, a chapter in Epilepsy Patient and Family Guide, discusses the mental and behavioral aspects of epilepsy in adult patients. Behavioral disturbances in people with epilepsy may be unrelated to epilepsy, or related to the person's emotional reactions to having epilepsy, the effect of medications, or epilepsy. The chapter discusses (1) personality and epilepsy, (2) depression in epilepsy and in the general population, (3) causes of depression in people with epilepsy, (4) treating depression, (5) anxiety disorders in patients with epilepsy and in the general population, (6)

The devaluation of diagnosis

Whereas in the past mental illnesses were few and clearly defined, today disease labels are both more numerous and more diffuse. In 1952, the Diagnostic and Statistical Manual of American psychiatry recognised 60 categories of abnormal behaviour by 1994 this had expanded to 384 (plus 28 'floating' diagnoses) (American Psychiatric Association 1994). Furthermore psychiatric authorities have identified a much wider prevalence of 'sub-syndromal behaviour'. Some reckon that many, if not most, people in society are suffering from 'shadow syndromes', mild or partial forms of familiar psychiatric conditions, such as depression and anxiety, obsessional compulsive disorder and autism (Ratey, Johnson 1997). Clinical psychologist Oliver James, author of the popular book Britain on the Couch, snappily subtitled 'why we're unhappier compared with 1950 despite being richer a treatment for the low-serotonin society', reckons that around one third of British adults could be diagnosed as having some...

Support Capability 1 Acceptance and Recognition of Experimentation

There are indeed managers who cringe at the thought of a mistake being made or of being used as an example of what not to do, and often their anxiety is justified. On the other hand, there is a pervasive idea in the literature that effective and wise leaders are those who encourage experimentation, expect mistakes, and have a practical understanding of which experiments and mistakes can be made without undue consequence to the organization (Chaffee and Arthur, 2002 Grazier, 2003 Christensen and Raynor, 2003). The emotionally astute leader masters this kind of weighing of risks versus benefits and builds his followers' comfort level with this mind-set. The effective leader will be able to manage the emotional conflicts (fear, anxiety, embarrassment) arising from an aversion to risk taking and find it possible to promote experimentation within their team. Grazier (2003) describes a hospital training program that seeks to integrate the ideas of innovation,...

In Dyadic Interactions And Attachment

In dyadic interactions, infants' focus is entirely on the mother, but in the attachment relationship, infants use the mother to regulate their anxiety about objects or events in the environment. The warmth experienced in the relationship buffers the uncertainty experienced in unfamiliar circumstances. In this way, infants' emotional orientation to the outside world can be modified by the mother's orientation. Now the focus of the interaction is in part outside the two-person confines of the dyadic interaction. This shift in focus of the interaction from within the dyad to external objects and events is a critical step in the development of commonsense psychology. It Although it is the emotional connection between infant and mother that enables the correspondence between first- and third-person information to be maintained as the focus shifts away from the dyad, other forms of psychological information are involved. As we shall see in chapter 6, information pertaining to what I have...

Maternofetal transmission See transmission

It's chemical name is 3, 4-methylenedioxymethamphetamine. It is an illegal psychoactive drug that has both hallucinogenic and stimulant properties. It is known to interact with several protease inhibitors, causing an increase of MDMA in the body. This increase can quickly cause overdoses, which could lead to death. MDMA is taken orally, usually in tablet or capsule form, and its effects last approximately four to six hours. Users of the drug say that it produces profoundly positive feelings, empathy for others, elimination of anxiety, and extreme relaxation. MDMA is also said to suppress the need to eat, drink, or sleep, enabling users to endure two- to three-day parties. Consequently, MDMA use sometimes results in severe dehydration or exhaustion. MDMA users also report aftereffects of anxiety, paranoia, and depression. An MDMA overdose is characterized by high blood pressure, faintness, panic attacks, and, in more severe cases, loss of consciousness,...

Theories of Confabulation Compensation

Many of these patients, who suffer injury to the medial aspect of the frontal lobes, are also apathetic and indifferent about their situation and about social interactions. It is unlikely that someone who is unaware of a deficit and seems to be indifferent to it would feel a need to resort to confabulation in order to alleviate anxiety associated with embarrassment or memory lapses. Stuss et al. (1978) have even postulated that the lack of concern about performance is one of the frontal characteristics necessary to produce confabulation. DeLuca (2000a) points out that confabulation often tends only to appear early following the injury, while the amnesic disorder is long-lasting, raising the question of why should patients only fill in gaps early in their illness. These clinical observations, however, do not rule out the possibility that a tendency to fill in gaps in memory plays some role in confabulations.

Punishment and Extinction Decreasing the Rate of Responding

The immediate effect of punishment is to reduce the frequency of an operant behavior. Animals in Skinner boxes learn quickly to stop doing whatever brings a punishing electric shock. Unfortunately, punishment also has unintended adverse effects that make it a generally undesirable technique for controlling behavior. Punishment produces emotional reactions, including fear and anxiety, which remain even after the undesirable behavior has ceased. These emotions often generalize to other situations. For example, children punished for sexual exploration may experience anxiety later, even under circumstances when sexual behavior would be appropriate. Children punished for talking back to their parents may become nervous when they want to state an opinion later, even when speaking up would be desirable. Punishment is often effective in the short run in reducing behavior, but unless the controlling agent is able to stay to administer continuing punishments as a reminder, in the long run the...

Common Expressions of Distress Attitudes and Reactions

Nervous) is probably the most commonly used chief complaint irrespective of eventual underlying disorders. This idiom of distress has been reported in other parts of Latin America and is described extensively by Low (1985). In my experience, this is a neutral phase used to express subjective discomfort regardless of whether the discomfort stems from anxiety, depression, or psychosis. Other phrases are occasionally used, such as ancioso (anxious), desganado (lacking interest or energy), and como si quiero correr (I feel like running agitation). Nervioso or nerviosa is neutral in the sense that it suggests an emotional problem but does not necessarily imply mental illness (enfermo mental) or worse still, locura (psychosis or craziness). It thus makes it easier for the person to accept the patient role and the need for treatment.

Epilepsy in Children A Primary Care Perspective

Summary Epilepsy in Children A Primary Care Perspective, a videotape, reviews the diagnosis and management of childhood seizures. Most childhood seizures can be successfully controlled the keys are accurate diagnosis and administration of the most appropriate anticonvulsant medication. A seizure is a symptom of an underlying neurological disorder, which may be epilepsy or an epileptic syndrome. Syndromes are defined by the clinical event, electroencephalography (EEG) characteristics, age at onset, evolution and prognosis, family history, clinical history, and physical findings. Many conditions mimic epilepsy in children, including breath holding, pallid infantile syncope, night terrors, sleep walking, syncope, cardiac arrhythmia, and movement disorders. Once the physician has established that a seizure has occurred, it is important to take a clinical history, especially a detailed description of the event. Diagnosis is based on clinical, not EEG, data, but EEG's may suggest a seizure...

Purkinje Jan Evangelista 263

taking hold ) refers to one of a group of drugs used to modify the manifestation of psychosis. They are also known as major tranquilizers or antipsychotics. Psychopharmacologic drugs include the following drug classes antipsychotics, anti-neurotics (or antianxiety drugs), and antidepressants. The most common type of psychosurgery today is stereotaxic surgery in which a scalpel or probe is inserted into a small drilled hole in the skull above one temple. Under x-ray control, the probe is guided to a specific brain area where the surgeon makes small cuts in nerve fibers. This type of surgery is used to treat severe depression, anxiety, or severe obsessive-compulsive disorder.

Medications for Mild to Moderate Alzheimers Disease

After using one of the cholinesterase inhibitors for several weeks, about half of patients are somewhat more alert and better able to care for themselves and engage in activities. The drugs may have other benefits, according to a 2003 report in the Journal of the American Medical Association. This review of twenty-nine studies found that cholinesterase inhibitors might also ease some of the psychiatric symptoms of Alzheimer's disease, such as depression, anxiety, hallucinations, and delusions.

Approach Avoidance Conflict

In an approach-avoidance conflict, a person has competing tendencies to both approach and to avoid the same goal because the same course of action will lead to both reward and punishment. Because an avoidance gradient is steeper than an approach gradient, the two may cross. In this case, the approach tendency will be higher further from the goal when the trip is several weeks away, Bill signs up. But the avoidance tendency is higher near the goal as the departure date nears, Bill backs out. People can behave quite inconsistently in approach-avoidance conflicts. When the gradients cross like this, anxiety is acutely felt at the crossover point, where approach and avoidance tendencies are equally strong.

Avoidance Avoidance Conflict

In an avoidance-avoidance conflict, the person must choose between two goals, both of which are undesirable. If possible, the person will avoid both. If constrained to stay in the situation, the person will become immobilized partway between the two goals, where the two avoidance gradients cross, since movement in either direction would increase anxiety. Such decisions invite postponement and procrastination.

Issues of Clinical Relevance

The most prevalent diagnoses among Nicaraguans in the United States are depression, anxiety, and posttraumatic stress disorder (PTSD). The following case vignettes have been selected to illustrate psychiatric issues that are pertinent to the Nicaraguan community. Ms. H, a divorced woman in her 40s, sought psychiatric treatment because she was experiencing poor sleep, anxiety, weight loss, and tearfulness. She was the sole supporter of her two children but was employed in a low-paying position, even though she had had a professional career in Nicaragua. This greatly affected her self-esteem, and she was distressed that she could not do better. Her alcoholic ex-husband had verbally and physically abused her. John, a 16-year-old boy, was brought to treatment by his mother, who was concerned about her son's habits. She reported that he was reclusive and spent long hours in his room listening to heavy metal music and not participating in family life. She also reported that he wore torn and...

Seasonal rhythm See circadian rhythm

Sedatives Drugs that relieve anxiety and tension, including barbiturates, administered at lower doses than those needed for sleep. They have been generally replaced by tranquilizers, which are less likely to cause dependence. (See also central nervous SYSTEM DEPRESSANTS.)

Norwalk agent virus infection 371

Parents and the school should not underestimate the gravity of this disability. The main problem in the painstaking approach to teaching the child is the caregiver's faulty impression that the child is much more adept than he is. Everyone tends to overestimate the intelligence of NLD adolescents. The child should be shielded from teasing, persecution, and other sources of anxiety.

James K Rowlett Angela N Duke and Donna M Platt

Ligands that act at y-aminobutyric type A (GABAa) receptors, in particular the benzodiazepines and related drugs, have broad clinical use but also the liability for abuse and dependence. Recent epidemiological data suggest that abuse of benzodiazepine-type drugs may be on the upswing, with a shift from primary misuse of benzodiazepines by people in a therapeutic setting to use by younger people engaging in recreational abuse. Laboratory findings suggest that benzodiazepine-type drugs have reinforcing effects both in human and non-human subjects. However, benzodiazepine-type drugs appear to have lower reinforcing effectiveness compared to other drugs of abuse, such as psychomotor stimulants. Recent research has begun to explore the role of GABAA receptor subtypes in the reinforcing effects of benzodiazepine-type drugs, and unlike other behavioral effects (e.g., motor coordination deficits) reinforcing effects are not easily attributed to a single receptor subtype. Perhaps the most firm...

Obsessive Compulsive Foundation OCF An

International nonprofit organization of more than 10,000 members with obsessive-compulsive disorder (OCD) and related disorders, their families, friends, professionals, and other concerned individuals. Founded by a group of individuals with OCD in 1986, the mission of the OCF is to educate the public and professional communities about OCD and related disorders to help people with OCD and related disorders, their family and friends and to support research into the causes and effective treatments of OCD and related disorders. (For contact information see Appendix I.) oppositional defiant disorder (ODD) A behavior disorder characterized by uncooperative, defiant, negative, irritable, and annoying behavior toward parents, teachers, and other authority figures in children and teens. Oppositional defiant disorder (ODD) is reported to affect between 2 and 16 percent of children and adolescents in the general population, usually appearing by age eight. ODD is more common in boys than in girls...

How To Be A Good Pediatrician

For both office visits and admissions to the hospital, all pediatricians first have to establish a good rapport with the child and his or her parents. A rushed introduction keeps the child and parents on edge, making the examination difficult and trust harder to gain. From the moment you walk in to the room, set the tone by going straight to the child and introducing yourself with your first name. Kids are usually apprehensive about meeting doctors, and if you introduce yourself to the parents first, it reaffirms their fear that the physician is there to talk about something bad that is going on. You then look at the child and parents to gauge their level of anxiety and worry. Especially if the diagnosis or prognosis is unknown, pediatricians have to use more concrete reasoning with a focus on the facts with both parent and child. After introductions, it is important to convey empathy for what the child and the parents are experiencing. Even a simple affirmation you guys must be...

How the Continuum Affects Individuals

Every work culture and every individual either knowingly or unwittingly subscribes to a continuum like this one. In other words, the cultural norm of the group encourages the use of emotion in a certain way or context, as does the individual's emotional ability. In a particular setting, dissatisfaction might be channeled into resolve, or it might inhibit the ability to carry out daily tasks. If we take this idea further in an example, we might think of a unit clerk who is disturbed by a feeling of being stepped on by doctors and nursing staff, he might channel that feeling into resolve (to become more visible and valuable) or resentment (which may lead to exacerbation of the perceived slight and an increased inability to function). In another scenario, imagine that an angry family member has just bawled out a nurse. That nurse might initially feel anxiety or embarrassment. Depending on that nurse's ability to apply that emotion to thought, she might meet it with a demonstrated desire...

Vocabulary Builder

Benzodiazepines A two-ring heterocyclic compound consisting of a benzene ring fused to a diazepine ring. Permitted is any degree of hydrogenation, any substituents and any H-isomer. nih Lorazepam An anti-anxiety agent with few side effects. It also has hypnotic, anticonvulsant, and considerable sedative properties and has been proposed as a preanesthetic agent. nih

The Significance of the Empathic Work Culture

One explanation may be that the culture, or environment, of their workplace is oppressive and anxiety-producing. Anxiety disorders related to work contribute to absenteeism and increasing health care costs, and sometimes they manifest themselves in overt misbehavior in the workplace. This subtle yet ever-present emotion probably does more damage than it is credited with. Studies cited by Sauter and others (1999) reveal that between 26 and 40 percent of employees report problematic job stress (p. 99).

Empirical evidence that consent reduces recruitment

There is some empirical evidence to support their concerns. The development from duty-based to goal-based arguments in their article is rational given that one of the reasons that recruitment levels are low, apart from patients not wanting to join trials once they have been informed, is the reluctance of their doctors to talk to them about randomization (Taylor et al., 1984). This is, presumably, out of concern for their patients' well being, although, as one correspondent pointed out, it may be that the doctor is simply transferring his anxiety about challenging the efficacy of a new product to his patient (Walsworth-Bell, 1993).

Ftstructive Alternativism

He calls this assumption constructive alternativism. Since we could construe the world differently, our beliefs do not have the status of objective truth. Instead, we should emphasize the act of construing, realizing that our concepts are never identical with ultimate reality but always tentative and subject to revision (McWilliams, 1993)- This uncertainty can bring freedom rather than anxiety. Rather than being determined, as stimulus-response theories and psychoanalytic theory assume, people are free to the extent that they are able to construct alternate interpretations of the universe.

The Emergence of Mothers Little Helper

The introduction of meprobamate raised the hopes that anxiolytics could be developed that were safer than barbiturates. These drugs would, in turn, begin to meet the needs of the then-recognized large portion of the population suffering from anxiety disorders. Meprobamate was by all accounts a hit, spurring the interest in the development of novel anxiolytic drugs (4). The apex of anxiolytic drug development was reached in 1960 with the introduction of chlordiazepoxide (Librium ) and with diazepam in 1963 (Valium ), by the Swiss company Hoffman-La Roche (Basel, Switzerland). The popularity of diazepam has been well documented, with this compound becoming the most widely prescribed drug irrespective of therapeutic use in the US and Europe between 1968 and 1987 (16). But by as early as 1967, reports in the popular media were warning against the potential for illicit use and abuse, particularly by youth and the counterculture (4,16). Use of benzodiazepines in fact entered the popular...

Mental Illness and Society

A gradual but sustained penetration of modern notions of mental illness has occurred, even in remote parts of the country. The growth of communication media and the easier access to those remote areas have contributed to this. Likewise, the use of medications (particularly major tranquilizers, anxiolytics, and antidepressants) is a noteworthy factor in the process. The figure of the doctor enjoys universal respect, admiration, and a sense of dependency that may contribute to acceptable degrees of medication compliance. However, this is not a generalized phenomenon, and poverty, inaccessibility of services, lack of professional attention, and chaotic administration of health programs make the follow-up and ultimately the prognosis of mental illnesses somber or, at best, uncertain (Alarcon 1990).

Management of the Acute Hepatic Porphyrias

Because infections can precipitate attacks, the patient should be evaluated and infections treated with safe antibiotics such as penicillins, cephalosporins, or tetracyclines. Pain, nausea, anxiety, and tachycardia can be treated with meperidine, acetaminophen, phenothiazines, and propranolol (all safe drugs for the porphyric patient4). Management of seizures in porphyrics is problematic because many anticonvulsants precipitate acute porphyric attacks. Benzodiazepines appear safe, and some of the newer agents such as gabapentin and topiramate might also be safe. Although the porphyrias have diverse clinical presentations arising from defects in complex biochemical pathways, all clinicians should understand the need to check for excess PBG excretion in cases of acute pain crises and check for porphyrins only if there are photosensitive skin lesions present. For the acute pain crises, avoiding drugs that can exacerbate the biochemical defect and administering glucose, hemin, and...

Outcomes of the Empathic Work Culture

Most people want to work for an organization that makes them feel safe and comfortable. This includes safety from physical harm and job loss, but it also includes protection from anxiety and fear. Increasing patient loads and responsibilities, not to mention spiraling technological advances and emphasis on controlling costs, are all factors that can lead to anxiety among nurses. Organizations that emphasize empathy in their culture will naturally display a greater level of support for worker concerns and attention to worker safety than organizations that do not encourage empathy. In return, they will likely garner high company loyalty, low absenteeism, and, as a result, positive impact on their bottom line. When companies pay attention to threats or anxiety-producing situations within the workplace, they are taking the first step toward identification and resolution of emotional situations that could easily spiral out of control. In addition, organizations can create a corporate...

Emotions Related to Change

When core constructs are changed by new incidental (rather than comprehensive) constructs, fear is experienced (rather than threat). The less we think about a matter, the more likely we are to experience fear the more we think about it, the more likely we are to experience threat. Anxiety occurs when we recognize that we are confronted by events outside the range of convenience of our construct system. Our constructs are not adequate to deal with events, and we know this. Anxiety is a sign of construct failure and the need for change.

Risk and risk management

We live in an age of fear not real fear of death and starvation, penury and war but a corrosive anxiety that in any situation the worst will happen, that nothing is safe and no one and no thing or principle is to be trusted.19 The environment that this insecurity spawns generates numberless attempts to regulate and check what has happened or what might happen and convoluted attempts to minimise any risk that an individual or organisation might fall prey to. The United States spends about 200 billion a year towards regulating health and safety and environmental risk. You could say this habit is simply wise caution or you could see it as a loss of trust and self confidence. Whatever your interpretation, it is for now a fact of life that one must manage risk actively and centrally. Between 1967 and 1972, risk was cited 1300 times in medical journals between 1987 and 1992 risk was cited 110 000 times between 1997 and 2002 this had jumped to a whopping 245 227 citations on PubMed. There...

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