Natural Anxiety and Panic Disorders Cure Ebook

Panic Away End Anxiety and Panic Attacks

Panic Away, which is a completely natural approach has been developed by Barry McDonagh over many years after he himself suffered from panic attacks and general anxiety for years. Barry McDonagh identifies the key element to curing panic attacks and overcoming anxiety as no longer fearing the thought of having a panic attack. The One Move technique is capable of breaking any panic attack cycle and it is proved that with this technique you can avoid any panic attack permanently. This is all obtained without any use of medication or relaxation systems. This unique and amazing technique has led to a program designed to assist people take their life back that has reached over 184,000 people in 32 countries. 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. Continue reading...

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Phobic anxiety disorders

A group of disorders in which anxiety is evoked only, or predominantly, in certain well-defined situations that are not currently dangerous. As a result these situations are characteristically avoided or endured with dread. The patient's concern may be focused on individual symptoms like palpitations or feeling faint and is often associated with secondary fears of dying, losing control, or going mad. Contemplating entry to the phobic situation usually generates anticipatory anxiety. Phobic anxiety and depression often coexist. Whether two diagnoses, phobic anxiety and depressive episode, are needed, or only one, is determined by the time course of the two conditions and by therapeutic considerations at the time of consultation.

Separation anxiety disorder of childhood

Should be diagnosed when fear of separation constitutes the focus of the anxiety and when such anxiety first arose during the early years of childhood. It is differentiated from normal separation anxiety when it is of a degree (severity) that is statistically unusual (including an abnormal persistence beyond the usual age period), and when it is associated with significant problems in social functioning. Excludes mood affective disorders ( F30-F39 ) neurotic disorders ( F40-F48 ) phobic anxiety disorder of childhood ( F93 .l) social anxiety disorder of childhood ( F93.2 )

Summary Drug Table Antianxiety Drugs

Xanax, generic Xanax, generic Anxiety disorders, short-term relief of anxiety Anxiety disorders, short-term relief of anxiety, acute alcohol withdrawal Anxiety disorders, short-term relief of anxiety, acute alcohol withdrawal Anxiety disorders, short-term relief of anxiety, acute alcohol withdrawal, anticonvulsant, preoperative muscle relaxant Anxiety disorders, short-term relief of anxiety Anxiety 5-25 mg PO 3 or 4 times d, 50-100 mg IM, IV, then 25-50 mg IM, IV 3 or 4 times d acute alcohol withdrawal up to 300 mg d PO in divided doses, 50-100 mg IM, IV may repeat in 2-4h 7.5-60 mg PO in divided doses (average dose, 7.5 mg PO TID)

Hypnosis In Enhancing Anxiety Reduction

While relaxation is not a requirement of hypnosis, the use of hypnosis can facilitate relaxation and reduction in the anxiety which may directly or indirectly impair sexual functioning. Hypnotically cued relaxation may be utilized at the time of sexual intimacy, during self-stimulation or during the sensate focus or pleasuring technique, a process of in vivo desensitization. This use of cued relaxation may also overcome the anxiety accompanying sexual guilt.

Transition From Acute To Chronic Pain Anxiety To Depression

Even acute pain is not a simple matter of stimulus intensity in the clinical situation. Beecher (1946, 1959) observed, on the Anzio beachhead during World War II, that wounded soldiers did not typically report pain as they waited to be removed from the battlefield, in spite of gunshot and shrapnel wounds that eventually may have needed major surgery, amputation, and long-term convalescence. He contrasted the wounded soldier's mild euphoria with similarly injured civilians in a hospital emergency setting, who typically expressed considerable pain and suffering. The soldier knew he was going home, and that he no longer had to fear being killed for the civilian the pain has socio-economic implications, fear of job loss, and so on. Subsequent studies have confirmed that acute pain is primarily mediated by anxiety (Sternbach, 1968). Beecher's (1959) emphasis on the manner in which the psychological significance of the pain modulates wound severity has led to the delineation of learning...

What Are Panic Attacks

Panic attacks are very common and more common in young people in both men and women. People feel that they are extremely ill, feel their heart beating fast and forcefully in their chest, notice a change in their breathing pattern, and may breathe very fast and deep (hyperventilation). Sweating, having a headache or intense fear, not wanting to leave the house (agoraphobia), wanting to run away into the open air, not being able to tolerate being in a room (claustrophobia), are other features of panic attacks. Some people may hyperventilate and lose consciousness.

Relieving Anxiety and Fear

The patient with newly diagnosed diabetes often has many concerns regarding the diagnosis. For some, initially coping with diabetes and the methods required for controlling the disorder creates many problems. Some of the fears and concerns of these patients may include having to give themselves an injection, having to follow a diet, weight control, the complications associated with diabetes, and changes in eating times and habits. An effective teaching program helps relieve some of this anxiety. The patient in this situation needs time to talk about the disorder, express concerns, and ask questions.

Hypnosis In The Management Of Anxiety Disorders

The psychological treatment of anxiety disorders involves a wide variety of techniques based on psychotherapeutic, behavioral and cognitive principles. Hyp The primary goals of psychological therapies for anxiety states are the exposure of the patient (via imagery or reality) to the situation provoking the anxiety, thereby allowing deconditioning, habituation or desensitization cognitive re-evaluations of the situation to alter the perception of threat determining the personal significance (symbolic) of the anxiety provocation increasing the sense of self-efficacy, behaviorally or cognitively, in the patient's ability to deal with the anxiety-eliciting situation and the symptoms and the rehearsal and effecting of coping strategies. More specifically, hypnosis may be used to facilitate the use of dissociation, altered perceptions, cognitions and memories, the enhanced control over anxiety symptoms, cued self-control techniques and uncovering for psychodynamic psychotherapy.

Hyperventilation Syncope

Hyperventilation in any human induces various organic symptoms that may in certain individuals stimulate further hyperventilation and exacerbation of the original symptoms. A degree of panic may be so engendered. Asking the child to hyperventilate (whether by getting the child to repeatedly blow out a candle, blow soap bubbles, blow a tissue, or to directly hyperventilate) may induce symptoms similar to those of which the child complains. Continuation of hyperventilation once the directed hyperventilation has been stopped may be of additional diagnostic value. Spontaneous hyperventilation may lead to apparent absences without spike and wave (29), but it should be remembered that a possible difficult-to-diag-nose absence-like seizure may be of frontal lobe origin (30). Studies on hypocapnea and the cerebral circulation include those found in references 31 and 32.

Psychoanalytic Perspectives On Anxiety

Freud placed the experience of anxiety at the core of our psychic functioning - the defining psychic burden of a human being. Because of the existence of the life and death instincts and their unavoidable conflict, Freud emphasised the inevitability of anxiety. Freud put forward two theories of anxiety. In his first theory he understood anxiety as a reaction to the build up of instinctual tensions. Anxiety was not connected to specific ideas or thoughts that were felt to be dangerous, but was said to result from an accumulation of sexual energy as a consequence of sexual abstinence. This situation, in turn, was said to give rise to unpleasure. This view was consonant with the drive model (see Chapter 1) that hypothesised an inherent motivation towards the discharge of instinctual tensions. In 1926, Freud put forward his second theory of anxiety. Here he described anxiety acting as a danger signal to the ego, alerting it to the occurrence of a trauma or an otherwise danger situation...

Behavioral Disorders Anxiety Disorders

Anxiety is a feeling of fear, worry, uneasiness, or dread. It may be associated with physical problems or drugs and is often prompted by feelings of helplessness or loss of self-esteem. Generalized anxiety disorder (GAD) is characterized by chronic excessive and uncontrollable worry about various life circumstances, often with no basis. It may be accompanied by muscle tensing, restlessness, dyspnea, palpitations, insomnia, irritability, or fatigue. Panic disorder is a form of anxiety disorder marked by episodes of intense fear. A person with panic disorder may isolate himself or herself or avoid social situations for fear of having a panic attack or in response to attacks. A phobia is an extreme, persistent fear of a specific object or situation. It may center on social situations particular objects, such as animals or blood or activities, such as flying or driving through tunnels. Obsessive-compulsive disorder (OCD) is a condition marked by recurrent thoughts or images that are...


Anxiety is a vague uneasiness or apprehension that manifests itself in varying degrees from expressions of concern regarding drug regimen to total lack of compliance with the drug regimen. When anxiety is high, the ability to focus on details is reduced. If the patient or caregiver is given information concerning the medication regimen during a high anxiety state, the patient may not remember the information. This could lead to noncompliance. The anxiety experienced during drug administration depends on the severity of the illness, the occurrence of adverse reactions, and the knowledge level of the patient. Anxiety is decreased with understanding of the therapeutic regimen. To decrease anxiety before discussing the treatment regimen with the patient, the nurse takes time to talk with and actively listen to the patient. This helps to build a caring relationship and decrease patient anxiety. It is critical for the nurse to allow time for a thorough explanation and to answer all...

Anxiety Disorders

While anxiety is a normal emotion experienced at some time by virtually all humans, 'pathological' anxiety, excessive or inappropriate to the situation, may appear in the form of an anxiety disorder. The distinction between normal and 'pathological' anxiety needs to be established for each. Normal anxiety has a protective function in threatening situations and may enhance motivation to resolve the threat. On the other hand, pathological anxiety serves no useful purpose and is associated with an inability to function at a satisfactory level. It has been estimated that perhaps as many as 10 of the population may experience an anxiety disorder. HYPNOTIZABILITYAS AN INFLUENCE IN ANXIETY DISORDERS An association between hypnotic susceptibility and several anxiety disorders has been suggested. Frankel (1976) first presented evidence that phobic patients show greater hypnotic susceptibility than other patient groups and that a disproportionate number of his 24 phobic patients were in the...

Antianxiety Drugs

Antianxiety drugs anxiety anxiolytics benzodiazepine withdrawal Discuss the uses, general drug actions, general adverse reactions, contraindications, precautions, and interactions associated with the administration of the antianxiety drugs. Discuss important preadministration and ongoing assessment activities the nurse should perform on the patient taking antianxiety drugs. List some nursing diagnoses particular to a patient taking antianxiety drugs. Discuss ways to promote an optimal response to therapy, how to mange common adverse reactions, and important points to keep in mind when educating patients about the use of antianxiety drugs. Antianxiety drugs (tranquilizers) The antianxiety drugs are discussed in this chapter. Antidepressant drugs and antipsychotic drugs are discussed in Chapters 31 and 32, respectively. Anxiety is a feeling of apprehension, worry, or uneasiness that may or may not be based on reality. Anxiety may be seen in many types of situations, ranging from the...

Completing the historytaking

The opportunity to provide further information should be given to the patient. As the history is being taken, anxiety and embarrassment may diminish, and rapport and trust develop. This may enable the patient to divulge information to the doctor that the patient had not disclosed earlier. T his is not always relevant, but from the patient's perspective it

Prospects For Nanobore Lcms In Small Molecule Drug Development

Rourick and co-workers endeavored to test the feasibility of nanoscale LC-MS on metabolite analysis with an in vitro assay based on human liver microsomal incubation 100 . Buspirone, an anxiolytic drug with a well-characterized metabolic profile 101 , was chosen as a test compound. At an initial concentration of 4 M, buspirone was incubated with micro-somal protein (1 mg mL) and 4 mM NADPH in 50 mM sodium phosphate

Approaching Psychoanalysis In The Consulting Room

Teaching a structured and evidence-based therapy often guarantees a happy, and usually grateful, group of students. By the end of the teaching session, they feel they have ''something to take away'' that will help them when they face their patients the following day. Teaching psychoanalytic therapy is a more uncertain and risky enterprise. Students often feel overwhelmed by this therapeutic approach, which, unlike many others, has the potential to evoke such anxiety that it paralyses otherwise able practitioners. Faced with the lack of structure or agenda for a therapeutic session, they are unsure about what to say to the patient. The anxiety arises not only because the psychoanalytic approach does not have the reassuring structure found in CBT approaches, for example, but also because it is an approach that encourages therapists to address unconscious forces in their patients as well as in themselves - an undertaking that we all at best approach with a measure of dread. Theory does...

Interventions 141 Prevention

In 1996 Yung and McGorry defined the so-called schizophrenia prodrome, characterised by sleep disturbance, depressed mood, social withdrawal, suspiciousness, perplexity, change in sense of self or others, poor appetite, raising thoughts, impulsivity or disinhibition, memory problems, anxiety, anger, irritability, deterioration of functioning, poor concentration, loss of motivation, fatigue perceptual changes, somatic complaints, thought blocking, odd behaviour and elevated mood. Although this is a very unspe-cific list of symptoms, with some of these being quite common in adolescents in puberty, the American Psychiatric Association defined prodromal schizophrenia in DSM III, the diagnostic and statistical manual for the classification of psychiatric diseases in the United States. Here we find in the definition such unspecific behaviour as social isolation and withdrawal, impairment in role functioning, peculiar behaviour, impairment of personal hygiene, blunted or inappropriate...

Alternative Medications

It is important to remember that all biologically active agents carry a slight risk, and alternative medications have not been systematically studied or approved by the FDA. This does not mean that they are ineffective instead it means that we lack information to support or refute the validity of therapeutic claims. Indeed, many of the standard agents that have been subjected to the scientific method and determined to be effective had their basis in herbal remedies (e.g., morphine and aspirin). Kava is an alternative medication that is widely accepted as effective in the treatment of anxiety and may be useful in patients with anxiety-amplified pain. Other agents, such as soy and glucos-amine sulfate, are under investigation.

Types of patient education

Preoperative education prepares the patient for the experience of surgery and what can be expected, by teaching relaxation and other coping skills that can reduce patient anxiety, length of hospital stay, postsurgical complications, use of pain medications, and overall hospital costs.

Advanced Workshop Approved And Acceptable By Aschandsceh

Four months later, an advanced workshop in Clinical Methods in Hypnosis and Psychotherapy Integration and Applications is offered. The art of psychotherapy depends on the individual therapist as well as his or her individual patients. The advanced workshop as given is different from the workshops usually given in annual meetings of the National Constituent Societies of the International Society of Hypnosis. Usually an intermediate workshop is given to further one's experience with deepening techniques and using hypnosis in more complicated clinical cases, before advanced workshops in treating specific syndromes such as chronic pain, cancer, post-traumatic stress disorders, sexual problems, anxiety disorders, and dissociative identity disorders (formerly Multiple Personality Disorders) are presented. My own advanced workshop, presented here, shifts the emphasis from the problems of the patient client to the professional development of the therapist. Let us examine what an 'ideal'...

Nonnuisance Nonmaleficence

There are inherent problems associated with extrapolating interventional trial study results to the clinical setting. Study patients are usually a highly select population with lower co-morbidity and profiles of symptomatology that are easier to treat as compared to clinic patients. Co-morbidity and co-medication are much more frequent in real life situations than in trials. That leads to a general underestimation of risks due to the combination of different interventions. Research programmes are usually targeted at the detection of an effective intervention, while documenting possible risks at the same time. This has nothing to do with safety in clinic situations, where patients are treated for months or even years not only with one drug, but with combinations of drugs or different drugs in turn. These patients are not usually followed up. This lack of studies leads to ever more debates on the safety of stimulant treatments, often sponsored by lobby groups like the Scientologists who...

Access to Health Care

A number of reports suggest that access to medical care may be limited for patients with schizophrenia. Multiple factors could contribute to decreased access, including limitations in the communication of symptoms by patients, poor cooperation by psychotic patients, prejudice (based on fear, frustration, or anxiety) against schizophrenic patients, and insufficient attention to medical problems by mental health providers (Adler and Griffith 1991 Druss and Rosenheck 1997 Goldman 1999 Pary and Barton 1988). Dixon et al. (1999) found that less than 70 of the patients with medical problems were receiving treatment for their medical conditions in a survey interview study of 719 patients from the Patient Outcomes Research Team project. Masterson and O'Shea (1984) speculated that inadequate breast examinations and incomplete reporting of breast lumps could have contributed to the increased rate of death from breast cancer in their report. Herrman et al. (1983) suggest that bias against...

First Impressions Count

Once the patient walks into the office, the waiting room should establish immediate rapport and put the patient at ease. First impressions are very important. Out-of-date furniture, worn upholstery, and grimy spots on walls may give the patient a message that the doctor does not care about patient comfort, or that he or she is reluctant to replace things when they wear out. No doubt, it's more a matter of heavy workloads and the fact that physicians rarely walk through their own waiting rooms. But perception is reality. It may subliminally suggest that the doctor is outdated on medical matters as well, which can lead to a lack of confidence and breed anxiety in the patient. Many people visit a physician or dentist during their work day. Excessive waiting leads to anxiety and hostility, with worries about time away from the office and being late for meetings. An emergency at the hospital or the delivery of a baby are situations that people will forgive. They understand medical...

Object relationships through the Freudian lens

A close look at the shift in Freud's theory of anxiety, however, reveals his own recognition of the importance of object relationships. In Freud's topographical model, anxiety was understood as a triangulation of blocked libido (i.e. undischarged sexual feelings). Anxiety was itself regarded as a discharge phenomenon, which precluded the mental representation of deflected somatic sexual impulses. The id was then thought to be responsible for producing anxiety. Freud later understood this formulation to have been an error. In his second theory, anxiety resulted primarily from conflict between the various demands exerted upon the ego by the id and superego. This new conceptualisation of anxiety had important repercussions. It led Freud to shift from an energetic model to a meaning model, whereby childhood wishes were associated with childhood dangers related to loss (e.g. loss of an object, loss of the object's love, loss of or injury to the genital castration and fear of...

Beyond Freud Ego Psychology

Anna Freud (1965) was another important analyst who championed Freud's structural hypothesis. She highlighted that the primary function of the ego was to defend the self against anxiety arising from either powerful instinctual strivings, upsetting 'real experiences' or guilt feelings and associated fantasies. Anna Freud was one of the first analysts to adopt a coherent developmental perspective on psychopathology. She argued that psychological disorder could be studied most effectively in its developmental evolution. Her theory was based on the metaphor of developmental lines. Conflicts were understood to be not only intrapsychic but also developmental in nature and therefore transitory. The developmental conflicts were associated with libidinal phases but fixation and regression could occur along all developmental lines. For the ego psychologists, drives and their assumed location in the system unconscious remain the centre point of their theory and practice. Modern structural...

Case Study for Chapter

The Cushing response (described by famous neurosurgeon Harvey Cushing) consists of the development of hypertension, bradycardia, and apnea in patients with increased intracranial pressure most often a result of tumors or other lesions, such as hemorrhage, that compress the brain. The pressure is transmitted downward to the brainstem and distorts the medulla, where the centers for blood pressure, heart rate, and respiratory drive originate. Correct interpretation of these abnormalities in vital signs permits beginning treatments that reduce intracranial pressure. These include elevating the head of the bed, placing the patient on an artificial respirator, and then instituting hyperventilation to lower the blood PCo2 to produce cerebral vasoconstriction and giving mannitol to reduce the fluid content of the brain temporarily.

Theory in practice

Interpretations typically concern the patient's separation anxiety (e.g. as manifest in reaction to breaks in the therapy) and the defences against it, the projection of aggression and the resultant experience of being persecuted from without, depression and mourning and the patient's efforts at reparation. This emphasis contrasts, for example, with the content of interpretations influenced by an ego-psychological perspective where the focus would more often be on Oedipal triangulation, castration anxiety and the defences against it.

Educating the Patient and Family

Carefully planned patient and family education is important to foster compliance, relieve anxiety, and promote therapeutic effect. The nurse explains all adverse reactions associated with the specific prescribed antibiotic to the patient. The nurse advises the patient of the signs and symptoms of potentially serious adverse reactions, such as hypersensitivity reactions, moderate to severe diarrhea, sudden onset of chills and fever, sore throat, sores in the mouth, or extreme fatigue. The nurse should explain to the patient the necessity of contacting the primary health care provider immediately if such symptoms occur. The nurse cautions the patient against the use of alcoholic beverages during therapy unless approved by the primary health care provider. To reduce the incidence of noncompliance to the treatment regimen, a teaching plan is developed to include the following information

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While a researcher may be interested in the effects of maximum anxiety-producing stress on physical performance, knowing that such situations often occur in sport situations, it is unlikely that a review board would approve such a study in the laboratory. The potential for physical or mental harm would far outweigh the possible benefits of the results obtained. The researcher probably would have to be satisfied with studying naturally occurring instances of such behavior.

Neuropsychological Outcomes

Pre-existing neurological or psychiatric diseases 40 . These authors found that 28 of the ARDS survivors had a PTSS-10 score above the cut-off for PTSD, a significantly higher proportion than two control groups patients who had undergone maxillofacial surgery and German United Nations soldiers who had experienced prolonged service in Cambodia 40 . These authors showed that if patients reported memories of traumatic experiences during their ICU stay, including memories of respiratory distress, feelings of anxiety, pain, or nightmares, they were more likely to have symptoms of PTSD.

Psychic Trauma and the Impaired Recontextualization of Memory

When this man was three years old, he and his parents were residents of a central European country and, as Jews, were desperately attempting to escape from the Nazis. They did in fact manage to obtain an airline passage to freedom, but until that point, the outcome was very much in doubt. Although my patient did not recall his affective state at that time, his parents reported that he seemed cheerful and unaffected by their anxiety. In this example, his helpless inability to leave a foreign city, combined with the intransigence of the authorities, evoked a specific affect category that remained as a potential memory of an unassimilated past experience. In this example, an unconscious memory was

Mood [affective disorders F30F39

This block contains disorders in which the fundamental disturbance is a change in affect or mood to depression (with or without associated anxiety) or to elation. The mood change is usually accompanied by a change in the overall level of activity most of the other symptoms are either secondary to, or easily understood in the context of, the change in mood and activity. Most of these disorders tend to be recurrent and the onset of individual episodes can often be related to stressful events or situations.

Assess Whether Expected Patterns of Disease are Present

This strategy is illustrated in a recent study of the possible role of anxiety and depression in the etiology of spontaneous labor and delivery (Dayan et al., 2002), a topic for which results of previous studies have not led to firm conclusions. A cohort of 634 pregnancies was identified during 1997-1998 in France, and women were administered instruments to measure anxiety and depression as well as a range of other known and suspected risk factors for preterm birth. In addition to examining and presenting results for anxiety and depression, exposures of unknown etiologic significance, the authors presented results for a range of factors for which the associations are well established (Table 4.2). Despite the imprecision in this relatively small cohort, increased risk associated with heavy smoking, low prepregnancy body mass index, prior preterm delivery, and genitourinary tract infection was confirmed. This does not guarantee that the results found for anxiety and depression are...

Obsessivecompulsive disorder

The essential feature is recurrent obsessional thoughts or compulsive acts. Obsessional thoughts are ideas, images, or impulses that enter the patient's mind again and again in a stereotyped form. They are almost invariably distressing and the patient often tries, unsuccessfully, to resist them. They are, however, recognized as his or her own thoughts, even though they are involuntary and often repugnant. Compulsive acts or rituals are stereotyped behaviours that are repeated again and again. They are not inherently enjoyable, nor do they result in the completion of inherently useful tasks. Their function is to prevent some objectively unlikely event, often involving harm to or caused by the patient, which he or she fears might otherwise occur. Usually, this behaviour is recognized by the patient as pointless or ineffectual and repeated attempts are made to resist. Anxiety is almost invariably present. If compulsive acts are resisted the anxiety gets worse.

Promoting an Optimal Response to Therapy

Superficial and deep fungal infections respond slowly to antifungal therapy. Many patients experience anxiety and depression over the fact that therapy must continue for a prolonged time. Depending on the method of treatment, patients may be faced with many problems during therapy and therefore need time to talk about problems as they arise. Examples of problems are the cost of treatment, hospitalization (when required), the failure of treatment to adequately control the infection, and loss of income. The nurse must help the patient and the family to understand that therapy must be continued until the infection is under control. In some cases, therapy may take weeks or months. the nurse to develop a therapeutic nurse-patient relationship that conveys an attitude of caring and develops a sense of trust. The nurse listens to the patient's concerns and assists the patient in accepting the situation as temporary. The nurse encourages the patient to verbalize any feelings or anxiety about...

Beneficial And Adverse Effects Of Screening

Those who benefit most from participating in a screening programme are individuals in whom the serious consequences of the target disease have been prevented or postponed by the early treatment. This is also the reason why we do the screening in the first place. What about those screened to be at high risk, where serious consequences of the target disease do not develop, even if followed for a very long time. Psychologically, they may be in a lose situation. They have been alerted of a serious risk, without having cause to be alarmed, and may react with anxiety and depression. How much unjustified anxiety and depression is evoked in individuals participating in different screening programmes The question is impossible to answer in any precise manner and has not received much attention in the evaluation of screening programmes. A study examining potential adverse psychological effects of screening for cardiovascular risk factors showed that a minority (about 20 ) of those screened to...

F431 Posttraumatic stress disorder

Arises as a delayed or protracted response to a stressful event or situation (of either brief or long duration) of an exceptionally threatening or catastrophic nature, which is likely to cause pervasive distress in almost anyone. Predisposing factors, such as personality traits (e.g. compulsive, asthenic) or previous history of neurotic illness, may lower the threshold for the development of the syndrome or aggravate its course, but they are neither necessary nor sufficient to explain its occurrence. Typical features include episodes of repeated reliving of the trauma in intrusive memories (flashbacks), dreams or nightmares, occurring against the persisting background of a sense of numbness and emotional blunting, detachment from other people, unresponsiveness to surroundings, anhedonia, and avoidance of activities and situations reminiscent of the trauma. There is usually a state of autonomic hyperarousal with hypervigilance, an enhanced startle reaction, and insomnia. Anxiety and...

The Aims of Psychoanalytic Psychotherapy Different Perspectives

The aims of therapy reflect, at their core, the respective models of the mind espoused by the different schools of psychoanalysis. Thus the ego psychologists' aim is the alteration of psychic structure on the basis of conflict resolution, resulting in an increase in the autonomy of the ego that will tolerate conflicts, the pull of different emotions and the irrationality of the unconscious. The emphasis of the treatment is on troubled relationships between unconscious impulses and consciousness. Self psychologists aim to achieve greater coherence of the self. Object relationists focus on a modification of inner representations of significant others and more adaptive external relationships. Kleinians focus on a lessening of persecutory and depressive anxieties and on helping the patient to deal satisfactorily with mourning and integrating split-off aspects of the self. For Klein, the task of psychoanalysis was to facilitate the integration of the psyche through overcoming splits that...

F432 Adjustment disorders

States of subjective distress and emotional disturbance, usually interfering with social functioning and performance, arising in the period of adaptation to a significant life change or a stressful life event. The stressor may have affected the integrity of an individual's social network (bereavement, separation experiences) or the wider system of social supports and values (migration, refugee status), or represented a major developmental transition or crisis (going to school, becoming a parent, failure to attain a cherished personal goal, retirement). Individual predisposition or vulnerability plays an important role in the risk of occurrence and the shaping of the manifestations of adjustment disorders, but it is nevertheless assumed that the condition would not have arisen without the stressor. The manifestations vary and include depressed mood, anxiety or worry (or mixture of these), a feeling of inability to cope, plan ahead, or continue in the present situation, as well as some...

The Management Of Chronic Stress

The treatment of stress is divided into three phases (Stanley, Norman & Burrows, 1999). Firstly, the medical, psychiatric and psychological conditions that are the outcome of the stress experience are treated in their own right. Anxiety, depression or the effects of attempts to manage their psychological distress by alcohol or drug use require appropriate clinical management first. Secondly, the chronic hyperarousal is treated, and this 'arousal management' contributes to controlling the secondary psychological distresses. In the third phase, the patient is assisted with stress prevention by developing more effective strategies for dealing with life stressors as well as changing attitudes, habitual thought processes and learned behavioral patterns. Hypnosis as a therapeutic approach contributes to all three of these components of stress management. The part hypnosis may play in cognitive attitudinal change, arousal management and in the treatment of the psychological and physical...

Style and Technique in Psychotherapy

What psychoanalytic therapists do with their patients relies on the use of particular techniques, such as the interpretation of transference, and the personal manner in which these techniques are deployed. Therapists vary widely in their therapeutic styles ranging from being more aloof and silent to being more interactive and self-disclosing. Some use humour to engage the patient others view it as an enactment that should be understood and interpreted. Some are willing to answer personal questions others approach them as a manifestation of the patient's anxiety or as an enactment if the therapist chooses to answer. Some smile as they greet their patients others look sombre.

F481 Depersonalizationderealization syndrome

A rare disorder in which the patient complains spontaneously that his or her mental activity, body, and surroundings are changed in their quality, so as to be unreal, remote, or automatized. Among the varied phenomena of the syndrome, patients complain most frequently of loss of emotions and feelings of estrangement or detachment from their thinking, their body, or the real world. In spite of the dramatic nature of the experience, the patient is aware of the unreality of the change. The sensorium is normal and the capacity for emotional expression intact. Depersonalization-derealization symptoms may occur as part of a diagnosable schizophrenic, depressive, phobic, or obsessive-compulsive disorder. In such cases the diagnosis should be that of the main disorder.

Clinical features

Acidotic breathing - hyperventilation, deep breathing - may develop in severely ill patients who are shocked, hypoglycaemic, hyperparasitaemic or in renal failure. This is usually due to lactic acidosis, and lactic acid concentrations in both blood and CSF are raised. Perfusion is improved by correcting hypovolaemia.

Variability with Time in the Same Patient

Unless comatose, mechanically ventilated patients are subject to many influences that normally affect ventilatory demand. Examples include sleep wake transitions, motor activity, temperature changes, sedation, changes in pH, anxiety, etc. The extent to which these influence ventilatory demand over time in the typical ventilator dependent patient is unknown with conventional ventilation (VCV, PSV), changes in Vt demand, or in patient RR, do not necessarily result in corresponding changes in ventilator output 1 . With PAV, however, it is possible to assess the changes in ventilatory demand over time. Figure 3 illustrates two examples in patients monitored for about 2 hours on PAV. These examples represent the extremes of responses observed in a limited sample of patients (n 20), randomly selected (for the sake of this review) from patients studied on PAV, and is not a comprehensive display of this type of variability. In each case the data represent one minute moving averages of Ve (to...

Palpitations due to arrhythmias

Such palpitations are likely to be of sudden onset, to last for minutes or longer and to be unrelated to anxiety or stress. Specific triggers may be identified such as exercise, and manoeuvres may be found which terminate the arrhythmia. - are there any precipitating factors (e.g. exercise, anxiety or stress)

Cognitively Restructuring The Experience Of Depression

Alladin's (1994) Cognitive Dissociative Model utilizes the hypnotic process to facilitate cognitive restructuring. He describes a theoretical model linking hypnosis with depression and reports preliminary data finding no difference in outcome between this treatment methodology and Beck et al.'s (1979, 1985) cognitive therapy approach . However, subjects in the cognitive hypnotherapy group showed more rapid improvement, greater reduction in anxiety scores, and a significant increase in self-confidence.

Uncovering Age Regression Approaches Intrapsychic Conflicts

A significant amount of more recent case material also utilizes hypnotic techniques within a psychodynamic framework. Alden (1995) reports the case of a 35-year-old man with long-standing symptoms of anxiety, depression and multiple traumas, involving the use of hypnosis to provide a 'safe, relaxing framework for the client's therapy and regression to traumatic events'. Gravitz (1994) describes a treatment method illustrated by three cases involving the retrieval and restructuring of past memories of traumatic experiences using hypnotic regression and revivification. Leistikow (1990) details the case of a male patient undergoing hypnoanalysis for depression using techniques such as word association, dream suggestion and age regression in conjunction with hypnosis. Griggs (1989) also describes the process of medical hypnoanalysis, using hypnosis in conjunction with dream analysis and age regression. Mendelberg (1990) used an uncovering technique in

Herbal Alert Passion Flower

The term passion flower is used to denote many of the approximately 400 species of the herb. Passion flower has been used in medicine to treat pain, anxiety, and insomnia. Some herbalists use the herb to treat symptoms of parkinson-ism. Passion flower is often used in combination with other herbs, such a valerian, chamomile, and hops, for promoting relaxation, rest, and sleep. Although no adverse reactions have been reported, large doses may cause CNS depression. The use of passion flower is contraindicated in pregnancy and in patients taking the monoamine oxidase inhibitors (MAOIs). Passion flower contains coumarin, and the risk of bleeding may be increased when used in patients taking warfarin and passion flower.

Discontinuation of Mechanical Ventilation

Frequent clinical manifestations of decompensated cardiovascular disease during weaning are dyspnea, anxiety, tachypnea, tachycardia, wheezing, hypoxemia and hypercapnia. These are common in COPD patients as well. As these signs and symptoms are not specific, they are difficult to differentiate from respiratory pump failure alone. Proper differential diagnosis may require invasive tests.

Hypothalamus and Pituitary Gland

Posterior Hypothalamus Shivering

The hypothalamus is also where the body's thermostat is located. Experimental cooling of the preoptic-anterior hypothalamus causes shivering (a somatic motor response) and nonshiver-ing thermogenesis (a sympathetic motor response). Experimental heating of this hypothalamic area results in hyperventilation (stimulated by somatic motor nerves), vasodilation, salivation, and sweat-gland secretion (regulated by sympathetic nerves). These responses serve to correct the temperature deviations in a negative feedback fashion.

Clinical Aspects of Respiration

As noted above, changes in ventilation can affect the acidity and alkalinity of the blood. If too much carbon dioxide is exhaled by hyperventilation, the blood tends to become too alkaline, a condition termed al-kalosis. If too little carbon dioxide is exhaled as a result of hypoventilation, the blood tends to become too acidic, a condition termed acidosis.

Acute Stress Disorder

Acute Stress Disorder (ASD) as a new diagnosis in the DSM-IV (Spiegel & Cardena, 1991 Liebowitz, Barlow et al., 1994). It is diagnosed when high levels of dissociative, anxiety and other symptoms occur within one month of trauma, and persist for at least 2 days, causing distress and dysfunction. Such individuals must have experienced or witnessed physical trauma, and responded with intense fear, helplessness, or horror. This 'A' criterion of the DSM-IV requirements for ASD is identical to that of PTSD. The individual must have at least three of the following five dissociative symptoms depersonalization, derealization, amnesia, numbing, or stupor. In addition, the trauma victim must have one symptom from each of the three classic PTSD categories intrusion of traumatic memories, including nightmares and flashbacks avoidance and anxiety or hyperarousal. If the symptoms persist beyond a month, the person receives another diagnosis based on symptom patterns. Likely candidates are...

Preoperative Evaluation

The preoperative evaluation determines the type of anesthetic procedure to be used as well as the need for any drug for pain relief after the treatment. Simple procedures rarely require the use of adjunctive agents, except in very anxious patients. Be aware that a medical history must be taken and a physical examination performed prior to the use of any medication (Snow 1982). Preexisting medical conditions such as hypertension and heart diseases may influence the use of anesthetics in combination with epineph-rine. A history of alcohol consumption, use of sedatives, and problems with anesthetics dur-

Postoperative Rehabilitation Program

The requirements of the outpatient program are essentially the same as those for the preoperative phase. The support groups should include other post-LVRS patients, or at least other postsurgical patients. The ongoing support will be best (and anxiety least) if the patient reestablishes contact with the same program. The exercise program here can often be done on a 1-2 times wk basis, as the educational components have been covered, and supervised exercise is the main goal. By decreasing the intensity of the program somewhat, it may also allow the patient to have a somewhat longer duration of therapy, thereby allowing a better conditioning effect. Another goal of the postoperative program is to establish the patient in an independent and sustainable exercise program. The team needs to focus on the reassurance to the patient that gains will be realized through continued exercise and that failure to adhere to the exercise regimen will lead to a loss of function.

Gerontologic Alert

Although the use of barbiturates and miscellaneous sedatives and hypnotics for sedation has largely been replaced by the antianxiety drugs (see Chap. 30), they occasionally may be used to provide sedation before certain types of procedures, such as cardiac catheterization or the administration of a local or general anesthesia. Sedative doses, usually given during daytime hours, may be used to treat anxiety and apprehension. Patients with chronic disease may require sedation, not only to reduce anxiety, but also as an adjunct in the treatment of their disease.

Health Supplement Alert Melatonin

Valerian was originally used in Europe and was brought on the Mayflower to North America. The herb is widely used for its sedative effects in conditions of mild anxiety or restlessness. It is particularly useful in individuals with insomnia. Valerian improves overall sleep quality by shortening the length of time it takes to go to sleep and decreasing the number of nighttime awakenings. It does not cause the adverse reactions common with sedative drugs, such as addiction and drug hangovers the morning after taking the herb. Valerian is classified as generally recognized as safe (GRAS) for use in the United States. Valerian is used as a tea, tablet, capsule, or tincture. When valerian is used as an aid to sleep, the herb is taken approximately 1 hour before bedtime. The dose is less if used for anxiety, and the herb can be used in combination with other calming herbs, such as lemon balm or chamomile. It may take 2 to 4 weeks before the full therapeutic effect (ie, improvement of mood...

Significant Interactions Occur Among the Chemoresponses

The sequence of events in the response to hypoxia (e.g., ascent to high altitude) exemplifies interactions among chemoresponses. For example, if 100 oxygen is given to an individual newly arrived at high altitude, ventilation is quickly restored to its sea level value. During the next few days, ventilation in the absence of supplemental oxygen progressively rises further, but it is no longer restored to sea level value by breathing oxygen. Rising ventilation while acclimatizing to altitude could be explained by a reduction of blood and CSF bicarbonate concentrations. This would reduce the initial increase in pH created by the increased ventilation, and allow the hypoxic stimulation to be less strongly opposed. However, this mechanism is not the full explanation of altitude acclimatization. Cerebrospinal fluid pH is not fully restored to normal, and the increasing ventilation raises Pao2 while further lowering Paco2, changes that should inhibit the stimulus to breathe. In spite of much...

Infiltrative Anesthesia

Distention, and so the use of smaller volumes is advised to avoid this discomfort. The combination of freshly prepared solutions with epinephrine or bicarbonate can greatly reduce the pain during infiltration (McKay et al. 1987). For very anxious patients it may be useful to apply topical anesthetics before administering the infiltrative anesthesia.

The Response To High Altitude

How the body responds to high altitude has fascinated physiologists for centuries. The French physiologist Paul Bert first recognized that the harmful effects of high altitude are caused by low oxygen tension. Recall from Chapter 21 that the percentage of oxygen does not change at high altitude but the barometric pressure decreases (see Fig 21.1). So the hypoxic response at high altitude is caused by a decrease in inspired oxygen tension (PlO2). At high altitude, when the PlO2 decreases and oxygen supply in the body is threatened, several compensations are made in an effort to deliver normal amounts of oxygen to the tissues. Chief among these responses to altitude is hyperventilation. Figure 22.7 shows, that hypoxia-induced hyperventilation is not significantly increased until the alveolar Po2 decreases below 60 mm Hg. In a healthy adult, a drop in alveolar Po2 to 60 mm Hg occurs at an altitude of approximately 4,500 m (14,000 feet). Figure 22.10 shows how ventilation and alveolar...

The Integrative Period The Acceptance Of Hypnosis And The Integration Of Technique And Theory

In a second paper, Baker (1983b) examined various aspects of resistance that became manifest in hypnotherapy with borderline, narcissistic and psychotic patients and gave specific suggestions for the management of this resistance. A brief vignette of a schizophrenic patient was presented to illustrate resistance due to a need for distance and the therapist's utilization of boundaries and separation to reduce patient anxiety.

Pitfalls and Limitations

Pacemakers, aneurysm clips and orbit metal fragments are contraindications of MR examination. Patients with severe claustrophobia may require sedation (Valium 5-10 mg or Xanax 1-2 mg po to be taken 30 minutes prior to MRI). Ferromagnetic stents (eg. Palmaz stent) are impossible to be imaged because of the artifact they produce. However, non-magnetic stents made of nitinol or platinum may be imaged successfully although there is some radiofrequency shielding by the stent mesh, which acts like a Faraday Cage. This can be overcome by using more radiofrequency (RF) power, which is achieved by raising the flip angle of the RF pulse. A flip angle of 60-75 has worked for platinum-iridium, nitinol and tantalum stents. Respiratory motion blur obscures renal arterial detail so breath-holding is essential.

Adverse Reactions

Antianxiety drugs are used in the management of anxiety disorders and short-term treatment of the symptoms of anxiety. Long-term use of these drugs is usually not recommended because prolonged therapy can result in drug dependence and serious withdrawal symptoms. Some of these drugs may have additional uses as sedatives, muscle relaxants, anticonvulsants, and in the treatment of alcohol withdrawal. For example, clo-razepate (Tranxene) and diazepam (Valium) are used as anticonvulsants (see Chap. 28). Additional uses of the individual antianxiety drugs are given in the Summary Drug Table Antianxiety Drugs. Transient, mild drowsiness is commonly seen during the first few days of treatment with antianxiety drugs. Discontinuation of therapy because of the undesirable effects of the antianxiety agent is rare. Depending on the severity of anxiety or other circumstances, it may be desirable to allow some degree of sedation to occur during early therapy. Other adverse reactions include...

Preadministration Assessment

A patient receiving an antianxiety drug may be treated in the hospital or in an outpatient setting. Before starting therapy for the hospitalized patient, the nurse obtains a complete medical history, including mental status and anxiety level. In the case of mild anxiety, patients may (but sometimes may not) give a reliable history of their illness. When severe anxiety is present, it is important to obtain the history from a family member or friend. During the time the history is taken, the nurse observes the patient for behavioral symptoms indicating anxiety (eg, psychomotor agitation extreme restlessness , facial grimaces, tense posture). Physiologic manifestations of anxiety include increased blood In addition, if possible, the nurse obtains a history of any past drug or alcohol abuse. Individuals with a history of previous abuse are more likely to abuse other drugs, such as the antianxiety drugs. Some patients, such as those with mild anxiety or depression, do not necessarily...

Ongoing Assessment

An ongoing assessment is important for the patient taking an antianxiety drug. The nurse checks the patient's blood pressure before drug administration. If systolic pressure drops 20 mm Hg, the nurse withholds the drug and notifies the primary health care provider. The nurse periodically monitors the patient's mental status and anxiety level during therapy. The nurse assesses for improvement or worsening of behavioral and physical symptoms identified in the preadministra-tion assessment. The patient is monitored for adverse reactions. The sedation and drowsiness that sometimes occur with the use of an antianxiety drug may decrease as therapy continues. Prolonged therapy (> 3-4 months) may lead to dependence. Anxiety related to (individual manifestations)

Risk Reduction Interventions and Strategies for HIVHCV

HIV prevention programs that primarily dispense AIDS information have not been shown to influence risk behavior levels because, as evidence from studies demonstrates, knowledge by itself is necessary but not sufficient to produce behavioral changes. Intensive, small-group programs that simultaneously target knowledge, attitudes, motivations, and cognitive and behavioral skills have been tried and found to produce reductions in high-risk sexual behaviors, including some that are substance related, among people with serious mental illness. Effective elements from randomized outcome trials of these HIV risk-reduction interventions (Kelly 1997 Otto-Salaj et al. 2001) include 1) information and skills training in sexual assertiveness, negotiation, problem solving, use of condoms, and risk self-management 2) intensive sessions (6-15 hours to achieve reductions in high-risk behaviors) 3) training participants to become AIDS educators or advocates 4) booster or maintenance sessions, which...

Critical Thinking Exercises

Stovall, age 66 years, is hospitalized for congestive heart failure. She is improving, but has been complaining of feelings of anxiety Her respirations are 32 min, heart rate 88 bpm, and blood pressure 118 60 mm Hg. The primary health care provider prescribes alprazolam 0.25 mg PO TID. What precautions would the nurse expect to be taken because of Ms. Stovall's age Discuss what assessment findings would indicate increased anxiety. 2. The primary health care provider prescribes lorazepam for short-term management of anxiety What information would be included in a teaching plan for this patient 3. A patient is prescribed buspirone 5 mg PO TID to be taken on an outpatient basis. What assessments would be important for the nurse to make when the patient comes to the clinic for a visit

Accessing the Range of Hivhcvrelated Services That Psychiatric Patients Need

Set the anxiety level for the patient, and normalizing any patient discomfort can create a more relaxed tone. The initial diagnosis of HIV infection may occur when a patient first becomes infected, in advanced AIDS, or at any time in between. Shock and disbelief may be followed by depression, anxiety, and fear in adjusting to having contracted a serious and still potentially deadly illness. In many nonindustrialized countries AIDS remains a rapidly terminal condition. Untreated depression and hopelessness may be associated with continuing risk behavior, even suicidal ideation (Liberman et al. 1986). Like serious mental illness, HIV and AIDS can be highly stigmatizing, possibly resulting in rejection, abandonment, and further social isolation. If a worsening of psychiatric symptoms follows the initial HIV diagnosis, the most effective intervention is individual counseling and supportive therapy geared to both the current mental status of the patient and his or her knowledge and...

Miscellaneous Antidepressants

The effects of buspirone are decreased when the drug is administered with fluoxetine. Increased serum levels of buspirone occur if the drug is taken with erythromy-cin or itraconazole. Should any of these combinations be required, the dosage of buspirone is decreased to 2.5 mg BID, and the patient is monitored closely. Venlafaxine blood levels increase with a risk of toxicity when administered with MAOIs or cimetidine. There is an increased risk of toxicity when trazodone is administered with the phenothiazines and decreased effectiveness of tra-zodone when it is administered with carbamazepine. Increased serum digoxin levels have occurred when digoxin is administered with trazodone. There is a risk for increased phenytoin levels when phenytoin is administered with trazodone.

Therapeutic Intervention With Hypnosis

When evaluating a new patient, I listen to the patient's communication regarding dysphoric feelings of helplessness, anxiety, hopelessness, inner tension, insomnia, fear, restlessness, and so on. I introduce the idea of using hypnosis by making it relevant to the patient's presenting symptoms, saying to the patient something like this, 'Would you like to learn an exercise of how to reduce your anxiety and promote a sense of calmness and relaxation ' Patients generally respond affirmatively. I then proceed by teaching the patient a self-hypnosis exercise loaded with suggestions and images of calmness and comfort, asking the patient to select a place associated in their mind with such feelings. Some patients select a mountain trail, an inland lake or a state park, many select an ocean beach. Most patients respond positively to this exercise which, as mentioned before, can be tailored to the patient's choice of place. At its completion, the patients have an experience of success in...

Assessment Of Effectiveness

Symptom relief Patients who come for treatment suffer from a variety of symptoms that can be measured and recorded with the psychiatric interview, the Mental Status Examination, and a variety of scales such as the Eating Disorders Inventory (EDI) (Garner, Olmsted & Polivy, 1983), the Zung Scale for rating Anxiety (Zung, 1971), and the Zung Scale for rating Depression (Zung, 1965). There should be an easing of these symptoms in terms of intensity, frequency, and effect on the patient's ability to function adaptively with the activities of daily living.

Abnormal findings

Generalised resistance is commonly due to anxiety in a patient unable to relax. The associated increase in muscle tone can be confirmed by the finding of a reduction in resistance to palpation during the early phase of expiration. Resistance also accompanies intra-abdominal disease, particularly when pain is present. It may be restricted to one site according to the organ affected and the extent of the peritoneal involvement, e.g. McBurney's point in appendicitis. Deep-seated inflammation not causing localised guarding may be revealed by rebound tenderness. Although the initial pressure of palpation may fail to elicit a painful response, the abrupt withdrawal may cause the sudden movement of a deeply placed, inflamed organ, resulting in pain. Generalised board-like' rigidity implies peritonitis the abdomen docs not move on respiration and bowel sounds are absent. Attempts to elicit olher signs such as rebound tenderness are inappropriate. It should, however, be remembered that pelvic...

Preparing the Patient for Local Anesthesia

Depending on the procedure performed, preparing the patient for local anesthesia may or may not be similar to preparing the patient for general anesthesia. For example, administering a local anesthetic for dental surgery or for suturing a small wound may require that the nurse explain to the patient how the anesthetic will be administered, take a patient's allergy history, and when applicable, prepare the area to be anesthetized, which may involve cleaning the area with an antiseptic or shaving the area. Other local anesthetic procedures may require the patient to be in a fasting state because a sedative may also be administered. The nurse may administer an intravenous sedative such as the antianxiety drug diazepam (Valium) (see Chap. 30) during some local anesthetic procedures, such as cataract surgery or surgery performed under spinal anesthesia.

Selection of Preanesthetic Drugs

The preanesthetic drug is usually selected by the anesthesiologist and may consist of one or more drugs (Table 35-2). A narcotic (see Chap. 19), antianxiety drug (see Chap. 30), or barbiturate (see Chap. 26) may be given to Antianxiety Drugs With Antiemetic Properties Antianxiety Drugs relax or sedate the patient. Barbiturates are used only occasionally narcotics are usually preferred for sedation. A cholinergic blocking drug (see Chap. 25) is given to dry secretions in the upper respiratory tract. Scopolamine and glycopyrrolate also have mild sedative properties, and atropine may or may not produce some sedation. Antianxiety drugs have sedative action when combined with a narcotic, they allow for a lowering of the narcotic dosage because they also have the ability to potentiate the sedative action of the narcotic. Diazepam (Valium), an antianxiety drug, is one of the more commonly used drugs for preoperative sedation.

Concluding Assessments

It is not unreasonable for patients at the end of an assessment to want to find out what we think. They may be preoccupied with whether they are ''mad'' or ''bad'', or whether we think they will get better or not. It is important to avoid colluding with the patient's wish for a definitive answer to his problem by offering a formulation based on insufficient evidence. Nevertheless, it is part of the responsibility of an assessment to convey to the patient our understanding of his predicament. Merely interpreting his questions about what we think as reflecting anxiety about the process or his fear that he might be going mad or is ''bad'' is unhelpful, though such speculations will be true for some patients. In our response, we can offer some opinion about what kind of help he needs as well as attend to the anxiety that may lurk behind the question. At the end of an assessment, assuming we have agreed to offer therapy, some patients will ask about our training and qualifications or about...

Treatment Of Sexual Dysfunctionan Integrated Approach

Masters & Johnson (1966, 1970) proposed an approach to the treatment of sexual difficulties that took these problems out of the realm of long-term psychotherapy. Their investigation of sexual functioning, and focused therapy for sexual difficulties, was an important shift in treatment which created the specialty of 'sex therapy'. Their approach was essentially behavioral in its focus and based around the in vivo desensitization, anxiety control and positive rehearsal of appropriate intimacy skills, all incorporated into the 'sensate focus' technique.

Saturation Assays for mGAT1 73211 GABA Transporters

Transmission was linked, directly or indirectly, to a variety of neuro-pathological and psychiatric medical conditions, e.g. epilepsy, Huntington's chorea, Parkinson, Tardive dyskinesia, schizophrenia, anxiety, depression and other behavioral disorders. The GABA transporters (GATs) that remove the neurotransmitter from the synaptic cleft after its release are very interesting targets for the development of new agents for the indications listed above 81 . Inhibitors of these transporters can extend the presence of GABA in the synaptic cleft and therefore increase the inhibitory effect of the neurotransmitter. For the GABA transporters that are a part of the superfamily of Na+ Cl -dependent transporters four subtypes are known. Among them the transporter subtype most frequently found in the brain is GAT1, an already validated target in the search for anticonvulsants 82-85 . A successful example is the agent tiagabine, an effective and selective inhibitor of GAT1 which has already been...

Metaphorical Therapies

Other metaphors including warmth, sweating, and so on, may also be used to enhance the sexual response. Cartoon or dramatic representations of the most erotic involvement have also been used (Araoz, 1982) to rehearse, give permission for and enhance involvement in sexual activity. Symbolic transformation of the parts of the anatomy which may be perceived negatively has also been used to remove anxiety-based inhibitory responses (Araoz, 1982) (e.g. the labia are perceived as the petals of a lovely flower or the penis may be represented as a beautiful ivory or marble column, and so on).

Why Do Some People Cope Better Than Others

But if you think that a person who strolls around, seemingly without a care in the world, is free of stress, anxiety, and pressures, you are wrong It's just that you don't know the person well enough to know what they feel inside. Their stress may be mild and manageable, but there must be something on their mind or something in their life that they would want to change.

Treatment Of Disorders Of Sexual Interest Or Desire

Disorders of sexual interest have become one of the more commonly presenting disorders and their treatment is by no means straightforward. Schover & LoPiccolo (1982) found that up to 50 of patients presenting in the 'sex therapy clinic' complained of 'inhibited sexual desire' and yet, as Hammond (1990) notes, this is one of the most complex and least successfully treated of the sexual disorders. Careful evaluation is required to exclude medical and psychiatric causes. If of a psychological aetiology, such disorders may arise from inadequacies in sexual stimulation an inability to become absorbed in sexual intimacy distracting negative self talk, thoughts or images anxiety, guilt, or anger or a lack of sexual pleasure resulting in little interest due to there being insufficient pay-off for sexual activity. Traumatic sexual experiences and inadequate parental models are also frequently implicated in the aetiology of disorders of sexual desire (Hammond, 1990). The nature of the...

Table 151 Characteristics of different pain types

Assessing the pain type and characteristics requires an adequate history and physical examination. In addition, any medical risk factors should be well understood. Table 15.2 gives general inclusion and exclusion criteria for intraspinal opioid therapy. The patient should have progressed to level 3 of the World Health Organization (WHO) pain ladder (Table 15.3) and should have demonstrated opiate responsivity.19 Psychological assessment has become an important part of ongoing management for chronic pain patients as well as an integral part of selection for implantable therapies. The question asked of the neuropsy-chologist or psychiatrist is whether any untreated psychosocial problems exist that might lead to a bad outcome from the therapy. The question of whether a patient is a candidate for implantable therapy is answered by the implanter, generally not by the psychologist. However, certain psychiatric diagnoses such as psychosis or conflicting motives and expectations may lead to...

Treatment Of Premature Ejaculation

Premature ejaculation is one of the most treatable of male sexual dysfunctions a variety of direct and indirect suggestions have been used in its treatment. Many approaches have focused on anxiety reduction as the primary goal, as performance anxiety is the most common cause of a rapid ejaculatory response. Hypnotically assisted desensitization and rehearsal of appropriate sexual responding are applicable to this anxiety-driven disorder. Creative uses of healthy dissociation and distraction can also assist the male in being able to psychologically distance themselves from overarousal. Acquired oversensitivity to sexual stimulation has been implicated in those who observe their sexual responsiveness too closely. On that basis, partial genital anaesthesia to reduce erotic stimulation has been used (Doane, 1971) with a later return of sensation during intercourse. Time distortion techniques have been applied to extend the perceived length of time of sexual activity, reducing anxiety and...

Clinical Course of Rabies

The disease goes through three stages. The initial, or prodromal, stage involves itching and burning at the portal of entry (bite wound), nausea, vomiting, and possibly a melancholy mood. In the second or excitative stage, cramps and spasms of the pharynx and larynx are the main symptoms, rendering swallowing very painful. The spasms can be induced by the mere sight of water (hydrophobia). Other mild acoustic and visual stimuli may elicit exaggerated reactions including attacks of cramps and violent anger, hitting, biting, and screaming. Death occurs within three to four days at the earliest. The third, paralytic, stage may develop instead of early death, with ascending paralysis and asphyxia, leading to exitus. Therapy is exclusively symptomatic. Since the patient experiences the disease in a fully conscious state, most of the medication serves to alleviate the pain and anxiety states. The disease runs essentially the same course in humans and animals, whereby the behavior of animals...

Dissociative And Placebo Components Of Hypnotic Pain Management

The noxious stimulation and the subjective experience of transient, acute pain, which also holds for the reduction of pain following hypnotic analgesia. Most experimental studies of acute pain and hypnotic analgesia have been conducted in situations where the significance of the stimulation is not psychologically meaningful beyond the transient noxious stimulation. Anxiety about the meaning of the painful stimulation is minimized or eliminated. Such studies are probably not helpful to the clinician confronted with patients in pain. Effects of hypnotic intervention on experimental pain have been documented only over the last three decades. Most earlier studies (see reviews by Shor, 1962 Hilgard, 1977 Elton, Burrows & Stanley, 1980 Spanos, 1986 Holroyd, 1996) used transient painful stimulation such as electric shock and radiant heat procedures which share neither the enduring qualities of chronic pain, nor the debilitating anxiety of acute pain. Indeed, early studies deliberately...

The Origins Of Defences

Anxiety is an inevitable part of life but too much anxiety is disabling. One of the most crucial capacities that we need to acquire early on is how to manage anxiety and other strong affects. Our early experiences with caregivers are crucial to the development of a capacity to regulate our affective experiences. Nowadays the regulation of affects is understood to be first mediated by the parental figures the child interacts with in 2This anxiety was vividly captured by Bion's notion of ''nameless dread''. early life (Fonagy et al., 2002). Anxiety, we could thus say, is managed, to begin with, through the earliest relationships with significant others. The presence of an emotionally responsive figure who can process or digest the baby's most primitive anxieties provides the building blocks for a functioning affective regulatory system. The absence of such a figure contributes to the development of potentially enduring systems of defence set up to manage intolerable affective states.

Environmental Factors Influencing The Hpa Axis

As the homeostasis is constantly threatened by internal or external adverse factors, stressors, stress is usually defined as a state of threatened homeo-stasis (17). There are physical stressors such as cold, trauma, fever and infection psychological stressors such as social subordination, anxiety and depression (94). Traits of anxiety and depression have a predictive association with visceral obesity in both men and women (55,56). Furthermore, alcohol consumption and smoking are common among subjects with elevated WHR (51,52). In addition, we have recently identified a number of psychosocial and socioeconomic handicaps in this condition (51,52). The most prominent factors are divorce, solitude, poor economy and low education, unemployment, and problems at work when employed. Interestingly, socioeconomic inequality and low educational have recently been shown to be associated with elevated stress-related cortisol secretion as well as visceral obesity (95). Moreover, we have identified...

The Functions Of Defence

Whether we approach defences as attempts to manage intrapsychic or interpersonal conflicts, they always exist to protect us from perceived danger and the ensuing psychic pain. Defences are mobilised against forbidden impulses and painful affective states - not just anxiety, even though this is often the underlying subjective experience. Defences falsify, negate or distort reality in order to avoid situations experienced as dangerous. They act primarily to obliterate awareness to ensure that anxiety does not break through into consciousness.

The Therapeutic Alliance

A common defense mechanism against uncertainty is for a patient to endow his or her doctor with omniscience in the science of medicine, an aura of omnipotence. By weighing how you say something as heavily as what you say, you can turn an anxiety-ridden ritual into an effective therapeutic alliance. Psychiatric literature refers to this as the sharing of uncertainty. Rather than shattering a patient's inherent trust in you by presenting an insensitive approach, your dialogue should be sympathetic to the patient's particular concerns or tensions and should project believable reactions to an anxious and difficult situation. To allay anxiety, you may seek to reassure your patients. However, in so doing, be wary of creating unwarranted expectations or implying a guarantee. The therapeutic objective of informed consent should be to replace some of the patient's anxiety with a sense of his or her participation with you in the procedure. Such a sense of participation strengthens the...

The Enigma of Sublimation

In a broader context, sublimation can be seen as an aspect of the corporeal imagination. As described earlier, feelings, by means of metaphor, can be displaced, conflated, and transformed. I find sublimation to be an obscure and somewhat muddled concept that encompasses two different ideas. Our direct response to works of art, which may consist of joy, anxiety, sadness, disgust, anger, and so forth, can be thought of as a form of sublimation The term sublimation refers not only to the awakening of these aesthetic feelings but also to the process that transforms these feelings into something that is deemed to be higher, to say, culturally valuable. Understanding the details of this process remains a challenging problem. Freud's best known illustration of sublimation can be found in his essay on Leonardo de Vinci, where Freud described how Leonardo's voyeuristic, childish sexual curiosity was transformed into scientific curiosity. Freud wrote, The child's sexual impulses are powerful...

Stage 1 Identifying the Hidden Feeling Impulse

Anxiety emerges in response to a feeling or impulse that gives rise to conflict. The patient's ability to tolerate consciously the existence of particular feelings within himself will determine whether the emergence of the feeling will give rise to anxiety that is so intolerable that defences need to be instituted or whether this can be named and addressed. In thinking about anxiety, therefore, we need to first consider the patient's capacity to freely access their affective experience and any limitations in this respect.

Pain Stress And The Immune System

Most data describe the physiological effects of acute pain. We know much less about the physiological effects of chronic pain. On the other hand, the effects of chronic pain on psychological health are well known. Chronic pain produces depression, anxiety and fear. These adverse psychological consequences affect the person, the family, and, because of the great costs of medical and social care, all of society.

The Interpretation of Sensations

Metaphor, in addition to the cognitive function of interpreting sensations, may contribute to a simple displacement of feeling. Metaphor transfers meaning between dissimilar domains, which allows for the play of similarity and difference. Anxiety and sexual arousal are experienced as similar and dissimilar forms of excitement, so by means of metaphor someone can experience the eroticization of anxiety. It may be arbitrary whether one describes this as a sublimation. Whether one recognizes a feeling as sublimated may depend on whether feelings are merely conflated or actually transformed. Perhaps the transformation of feeling reflects a more complex interpretation of sensation. In any case, sublimation can be better understood as a complex interpretation of feeling, rather than as a desexualization of instinct, as Freud believed.

Flexibility In The Hypnotic Management Of Pain

Hypnosis frequently contributes to anxiety reduction but this effect can be distinguished from pain reduction. Anxiety is strongly associated with pain but separate from it a person in acute pain will often be anxious whereas chronic pain is usually associated with depression. Benzodiazepine drugs have been shown to reduce pain by relieving anxiety but they do not affect the pain threshold or the physical sensation of pain. Pain tolerance is something beyond sensory pain and suffering so that, in some cases, hypnosis substitutes for a tranquillizer rather than acting as an analgesic.

Stage 4 Taking up Defences in the Transference

Our formulation of the triangle of conflict would be incomplete without attention to the way in which our patients use us in order to avoid anxiety. The use of primitive (i.e. in terms of ego development) defences makes itself known quite rapidly in the form of a strong countertransference. According to Joseph (1981), the more the patient relies on primitive

What Are Ways Of Coping With An Anxious Personality

People who are worriers and who are generally anxious about nearly everything in their lives, find many situations stressful. They may also have underlying depression or a true psychiatric illness. This maybe related to problems during childhood, which will also need to be dealt with. It is generally very difficult to change a person's personality, but their anxiety can often be managed simply and effectively without medication. Behavioral therapy and counseling may be effective.

Specific Pain Control Techniques

Suggestions of deep relaxation in themselves may reduce the anxiety that often accompanies pain. These suggestions can be enhanced by providing imagery under pleasant environmental conditions, with as much visual and sensory imagery as possible. For example, asking patients to imagine that they are in a mountain cabin in the snow can be therapeutic in itself or it can lead to the production of 'glove anaesthesia'. This may occur when patients are asked to imagine going for a walk in the snow, picking up a handful of snow, holding it to the pain area and then transferring the cold and numbness to replace the pain.

David A Gorelick and Stephen J Heishman

Better scientific understanding of cannabis effects and the development of treatments for cannabis dependence require clinical studies involving cannabis administration. Cannabis can be administered by smoking a plant-derived cigarette or by oral or intravenous administration of A9-tetrahydrocannabinol (THC), the primary psychoactive chemical in cannabis. The smoked route is most commonly used outside the laboratory, but is subject to wide variation in absorbed dose. Oral synthetic THC is a legally marketed medication (dronabinol), also subject to wide pharmacokinetic variation, but offering a greater safety margin because of slower onset of action and lower potency. Intravenous THC offers precise investigator control of dose and timing. Acute adverse effects of cannabis administration include tachycardia, orthostatic hypotension, pulmonary irritation (if smoked), motor incoordination, cognitive impairment, anxiety, paranoia, and psychosis. Screening of research subjects should...

Radiography and laboratory tests

Response to sympathetic blockade as a criterion for diagnosis. Although many earlier series made a response to diagnostic sympathetic blockade a sine qua non for the diagnosis of RSD, the role of this procedure has been reconceptualized. It is now employed to identify the contribution of sympathetically mediated pain in a given patient and to assess the utility of sympathetic blockade and related modalities for treatment. Thus, rather than being a diagnostic tool, sympathetic blocks are considered more of a therapeutic trial. As is the case for any test, misleading negative and positive results can occur. For example, failure to respond may result from the dominance of nonsympathetically mediated pain at the time the block was performed or the effect of high levels of circulating catecholamines (which may be increased in response to pain, depression, and anxiety). These will continue to induce sympathetically mediated pain even when local catecholamine release is blocked....

Anger A Root Cause of Malpractice Claims

Patients feel both anxious and bewildered when elective surgery does not go smoothly. The borderline between anxiety and anger is tenuous, and the conversion factor is uncertainty fear of the unknown. A patient frightened by a postoperative complication or uncertain about the future may surmise If it is the doctor's fault, then the responsibility for correction falls on the doctor. reaction can set in motion or prevent a chain reaction. The physician must put aside feelings of disappointment, anxiety, defensiveness, and hostility to understand that he or she is probably dealing with a frightened patient who is using anger to gain control.

Measurement of Cannabis Effects

The acute subjective effect most commonly reported by experienced cannabis users is the pleasant, euphoric state known as the drug high. The intensity of this and other subjective effects (e.g., sedation, hunger, anxiety, clarity of thinking) can be assessed by two different types of questions. Visual analog scales (VAS) require subjects to place a vertical mark along a 100-mm line anchored by not at all on the left and extremely on the right. Responses are measured in mm from 0 to 100. A Likert scale requires subjects to choose from among several categories of intensity, e.g., not at all, mild, moderate, and severe. Responses are scored as ascending integers starting with 0. The simplest scale is dichoto-mous, i.e., the effect is scored as either present (1) or absent (0). For both types of questions, the higher the score, the greater the intensity of the subjective effect. Cannabis-specific questions should be interspersed with nonspecific questions to minimize response bias (see...

Anxiety and Depression 101

Anxiety and Depression 101

Everything you ever wanted to know about. We have been discussing depression and anxiety and how different information that is out on the market only seems to target one particular cure for these two common conditions that seem to walk hand in hand.

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