Are you feeling the following?

Panic Attacks

Panic attacks are the sudden onset of intense anxiety with heart-palpitations, chest-pain, and the fear of "going crazy" or loosing control.

Criteria for Panic Attacks:

  • Palpitations, pounding heart or accelerated heart rate
  • Sweating, trembling or shaking
  • Shortness of breath or hyperventilation
  • Choking sensations and chest pain
  • Nausea, abdominal distress
  • Feeling dizzy, light-headedness or fainting
  • De-realizations (feeling of unreality)
  • Depersonalization (feeling split or out-of-body experiences)
  • Fear of going crazy or loosing control
  • Fear of dying such as the fear of sudden death from a heart attack
  • Numbness and tingling sensations over mouth, fingers
  • Chills or hot-flashes

Agoraphobia: Agoraphobia is the fear of going to places such as the supermarket, driving on highways, avoiding bridges and the fear of leaving the house or driving in general. Transportation gets constricted and one might completely stop driving and looking for employment. Panic attacks may result in many emergency room visits with the fear of dying resulting in costly workups such as cardiology tests, endoscopic examinations for gastroenterology, neurological exams such as CT scans, EEG tests that yield negative results. Patients get frustrated when no causes have been found.

Causes: In fact, panic attack is a physical condition that we don't have a routine clinical test for. Panic attacks are due to an abnormal sympathetic nervous system with the sudden release of adrenaline due to malfunctions of part of the brain stem called locus cereuleus. Panic attacks can occur in sleep also. Experimental tests such as IV lactose infusion (similar to glucose) can induce panic attacks. Voluntary heavy breathing can increase dizziness and numbness. The opposite is also true; breathing slowly with relaxation can reduce tingling and dizziness.

Treatment: Panic attack is a physical condition that needs to be treated with SSRI medications such as Zoloft, Prozac, Paxil, Celexor, etc. Agoraphobia is a psychological condition which needs psychological treatment which may include:

  • Medications
  • Behavioral - relaxation, paper bags, etc.
  • Self-help groups, aims
  • Suggested reading
  • Associations

The following are sources for additional information on panic attacks:

Anxiety Disorders Association of America (ADAA)
6000 Executive Blvd., Suite 513
Rockville, MD 20652
Tel: (800) 737-3400 or (301) 231-9350

National Institute of Mental Health (NIMH)
NIMH Clinical Center, Bldg. 103N234
Bethesda, MD 20892
Tel: (800) 64-PANIC(647-2642)

Freedom from Fear
308 Seaview Avenue
Staten Island, NY 10305
Tel: (718) 351-1717

National Mental Health Association (NMHA)
1021 Prince St.
Alexandria, VA 22314-2971
Tel: (800) 969-NMHA (969-6642)

The National Alliance for the Mentally Ill (NAMI)
200 N. Glebe Rd., Suite 1015
Arlington, VA 22203-3754
Tel: (800) 950-NAMI (950-6264)

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Depression

Clinical Depression or Major Depressive Disorder is not simply having the "daily blues". The blues may pass without treatment, however clinical depression needs professional help.

CAN DEPRESSION OCCUR WITHOUT DEPRESSED MOOD?

Yes, depression can occur without depressed mood. Depression is a misleading name.

Depression can manifest without feeling sad with the following symptoms: loss of interest or motivation, poor memory, loss of concentration, loss of appetite, loss of sleep, etc.

In children and adolescents, depression can manifest itself by: irritable angry mood with behavioral problems is more common than depressed mood.

CRITERIA FOR DEPRESSION

  • Feeling of sadness or tearfulness
  • Loss of interest in hobbies and activities
  • Loss of appetite or nervous binging
  • Loss of sleep or excessive sleep with craving for sweets and chocolates
  • Low energy level, tiredness, lack of concentration
  • Guilt
  • Suicidal thinking

HOW DOES UNTREATED DEPRESSION EFFECT LIFE?

Difficulty in relationships in marriage, family, and work situations. Both individuals and employers and society as a whole encounter economic loss because depression is disabling temporarily or permanently.

CAUSES OF DEPRESSION

  • Genetic or heredity
  • Traumatic or disorganized childhood life
  • Current life situations: personal, family, or occupational stresses. Sudden loss of a loved one, loss of a relationship such as in divorce, children leaving for school, loss of job, loss of limbs or medical illness can precipitate depression for a person who is genetically or developmentally vulnerable.

TREATMENT

  • SSRI group of medications such as Prozac, Zoloft, Paxil, Celexa, etc
  • Counseling - individual, family, or group
  • Self-help groups
  • Suggested readings
  • Associations
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ADHD

ADHD comprises a pattern of symptoms that are maladaptive and inconsistent with the patient's developmental level and that persist for at least 6 months.

To be diagnosed with ADHD, the patient must have the following

  • Some symptoms of hyperactivity - impulsivity or inattention present before age 7.
  • Some impairment observed in at least 2 settings (e.g., school and home )
  • Clear evidence of interference with social, academic, or work function
  • No other mental disorders present (e.g., mood disorder, anxiety disorder, dissociative disorder, or personality disorder)
  • 6 or more symptoms of inattention AND / OR 6 or more symptoms of hyperactivity - impulsivity.

SYMPTOMS OF INATTENTION

  • Often fails to pay close attention to details or makes careless mistakes in schoolwork, work or other activities.
  • Often has difficulty maintaining focus on tasks or play activity.
  • Often does not seem to listen when spoken to directly.
  • Often does not follow through on instructions and fails to finish schoolwork, chores, or other responsibilities (not due to oppositional behavior or failure to understand instructions).
  • Often has difficulty organizing tasks and activities.
  • Often avoids, dislikes, or is reluctant to take part in activities that require continuous mental effort, such as homework or schoolwork.
  • Often loses things needed for tasks or activities, such as toys, assignments, books or tools.
  • Is often easily distracted by extraneous stimuli.
  • Is often forgetful in daily activities.

SYMPTOMS OF HYPERACTIVITY

  • Often fidgets with hands or feet or squirms in seat.
  • Often runs around or climbs excessively in situations which is not appropriate.
  • Often leaves seat in classroom or in other situations in which staying seated is expected.
  • Often has difficulty playing or engaging in leisure activities quietly.
  • Is often " on the go " or often acts as if "driven by a motor".
  • Often talks Excessively

SYMPTOMS OF IMPULSIVITY

  • Often blurts out answers before questions have been completed.
  • Often has difficulty waiting for turn.
  • Often interrupts or intrudes on others (e.g., butting into conversations or games)

* The above information is adapted from American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, IV Edition (DSM-IV™)

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Coping With Loss

We all deal with loss many times throughout the course of our lives. Usually Loss is associated with the death of loved ones, but it can take many other forms too. What may seem on the surface to be a minor or trivial change in our life can actually bring on the pain of grief due to loss. Though change may bring with it a sense of loss, there is also the promise of growth and gain as we work through our feelings.

Sometimes, the anguish of loss is so painful we just don't want to experience it. We deny the feelings we have and in doing this the grief process is interrupted. Because grieving is essential to coping with loss, not grieving can be very harmful to our emotional and physical well-being.

GRIEVING

One way to think of grief is to describe it as a reaction to any important loss. Parts of ourselves, in the form of energy, attention, and feelings, are invested in people and things that have value to us. When those things are gone, we also grieve over a lost part of ourselves. Acute grief is marked by symptoms of bodily distress, such as fatigue and loss of appetite, a preoccupation with the image of the lost loved one, guilt and anger reactions, and a loss of normal behavior patterns such as changes in daily routine and a loss of social skills. It is important to remember that grief is not a temporary state, but rather a process of healing.

There are four stages to the grief process:

  • numbness and shock
  • searching and pinning
  • depression
  • restructuring

These stages only provide us with a model of the process, since there is no right or wrong way to grieve. Each of us needs to find our own unique way of passing through the storm of grief to emerge as a stronger individual.

UNRESOLVED GRIEF

When grief can't follow its usual paths towards wholeness and healing, it can turn towards some dangerous avenues of expression. Unresolved grief can appear as illness, disease, and even death.

Blocked feelings, those that are not acknowledged and expressed, can have profound effects on the immune system. Research indicates that the immune system helps defend the body against cancer. It seems to be the way we deal with stress (such as that brought by loss) in addition to the stress itself, that disturbs the various systems in our bodies.

Depression is a normal part of grief. It allows us to experience feelings of anger and guilt slowly, in our own time. But when we bury those feelings, the depression lingers, the movement towards growth comes to a halt, and life becomes a chore.

Emotional breakdowns as well as self-destructive behaviors, including substance abuse, can affect our well-being. It becomes apparent that unresolved grief due to unblocked feelings can become life-threatening.

HELPING OTHERS

In many societies, it is important to maintain an image of strength and control. We learn how to hold back many of our feelings. Because of this it is often difficult to know what to say to someone or how to help them after they have suffered a loss.

It might help us to respond in a supportive way if we remember:

  • Grief is a process that leads to health and growth. There is no correct way to grieve, and people will find their own unique way to process grief.
  • A person experiencing grief must be allowed to express their feelings.
  • Be willing to listen. This will encourage sharing.
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Surviving Adolescence

"Those kids are driving me crazy!"

"You know teenagers. They're just impossible!"

"I just can't control them anymore."

Any parent of adolescents knows the frustration and concern that are part of raising teenagers today. Somehow we manage to get through these years, experiencing the joy of watching our children grow up, and learning to relate to them as adults. Contrary to what our teens sometimes think, we want them to be independent and happy. It seems that parents and kids really have the same goal. then why, at times is there so much anger and hurt ?

LETTING GO

To some extent the frustration and anger are normal parts of the parent/teenager relationship. During adolescence our children are engaged in the process of separation. That is, the process of learning how to be an individual, separate from their parents. They are developing a sense of themselves socially and emotionally. Also at this time their bodies go through many changes and young people struggle to understand their sexuality and the role it has in their life.

It is so important for them to try out this new sense of independence, yet in many ways they are still very dependent on their parents. This shifting back and forth between childhood and young adulthood at least partially accounts for the shifts in mood. One minute they're so exuberant, and the next they seem so alienated.

As teens become more independent, parents must learn to 'let go'. It's not easy to take a back seat in our children's lives after many years of guiding and protecting them. For many parents this transition makes their role as parents unclear. They tighten controls or give mixed messages to their teens.

"MORE IS BETTER' SYNDROME

Conflicts occur when a child's behavior is out of sync with the parents' expectations. Control issues between parents and teens become prominent. When controls are tightened, it is predictable that adolescents will dig their heels in, becoming more rebellious. This seems to spur parents on to set further restrictions. Each party feels they are reacting to the behavior of the other; each blames the other for starting the conflict. There's probably no way to determine who started what, and knowing that is not essential to finding a solution. Communication can be restored and mutual respect can be reestablished. Most parents and kids manage to get through these difficult times. they rely on friends, ministers, older family members and others to support and advise them. Even so, communications can further deteriorate and a resolution seems impossible.

WHERE DO WE START

The true test of our communication skills comes at home. One creative use of these skills is negotiation. We have all been taught that compromise is unselfish, even noble. However, compromise can leave us feeling that the solution was the other person's rather than our own. Negotiation, on the other hand, can be a more dynamic, creative process that produces a more fulfilling solution. It encourages a team approach to problem solving.

Negotiation sounds like a great idea, but you're probably thinking, "Where do we start?". Direction is available to you through professional help. A phone call will put you in touch with a therapist. It may be just the start you need to reduce conflict between you and your children.

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Obsessive Compulsive Disorder-OCD

Persons with OCD have obsessions or compulsions. Obsessions are disturbing thoughts that people have over and over again. This in turn leads people to perform certain actions over and over again which are called compulsions.

OCD is a chronic but treatable illness that can affect one's ability to function in normal way.

Examples of Obsessions include:

  • Fear of contamination by dirt, germs , etc,.
  • Fear of having a serious illness.
  • A need for symmetry, order or exactness.

Examples of Compulsions include:

  • Repeated actions such as Hand washing or cleaning
  • Checking and rechecking that something has been done ( E.g. locking the door )
  • Arranging objects over and over again.
  • Hoarding possessions.
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Post Traumatic Stress Disorder-PTSD

PTSD is a medical condition that can occur in some people after they experience, see, or learn about a terrible event - an extreme traumatic event- that causes them to experience feelings of intense fear, helplessness or horror.

Some examples of traumatic events that may lead to PTSD include:

  • Witness to a horrible accident which involve death or serious injuries.
  • Being raped or sexually assaulted
  • Being involved in a natural disaster.
  • news of the sudden and unexpected death of a loved one.

Persons suffering from PTSD have:

  • Difficulty falling or staying asleep.
  • Recurring nightmares of the traumatic event
  • Difficulty in concentrating
  • Irritability or outbursts of anger

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Winter Blues: Seasonal Affective Disorder (SAD)

Definition of SAD: Onset of depression in late fall and early winter, with complete remission in summer.
Results/Symptoms:

  • Excessive eating, weight gain, craving for chocolate and carbohydrates
  • Excessive sleep and difficulty in waking up early in the morning
  • Sensitivity to rejection (in relationships)
  • Heavy feeling in extremities (arms & legs)
  • Afternoon slump in energy (after lunch sleepiness)

How common is SAD?
4-9% of the population has SAD, and 20% has a minor form of SAD. SAD and SAD spectrum disorders show a pattern amongst family members. Genetic polymorphism for serotonin receptors is known to cause SAD.

What causes SAD?
There are 2 theories about the cause for SAD:

  • Increase in Melatonin level: The biological clock fails to reset as the daylight hours change, causing a disturbance in the sleep cycle. People then have difficulty getting up in the morning when it is still dark. Because it stays dark longer in the morning, people with SAD will continue to produce Melatonin (hormone needed to maintain sleep) until the wee hours of the day.
  • Decrease in other neurotransmitters: There is a decrease in Norepinephrine, Serotonin, and Dopamine.

Treatments

  • Light Therapy (see below)
  • Cognitive Behavior Therapy (phase therapy)
  • Medications (Wellbutrin, MAOI)

Light Therapy
People can experience light therapy by sitting under various forms of specialized lamps. Light therapy decreases Melatonin production and increases Norepinephrine, Serotonin, and Dopamine production, and it can treat SAD, PMS, Bulimia, Sleep Disorders, Shift Work Sleep Disorder, and Jet Lag. 

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Tips to prevent holiday stress and depression

When stress is at its peak, it's hard to stop and regroup. Try to prevent stress and depression in the first place, especially if the holidays have taken an emotional toll on you in the past.

  1. Acknowledge your feelings. If someone close to you has recently died or you can't be with loved ones, realize that it's normal to feel sadness and grief. It's OK to take time to cry or express your feelings. You can't force yourself to be happy just because it's the holiday season.

  2. Reach out. If you feel lonely or isolated, seek out community, religious or other social events. They can offer support and companionship. Volunteering your time to help others also is a good way to lift your spirits and broaden your friendships.

  3. Be realistic. The holidays don't have to be perfect or just like last year. As families change and grow, traditions and rituals often change as well. Choose a few to hold on to, and be open to creating new ones. For example, if your adult children can't come to your house, find new ways to celebrate together, such as sharing pictures, emails or videos.

  4. Set aside differences. Try to accept family members and friends as they are, even if they don't live up to all of your expectations. Set aside grievances until a more appropriate time for discussion. And be understanding if others get upset or distressed when something goes awry. Chances are they're feeling the effects of holiday stress and depression, too.

  5. Stick to a budget. Before you go gift and food shopping, decide how much money you can afford to spend. Then stick to your budget. Don't try to buy happiness with an avalanche of gifts. Try these alternatives: Donate to a charity in someone's name, give homemade gifts or start a family gift exchange.

  6. Plan ahead. Set aside specific days for shopping, baking, visiting friends and other activities. Plan your menus and then make your shopping list. That'll help prevent last-minute scrambling to buy forgotten ingredients. And make sure to line up help for party prep and cleanup.

  7. Learn to say no. Saying yes when you should say no can leave you feeling resentful and overwhelmed. Friends and colleagues will understand if you can't participate in every project or activity. If it's not possible to say no when your boss asks you to work overtime, try to remove something else from your agenda to make up for the lost time.

  8. Don't abandon healthy habits. Don't let the holidays become a free-for-all. Overindulgence only adds to your stress and guilt. Have a healthy snack before holiday parties so that you don't go overboard on sweets, cheese or drinks. Continue to get plenty of sleep and physical activity.

  9. Take a breather. Make some time for yourself. Spending just 15 minutes alone, without distractions, may refresh you enough to handle everything you need to do. Take a walk at night and stargaze. Listen to soothing music. Find something that reduces stress by clearing your mind, slowing your breathing and restoring inner calm.

  10. Seek professional help if you need it. Despite your best efforts, you may find yourself feeling persistently sad or anxious, plagued by physical complaints, unable to sleep, irritable and hopeless, and unable to face routine chores. If these feelings last for a while, talk to your doctor or a mental health professional.

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