New Curesfor Anxiety Attacks

The 60 Second Panic Solution

The 60 Second Panic Solution' is a program created by Anna Gibson Steel to help sufferers of panic attacks triggered by their daily activities address and overcome them. In this program lies a method that when followed, you will be able to subdue your panic and in just a minute, you will attain a balanced emotional level. This program has undergone the test of time and in every situation, it has come out successful. It has been tested by various people of different backgrounds and age brackets and has produced a positive result in each case. As mentioned, with this program, it will be like you are seeing the fire burning and you calmly walk to a tank of water, fill up a bucket and gently quench the fire. So, all that is required of you is to simply follow the steps involved in this program as proposed by Anna and look forward to experiencing the best results. Use these steps to manipulate your brain into returning to its normal state. This program is available for purchase on their website at and is available in PDF format, videos and audio, whichever suits you. It is an awesome program meant mainly for those who suffer from these panic attacks. Although, if you are close to someone who has these attacks you can use this program to help them work their way through these attacks or better still introducing them to it for a firsthand experience. And then you can also follow the program and be enlightened for future purposes. More here...

The 60 Second Panic Solution Summary


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My The 60 Second Panic Solution Review

Highly Recommended

Recently several visitors of blog have asked me about this manual, which is being advertised quite widely across the Internet. So I purchased a copy myself to find out what all the fuss was about.

All the modules inside this ebook are very detailed and explanatory, there is nothing as comprehensive as this guide.

Pharmacology Benzodiazepines

Benzodiazepines act within the central nervous system (CNS) at specific benzodiazepine receptor sites. Occupation of these receptors results in augmentation of y-aminobutyric acid, which is an inhibitory neurotransmitter resulting in depression of cortical function. Thus, benzodiazepines result in a dose dependent continuum of effect from mild sedation through drowsiness and sleep to deep sedation. They produce sedation, anxiolysis, and amnesia. Midazolam is the preferred benzodiazepine of choice for sedation because of its rapid onset of action (3 to 5 minutes), short half-life (1.8 to 6.4 hours), and better antegrade amnesia properties. Dosing based on an otherwise healthy patient is 0.03 mg kg as an initial dose over 2 minutes. Initial dosing should not exceed 2.5 mg for patients under 60 years of age, and 1.5 mg for patients over 60 years of age. Additional midazolam may be given in 0.25 to 1 mg to maintain the desired level of sedation. Subsequent doses should be separated by at...

Anxiety disorder 1 phobias

Anxiety and panic disorders were discussed in passing in Chapters 2 and 3 and stress will be considered in the next chapter. This leaves phobias and obsessive-compulsive disorders to mention here. Phobias are persistent irrational fears of something - it can be anything, an object, an event, a setting anything that upsets the individual. All that the word irrational means in this context is that the fear does not make sense to others who do not share it, and that there appears to be no clear basis for it.

Anxiety disorder 2 obsessivecompulsive disorders OCDs

These anxiety-driven disorders take the form of persistent (unwanted) thoughts or impulses to perform certain actions that cannot be resisted, usually in order to be rid of the thoughts. 'If I walk through this doorway 17 times, then I'll stop thinking over and over again that she doesn't love me.' The thoughts and actions involved in OCD are unwanted and not enjoyed at all. The person knows that the behaviour is foolish, nonsensical or pointless, but cannot desist from doing it. He or she might know that they have just checked every window latch in the house and know that they have turned off all electrical appliances, but they just have to go and check again, and again, and again . . . If you think of these types of anxiety disorder or panic attacks and think of those people you know (perhaps yourself) who have suffered from them, what makes them into a disorder We all become a bit obsessional at times, or a bit panicked or certainly a bit stressed. We all have specific fears, of...

Symptoms of Depression or Anxiety

Some individuals well past childhood have repeatedly sought help for their difficulties from psychologists, psychiatrists, or other mental health professionals who did not recognize their ADHD impairments. In years past, and even today, many professionals in these fields have received no adequate professional training to help them understand and recognize impairments of ADHD. They are, however, usually trained to recognize depression, anxiety, and personality disorders. Consequently, many doctors are quick to identify symptoms of these more familiar disorders in individuals seeking help. They may also assume that conventional psychotherapy or antidepressant medications will alleviate ADD impairments. Unfortunately, these misguided therapies have caused a large number of older adolescents and adults with ADHD to struggle unsuccessfully, and often for many years, to overcome their ADHD symptoms. In 1992 John Ratey and others published a study that described sixty patients with ADHD who...

Depression anxiety and confusion

A common misapprehension is to assume that depression and anxiety represent understandable reactions to incurable illness. When cure is not possible, the analytical approach we adopt to physical and psychological signs and symptoms is often forgotten. This error of approach and the lack of diagnostic importance given to major and minor symptoms of depression result in underdiagnosis and undertreatment of psychiatric disorder.

Cognitive Model Of Anxiety Disorders

Whereas the cognitive themes in depression are deprivation, defeat, and loss, the cognitive theme in anxiety disorders is danger. Following the continuity hypothesis, anxiety reactions are on a continuum with normal physiologic responses, but are exaggerated reactions to perceived threat. Cognitive therapy views anxiety from an evolutionary perspective, as originating in the flight, freeze, or fight responses apparent in animal behavior. These innate responses to physical danger became less adaptive in humans over the mil-lenia as danger became less physical and more psychosocial in nature. The cognitive model of anxiety emphasizes the roles of beliefs and interpretations of events in maintaining and escalating anxiety. Anxious cognitions reflect unrealistic perceptions of danger, catastrophic interpretations about loss of control, or perceived negative changes in a relationship. As in depression, there are underlying beliefs, such as, the world is a dangerous place,'' which make one...

Differentiating Depression and Anxiety from Physical Health Problems

On the other hand, many illnesses common to the elderly, as well as prescribed medications, may have concomitant symptoms of depression and anxiety. For example, elders are at increased risk for hypothyroid-ism, cardiovascular disease, and chronic obstructive pulmonary disorder, which may cause fatigue, sleep disturbances, and negative affect. Other disorders, such as myocardial infarctions, vitamin deficiencies, anemia, pneumonia, and hyper- and hypothyroidism, may present with symptoms of anxiety. Further, many medications commonly prescribed in the elderly, such as antihypertensives, may also create symptoms of depression. Thus, physical, mental, and social health are often tightly intertwined in the elderly, and multi-pronged assessment techniques may be necessary to adequately establish the etiology of symptoms of depression and anxiety in the elderly.

Sorting Out Signs of Anxiety and Depression

Figuring out how depression and anxiety affect you Finding your personal starting point Knowing when to get more help veryone feels sad or worried from time to time. Such emotions are both natural and unavoidable. People worry about their children, bills, aging parents, jobs, and health. And most people have shed a tear or two watching a sad movie or a news story about a poignant tragedy. That's normal. A little bit of anxiety and depression is part of everyday life. But when sadness fills most of your days or worries saturate your mind, that's not so normal. You may be experiencing a real problem with depression or anxiety. Anxiety and depression can affect how you think, behave, feel, and relate to others. The discussion and quizzes in this chapter help you figure out how depression and anxiety affect your life. When you understand what's going on, you can start doing something about it. Don't freak out if the quizzes in this chapter reveal that you have a few symptoms of anxiety...

Depression and anxiety

These are broad terms that cover a continuum of emotional states. It is not always possible on the basis of a single interview to distinguish self limiting distress, which forms a natural part of the adjustment process, from the psychiatric syndromes of depressive illness and anxiety state, which need specific treatment. Borderline cases are common, and both the somatic and psychological symptoms of depression and anxiety can make diagnosis difficult. Somatic symptoms Depression may manifest itself as intractable pain, while anxiety can manifest itself as nausea or dyspnoea. Such symptoms may seem disproportionate to the medical pathology and respond poorly to medical treatments.

What is anxiety

Anxiety is a universal and generally adaptive response to a threat, but in certain circumstances it can become maladaptive. Characteristics that distinguish abnormal from adaptive anxiety include Anxiety out of proportion to the level of threat Recurrent panic attacks Severe physical symptoms One way to judge whether anxiety is abnormal is to assess whether it is having a negative effect on the patient's functioning. Abnormal anxiety can present with various typical symptoms and signs, which include Classification of abnormal anxiety Abnormal anxiety can be classified according to its clinical features. In standardised diagnostic systems there are four main patterns of abnormal anxiety. Anxious adjustment disorder Anxiety is closely linked in time to the onset of a stressor. Generalised anxiety disorder Anxiety is more pervasive and persistent, occurring in many different settings. Panic disorder Anxiety comes in waves or attacks and is often associated with panicky thoughts...


Benzodiazepines are best limited to short term or intermittent use prolonged use may lead to a decline in anxiolytic effect and cumulative psychomotor impairment. Low dose neuroleptic drugs such as haloperidol 1.5-5 mg daily are an alternative. p blockers are useful for autonomic overactivity. Chronic anxiety is often better treated with a course of antidepressant drugs, especially if depression coexists. Acute severe anxiety can present as an emergency. It may mask a medical problem such as pain, pulmonary embolism, internal haemorrhage, or drug or alcohol withdrawal or it may have been provoked by psychological trauma such as seeing another patient die. Whether or not the underlying cause is amenable to specific treatment, sedation is usually required. Lorazepam, a short acting benzodiazepine, can be given as 1 mg or 2.5 mg tablets orally or sublingually. Alternatively, midazolam 5-10 mg can be given subcutaneously. An antipsychotic such as haloperidol 5-10 mg may be more...

Anxiety Disorders

Psychopharmacologic treatment of anxiety disorders began with the use of sedative-hypnotics (e.g., bromide salts, alcohol, chlorol hydrate) at the turn of the twentieth century. Barbiturates (e.g., phenobarbital, pentobarbital) were introduced early in the twentieth century but their adverse side effects, including addiction liability and toxic overdose, limited the use of these agents. The development of the benzodiazepines (e.g., chlordiazepoxide, diazepam) in the 1960s as general anxiolytics (separate from the muscle relaxant properties) was a major breakthrough because of the wide effective dose range and the limited adverse side effects. Subsequently, beta-adrenergic receptor antagonists (e.g., propranolol), antihistamines (e.g., hydroxyzine), and anticholinergic agents were used to treat specific cases of anxiety disorders (e.g., speech anxiety, posttraumatic stress disorder PTSD ). More recently, azapirones (e.g., buspirone) that act via serotonergic antagonism and some...


Anxiolytics are generally avoided in the management of nonulcer dyspepsia because of the potential for habituation and abuse. There are, however, two scenarios in which these agents appear helpful. The first is in the management of patients with anxiety or panic disorders who have prominent dyspeptic features (Henningsen et al, 2003). Anxiety and panic may be associated with both symptom generation and enhanced symptom perception and decreased symptom tolerance. Additionally, a subset of patients with panic disorders may present with digestive symptoms (most often nausea) in the absence of more classic anxiety symptoms. The SCL-90-R is useful in identifying these patients, as are two other instruments, the Beck Anxiety Index and Spielberger State-Trait Anxiety Index. The second group that may benefit from anxiolytics is made up of patients with persistent nausea and vomiting. Nausea is an easily conditioned behavior, as has been repeatedly seen in patients with chemotherapy-induced...

Preface To The First Edition

Emergencies in children generate a great deal of anxiety - in the child, the parents, and in the medical and nursing staff who have to deal with them.We hope that this book will shed some light on the subject of paediatric emergency care, and that it will raise the standard of paediatric life support. An understanding of the contents will allow doctors, nurses, and paramedics dealing with seriously ill and injured children to approach their care with confidence.

Clinical Diagnosis Of Movement Disorders

Investigators gathering historical information from a clinical evaluation of movement disorders should gather data pertaining to age of onset, symptom progression, type of involuntary movement, aggravating factors, and relieving factors (e.g., anxiety, stress, sleep, alcohol, food, and medications). Almost all involuntary movements, except for segmental myoclonus, tics, and hemifacial spasm, disappear during sleep. In addition past medical history, recent travel history, family history, toxins chemical exposure, and information regarding medications are important. Dopamine receptor-blocking drugs, such as traditional antipsychotic and antiemetic medications, are associated with Parkinsonism and tardive dyskinesia other agents such as cortico-steroids and medications for obstructive pulmonary disease are known to produce tremor.

Assessment of Mental Health in Older Adults

Discriminant Validity The degree to which an assessment discriminates between groups and or shows differential patterns of correlations with different outcomes, for example, the personality trait of hostility should predict anger and resentment better than anxiety or depression.

Assessing Alcohol and Substance Abuse in the Elderly

Tobacco, alcohol, and prescription drugs (usually anxiolytics) are the most abused drugs in the elderly. Indeed, alcohol consumption both reduces thiamine uptake and interacts with prescription drug use, a fact that is further complicated by the reduced capacity of elderly persons for clearing such drugs. Thus, use of both types of substances may carry a risk for health problems that increases with age. Moreover, the elderly may not recognize that their relatively nonprob-lematic levels of consumption at younger ages may cause problems in later life. Unfortunately, there is no good way of assessing the dependence on prescription tranquilizers (principally benzodiazepines) in the elderly unless withdrawal symptoms, such as extreme anxiety and irritability, occur since dependence is not typically associated with dose increase. Such dependence is more frequent among elderly women than men. Signs of toxicity from long-term use are easily mistaken for other disorders of the elderly, such...

What We Assume About

By the sheer fact that you've picked up this book, we assume, perhaps foolishly, that you want to do something about depression and or anxiety. We hope you already know a little about these topics, but if you want to know more, we suggest you read either or both of the companion books to this workbook Overcoming Anxiety For Dummies (Wiley) and Depression For Dummies (Wiley). Of course, we're slightly biased toward these books because we wrote them, but honestly, they'll broaden your understanding of working through emotional distress.

How This Book Is Organized

The Anxiety & Depression Workbook For Dummies is organized into seven parts, which we outline in the following sections. This part is all about helping you identify your problem and take the first small steps toward recovery. Chapter 1 helps you discover whether you have a problem with anxiety or depression. The quizzes in this chapter help you see where these problems show up in your world and what they do to your thoughts, behaviors, feelings, and relationships. In Chapter 2, you go on a journey to the origins of your problems with anxiety and depression because knowing where it all began helps you realize that you're not to blame. Because change sometimes feels overwhelming, Chapter 3 addresses self-sabotage and helps you keep moving forward. Chapter 4 provides you with ways for keeping track of your moods and becoming more aware of your thoughts. Addressing the physical side of distress is as important as addressing the mental or emotional side. Excessive stress associated with...

Auguste Ds case history

That all conversations of the people around her were about her. She had no language disturbances and no paralysis. Later she often had a fear of dying and nervous anxiety during which she started to tremble. She would ring all the bells of the neighbors and knock on their doors. She could not find certain objects that she had put away.

Clinical Features of Tourette Syndrome

Tourette syndrome (TS) is characterized by chronic waxing and waning motor and vocal tics and usually begins between the ages of twelve and fifteen years and affects boys more frequently than girls. About half of the patients start with simple motor tics such as frequent eye blinking, facial grimacing, head jerking, shoulder shrugging, or with simple vocal tics such as throat clearing, sniffing, grunting, snorting, hissing, barking, and other noises. Most patients then develop more complex tics and mannerisms such as squatting, hopping, skipping, hand shaking, compulsive touching of things, people, or self, and other stereotypical movements. The tics may change from one form to another. Although described as a lifelong condition, up to one third of patients eventually achieve spontaneous remission during adulthood. Coprolalia, echolalia, and echopraxia are the most dramatic symptoms of TS, but are present in a minority of patients. In addition to the motor and vocal tics described...

Where to Go from Here

The Anxiety & Depression Workbook For Dummies can help you deal with your depression and anxiety. It's pragmatic, concrete, and goes straight to the point. As such, this workbook doesn't devote a lot of text to lengthy explanations or embellishments of basic concepts, so you may wish to find out more about specific types of depression and anxiety, available medications, and alternative treatments. For that purpose, we strongly recommend that you consider reading one or both of the companion books, Depression For Dummies (Wiley) and Overcoming Anxiety For Dummies (Wiley). M Jlj e help you figure out how anxiety or depression affects your thinking, behaving, feeling, and bodily sensations. You discover how your problems began and work toward accepting that you're not to blame for having them. In case you feel stuck or unable to move forward, we give you strategies for overcoming obstacles. Finally, you see how to keep track of both your moods and the thoughts that accompany distressing...

Hemifacial Spasm

Speaking, or changes in head position. Typically, the first muscles involved are in the periorbital region, preceded by facial weakness, and within months spreading to ipsilateral facial muscles. These twitches continue in sleep. Blink reflexes are expressed normally. Hemifacial spasms occur when the facial nerve is compressed at the root entry zone, usually by the anterior or posterior inferior cerebellar or vertebral artery. Treatment of choice is botulinum toxin injections, but clonazepam is also prescribed (Sathornsumetee and Stacy in press). Video Segment 29

Walking in Quicksand Apprehensive and Blue Behavior

If you were to follow a depressed or anxious person around, you might see some behavioral signs of their emotional turmoil. That's because depression and anxiety on the inside affect what people do on the outside. For example, a depressed person may look tired, move slowly, or withdraw from friends and family an anxious person may avoid socializing or have a trembling voice. Take the quiz in Worksheet 1-2 to see if your behavior indicates a problem with anxiety and or depression. Check off each statement that applies to you.

Neuropeptide Receptor Modulation 51 Neurokinins

The potential for NK1 antagonists as antidepressants has been the subject of a tremendous amount of research effort over the last decade 35 . At least three compounds (aprepitant, L759274, and CP-122721) showed early evidence of anti-depressant effects in clinical studies. The failure of aprepitant to separate from placebo in Phase III studies was a great disappointment 6 . Nonetheless, NK1 antagonists continue to be of interest for depression therapy since they have been shown to potentiate the activity of SSRIs. The NK1 antagonist vestipitant is currently being evaluated in combination with paroxetine for anxiety and depression. Interestingly, both of these activities have been attained in a single compound, 18, which is both a potent SERT inhibitor (pIC50 8.0) and an NK1 antagonist (pIC50 8.5) 36 . This compound reportedly increased rat 5-HT levels up to 250 of baseline (measured by microdialysis), and was orally active in the isolation-induced guinea-pig pup vocalization test of...

Adaptation to Cancer

Surgery often requires a great amount of recuperation, sometimes causes new physical problems, and may cause substantial disfigurement. Radiation and chemotherapy often cause significant side effects, including hair loss, sterility, even nausea and vomiting, fatigue, and diarrhea. Anticipatory anxiety, classically conditioned by these treatments, may increase the severity of many of these symptoms. In the long term, cancer patients face problems with physical, psychological, and sexual functioning, as well as family and work difficulties. Many studies have demonstrated that cancer patients exhibit increased rates of depression, and some have demonstrated increased rates of anxiety. Behaviorists working in treatment settings have attempted to help individuals with cancer cope as well as possible with these difficulties. Women assigned to the support groups survived an average of 36.6 months, while those in the control group survived an average of only 18.9 months....

Corticotropinreleasing factor

Corticotropin-releasing factor (CRF) is a well-known regulator of the hypothalamic-pituitary-adrenal (HPA) axis, which is activated in response to stress. Hyperactivity of the HPA axis has been linked to depression in humans, and both the elevation of CRF concentrations in the cerebral spinal fluid (CSF) and an increase in the number of CRF-containing neurons in the paraventricular nucleus have been observed in depressed patients. In addition, some antidepressants (e.g., desipramine and fluoxe-tine) have been shown to decrease CRF levels in the CSF. Furthermore, a number of CRF1 antagonists exhibits anxiolytic and antidepressant activity in certain animal models 37,38 . For example, antalarmin (CP-154,526) produces antidepressant-like responses in the rat learned helplessness and mouse chronic mild stress models of depression. Several CRF1 antagonists have reached human clinical trials, but to date

Melanocortin MC4 antagonists

Melanocortins participate in the HPA axis response to stress, at least partly through the release of CRF. The MC4 receptor has been identified as the receptor of particular interest in relationship to stress-related disorders including anxiety and depression 45 . The non-peptide MC4 antagonist MCL0129, 24, (K 7.9 nM) demonstrated antidepressant effects in the forced swim and learned helplessness models, and also showed anxiolytic activity after oral administration 46 . Interestingly, the same series of compounds led to the serendipitous discovery of MCL0042 (25), a dual SSRI-MC4 antagonist (MC4 IC50 124nM SERT IC50 42) that was active in the olfactory bulbectomized rat model of depression 45 .

The principles of control of cancer pain

Twycross Total Pain

Our understanding of the basic mechanisms of pain has improved considerably over the past few years. This understanding has included a greater appreciation of the relationship between the physical injury, pain pathways, and our emotional processing of this information these factors are interlinked in the nervous system, rather than working in parallel. We now understand from basic science more of the mechanisms of total pain than ever before. It is clear that anxiety, fear, and sleeplessness feed into the limbic system and cortex. In turn, the brain talks back to the spinal cord modifying pain input at spinal levels. This then feeds back to the brain and a loop is established.

The Sad Stressed Sensations Quiz

Although physical sensations overlap in anxiety and depression, even-numbered items in the quiz above are most consistent with anxiety, and the odd-numbered items usually plague those with depression. There's no cutoff point for indicating a problem. The more statements you check off, though, the worse your problem.

Reflecting upon Relationships

When you're feeling down or distressed for any length of time, odds are that your relationships with those around you will take a hit. Although you may think that your depression or anxiety affects only you, it impacts your friends, family, lovers, co-workers, and acquaintances.

Testing Your Comprehension

Suppose a person with a severe anxiety attack hyperventilates and exhales CO2 faster than his body produces it. Consider the carbonic acid reaction on page 70 and explain what effect this hyperventilation will have on his blood pH. (Hint Remember the law of mass action.)

Plotting Your Personal Problems Profile

The Personal Problems Profile provides you with an overview of your problematic symptoms. (If you skipped the quizzes in the previous sections of this chapter, go back and take some time to complete them your answers to those quizzes come into play in this exercise.) The profile exercise in this section helps you identify the ways in which anxiety and depression affect you. One good thing about this profile is that you can track how these symptoms change as you progress through the rest of this book. Tyler, a middle-aged engineer, doesn't consider himself depressed or plagued with any emotional problems. But when he sees his primary care doctor, Tyler complains of fatigue, recent weight gain, and a noticeable loss in his sex drive. After ruling out physical causes, the doctor suggests that he may be depressed. Funny, Tyler says, my girlfriend just bought me the Anxiety & Depression Workbook For Dummies and said she thought I was depressed too. Maybe I'll take a look at it. When Tyler...

What about Psychiatric Labels

Labels that are instrumental (they point to effective interventions) are helpful. For example, the understanding of anxiety disorders has advanced requiring the differential diagnosis among different categories (simple phobia, generalized anxiety, panic attacks and agoraphobia). Failure to use labels that are indeed informative may prevent clients from receiving appropriate intervention. Labels can normalize client concerns. Parents who have been struggling to understand why their child is developmentally slow may view themselves as failures. Recognition that their child has a specific kind of developmental disability that accounts for this can be a relief.

Definition And Identification Of Key Neuropsychiatry Symptoms

Anxiety is characterized by excessive and unjustified apprehension, feelings of foreboding, and thoughts of impending doom. Patients are tense and irritable, and frequently exhibit autonomic disturbances including sweating, palpitations, gastrointestinal distress, and shortness of breath. Both low-grade, free-floating anxiety and acute and intense panic attacks may occur. Although less frequently reported, a number of other neuropsychiatric symptoms need to be mentioned. Agitation, such as aggression, restlessness, and shouting, can usually be observed, and thus the identification of these symptoms is less problematic. However, key symptoms of agitation are often secondary to other psychiatric syndromes. For example, anxiety may lead to restlessness, shouting, or trailing carers, or aggression may be secondary to delusional beliefs. Disinhibition is characterized by inappropriate social and interpersonal interactions. Elation euphoria refers to an elevated mood with excessive...

Classification of functional syndromes

Psychiatric syndromes (such as anxiety, depression, and somatoform disorders) highlight psychological processes and the number of somatic symptoms irrespective of the bodily system to which they refer. Depression and anxiety often present with somatic symptoms that may resolve with effective treatment of these disorders. In other cases the appropriate psychiatric diagnostic category is a somatoform disorder. The existence of parallel classificatory systems is confusing. Both have merits, and both are imperfect. For many functional symptoms, a simple description of the symptom qualified with the descriptors single or multiple and acute or chronic may suffice. When diagnosis of a functional syndrome seems appropriate a combination of medical and psychiatric descriptors conveys the most information, such as irritable bowel syndrome with anxiety disorder.

Questions and possibilities

What are the major differences that you can think of between everyday anxiety and anxiety that might be labelled as abnormal What signs would demonstrate to you that someone else was suffering from an anxiety disorder Have you ever experienced generalised anxiety, that is, anxiety that does not seem to be attached to any particular event or circumstance How do you think that such anxiety comes about

Postoperative Management

A successful parathyroidectomy results in normalization of the calcium level. This level usually reaches its nadir 36 to 48 hours after the operation. Postoperative hypocalcemia is common in patients with severe skeletal calcium depletion, commonly referred to as bone hunger. This can be predicted preoperatively as such patients have an elevated preoperative alkaline phosphatase level with otherwise normal liver function tests. Clinical manifestations of hypercalcemia are perioral numbness, tingling of the fingers, muscle cramps, anxiety, trembling of the masseter muscle, contraction with facial nerve stimulation anterior to the ear (Chvostek's sign), carpopedal spasm (Trousseau's sign), convulsions, and opistho-tonus. If mild symptoms appear, calcium supplementation should be given orally with calcium carbonate (500 to 1,000 mg three times daily). If symptoms are moderate, the calcium dose can be increased, and calcitriol (0.25 to 1.0 mg orally twice daily 1,25-dihydroxyvitamin D...

Facing Feelings Avoiding Avoidance

7his chapter is all about fear and anxiety. We know what you're thinking this book is supposed to be about both anxiety and depression so what does fear have to do with depression Well, quite a lot actually. Fear is connected to anxiety, and anxiety, especially chronic anxiety, frequently leads to depression. And if you're already depressed, anxiety is likely to deepen your depression. If you experience fear and anxiety, you probably avoid the things that make you feel uneasy. For example, if you're dreadfully afraid of snakes, you probably don't hang out in swamps. Or if crowds make you nervous really nervous, that is you likely avoid the shopping mall during the holidays. So what's wrong with that The problem is that avoidance increases or intensifies anxiety. When you make the decision to avoid something you fear, you instantly feel relief, and relief feels pretty good. In a sense, you've rewarded yourself for avoidance. People tend to do things more often when they're rewarded...

Budding the Body Connection

Feelings can have biological beginnings. Does your Uncle Paul seem down in the dumps Was Cousin Jack a neat freak Was your grandmother a recluse What was your great-grandmother like Why are these questions important Because depression and anxiety tend to run in families. And genes could be responsible for a good portion of your emotional distress. If you have access to family members, ask if they'd be willing to talk with you about your family's history. Ask them if any relatives, from either side of the family, suffered from any symptoms of anxiety or depression. You may want to review the symptoms covered in Chapter 1 first. There's no exact number of relatives required for determining if genetics are responsible for your symptoms. However, the more family members with similar problems, the more likely you've inherited a tendency for depression or anxiety. Fill in the blanks here with what you learn. Members of my family with anxiety or depression (brothers, sisters, cousins,...

Principles Of Sexual Dysfunction Therapy

After assessment of the exact nature of the dysfunction and possible etiological factors, two basic steps mark the early stages of therapy managing anxiety and education. Quite often, the partners find it difficult to discuss sexual problems with each other or with the therapist, and the underlying lack of sexual education may well contribute to this and to sexual anxiety. Simple reading materials often allow the therapist to discuss problems, offer solutions, and peg the treatment planning. This basic education is often crucial in sex therapy. Anxiety management is usually carried out in a number of ways from physical muscle relaxation to yoga training or using tai chi or the Alexander technique. A valuable part of this anxiety management is the process of despectatoring, which encourages individuals to get away from focusing on the sexual act and instead allowing relaxation in their physical and intimate contact. If the therapist discovers that there are underlying angry or...

Ten Quick Ways Out of Upset

The ideas in this chapter are designed to give you a lift when you're feeling a little down or uptight. Mind you, we're not talking about deep depression or intense anxiety that's what the rest of the book is about. But if you're feeling not quite yourself, you're likely to find these tips useful.

Psychological symptoms and syndromes

Depression, post-traumatic stress disorder, and phobic anxiety are common after frightening trauma and can be severe, whether or not there is evidence of previous psychological and social vulnerability. These psychological complications are not closely related to the severity of any physical injury. The general principles of assessment are those for similar psychological problems occurring in the absence of trauma. Phobic anxiety may be associated with post-traumatic stress disorder but can occur separately. A particularly common form

Detection and diagnosis

Almost any symptom can occur in the absence of disease, but some, such as fatigue and subjective bloating, are more likely to be functional than others. Surprisingly, the more somatic symptoms a person has, the less likely it is that these symptoms reflect the presence of disease and the more likely there is associated depression and anxiety.

Patients with Left Lesions

Damage to the left hemisphere is often accompanied by anxiety, undue cautiousness, oversen-sitivity to the impairment, and depression (Buck, 1968 Galin, 1974 Jones-Gotman & Milner, 1977 Lezak, 1995). Lezak notes Patients with left hemispheric lesions are more likely than those with right-sided brain damage to exhibit a catastrophic reaction (extreme and disruptive transient emotional disturbance). The catastrophic reaction may appear as acute often disorganizing anxiety, agitation, or tearfulness, disrupting the activity that provoked it. Typically, it occurs when patients are confronted with their limitations, as when taking a test (p. 66). Goldstein (1948) first used the term catastrophic reaction to describe the profound depression ac

Worksheet 16Tylers Reflections

I can see that I do have signs of depression. I didn't realize that before. And I see that depression particularly shows up in my body. It's affecting my energy, sex drive, and appetite. It's also making me withdraw from my girlfriend, which I can see from my loss of sex drive and lack of desire to be with her Apparently, I also have a few symptoms of anxiety, and I think I always have. It's time to do something about this. This is the Anxiety & Depression Workbook For Dummies. You can't feel better without doing a little work. It isn't that difficult. Of course, you can skip a few exercises, but the more you do, the sooner you'll start feeling better. Odd as it may seem, writing things down does a world of good. Writing helps you remember, clarifies your thinking, and increases focus and reflection. In addition, put an A by the symptoms that are most indicative of anxiety (even-numbered items in the preceding quizzes) and a D by symptoms that are most consistent with depression...

Putting Events Feelings and Sensations Together

Jasmine suffers from constant worry and anxiety. She thinks that her worries mainly center on her children, but at times she has no idea where her anxiety comes from. So, she fills out a Mood Diary. She pays special attention to her body's signals and writes them down whenever she feels something unpleasant. She then searches for a feeling word that captures her emotion. She rates the emotions and sensations on a scale of 1 (almost undetectable) to 100 (maximal). She then asks herself what was going on when she detected her distress. Worksheet 4-7 is a sample of Jasmine's Mood Diary specifically, it's a record of four days on which Jasmine noticed undesirable moods.

Development of Dissatisfaction

The BFST approach relies on an intergenerational theory that suggests that degrees of differentiation do not change much from generation to generation. This is based on two assumptions. The first is that parental differentiation affects how well children are able to separate emotionally from their parents. Adult children of undifferentiated parents will experience unresolved emotional attachment to parents that will prevent them from becoming differentiated themselves. Second, people pick marital partners who have similar levels of differentiation. When undifferentiated partners marry, they tend to be overly dependent on one another and are very vulnerable to the development of distress when anxiety is encountered. Differentiated adults, in contrast, tend to have a strong sense of self within their own marriages, and their functioning is less dependent on the behavior of their partner. They are able to tolerate the anxiety that is generated when inevitable differences appear.

Physical treatments supportive and distractive techniques

The presence of parents during an invasive procedure on their child is important. In one study almost all children between the ages of 9 and 12 reported that the thing that helped most'' was to have a parent present during a painful procedure. As well as being present, parents need some guidance on how to help their child during the procedure. Studies suggest that talking to and touching the child during the procedure is both soothing and anxiety-relieving. Other distractive strategies include

Anaesthetic problems

Physical dependence and withdrawal signs and symptoms. Symptoms include yawning, sweating, lacrimation, and rhinorrhoea. Signs include tachycardia, tremors, acute anxiety, sweating, piloerection, mydriasis, nausea, and vomiting.There is evidence to suggest that brain catecholamines play some part in the aetiology of this syndrome (McGoldrick 1980). Signs begin about 12 h after the last dose of opioid and peak at about 48 72 h.

Management options

There is no reason that these women should not be given appropriate regional analgesia or anaesthesia. There need be no anxiety about accidental dural puncture. Because of the relatively benign nature of the disease, general anaesthesia is not contraindicated, although peaks of raised intracranial pressure are to be avoided.

Browsing Helpful Web Sites

Anxiety Disorders Association of America ( Lists self-help groups across the United States. It also displays a variety of anxiety-screening tools for self-assessment as well as an online newsletter and a message board. Because anxiety sometimes accompanies depression, you may want to check this site out even if you think you're only dealing with depression.

Education Of The Patient

To obtain the full advantages of a fast track surgical program, it is essential to provide patients with information about their perioperative care in advance of the procedure. Such educational efforts often serve to reduce patients' level of anxiety and need for pain relief, thereby providing a rational basis for collaboration with health care personnel, a process that is crucial for enhancing postoperative rehabilitation.1-3 Patients can supplement the information they receive directly from health care providers by accessing reference sources such as public_info operation aboutbroch.html, a collection of electronic brochures on specific clinical procedures that is provided by the American College of Surgeons.

Informal Peer Interaction Opportunities

Many opportunities exist for patients and families to interact and share experiences. Often this is the most effective approach, particularly for adolescents who may feel encumbered by the structured setting of a psychologist's office. A great deal of anxiety can be relieved as they and their families come to realize that others with IBD are leading normal and productive lives. We have sleep over events for adolescents, holiday parties for patients and families, a camp for patients and siblings, and a Patient Education Day for families that consists of formal lectures on a wide variety of IBD topics.*

Looking Out for Self Sabotage

Overcoming anxiety or depression is tough and sometimes even frightening work. (Even positive change evokes fear in most people ) As a result, people tend to resist, avoid, or procrastinate working on their problems. This means you have to be on the lookout for self-sabotage. Self-sabotage describes the things you do to keep from addressing and correcting your problems, and it appears in various forms and disguises.

Working up the courage E

Many people make decisions to do something but procrastinate when it comes to carrying out those decisions. Why Because many actions arouse anxiety, fear, or distress. If your choice of options makes you tremble, consider the following tips Brief relaxation strategy Not only is it quick and simple, but this technique helps calm acute anxiety. (See Chapter 13 for more information and practice with relaxation techniques.)

Making the Medication Decision

Today, we know more about the brain and its relationship to emotional problems than ever before we understand that chemical imbalances in the brain accompany both anxiety and depression. Because of this growing knowledge, some television commercials would lead you to believe that making some simple corrections to your brain chemistry with the advertised drug will cure your problem. Voila Because this is a workbook and space is limited, we don't review the myriad of medications available for the treatment of anxiety and depression. If you'd like more information on specific medications, look to Overcoming Anxiety For Dummies and Depression For Dummies (Wiley). And of course, talk the issue over with your doctor. One question we frequently encounter is, What works best, medications or therapies The answer is both. For depression, research tends to suggest that medication and therapy work just about equally well. But for some types of anxiety cognitive behavior, therapies such as the...

Childrens Reactions to Witnessing Domestic Violence

Children whose mothers have been physically and emotionally abused are considered victims of family violence. We know from research studies that individual children respond differently to the violence, from those who evidence major psychological disorders and posttraumatic stress symptoms, to those who appear resilient and unaffected by the trauma. Approximately 40 to 60 of children who witness the abuse of their mothers are above the clinical cutoff level on measures of mood and behaviors. That is, they are in need of clinical treatment for their anxiety, depression, and aggressive behavior. In one study, more than half of the children who witnessed domestic violence had symptoms of posttraumatic stress, and 13 qualified for a full Posttraumatic Stress Disorder (PTSD) diagnosis the diagnosis first given to returning combat veterans who showed extreme stress reactions to the atrocities witnessed during war. Most children who observe violence in the family are worried and concerned...

Psychiatric Disorders

Couples and family therapists have developed specialized interventions for a wide variety of psychiatric disorders, including depression, alcohol, and a variety of anxiety disorders. Outcome studies have generally found that intervening with couples and families (rather than individuals) leads to lower drop-out rates and higher treatment success rates. Behavioral and cognitive couples treatments for depression have been found to reduce depression and increase satisfaction when the depressed person is in a distressed relationship. Behavioral Couples Therapy has also been shown to reduce alcoholism and to improve couples' satisfaction. Finally, spousal involvement has been shown to increase the effectiveness of behavioral treatments for agoraphobia.

Disorders That May Accompany ADD Syndrome

MYTH Someone can't have ADD and also have depression, anxiety, or other psychiatric problems. ADHD has extraordinarily high rates of comorbidity with virtually every other psychiatric disorder listed in the DSM-IV, both in the cross-sectional and lifetime analyses. For example, studies have found that about 5 to 10 percent of children in the general population suffer from anxiety disorders (Tannock 2000). Among children with ADHD, the rate of anxiety disorders is three to six times greater.

Worksheet 23The Current Culprits Survey

You didn't ask for depression or anxiety. Your distress is understandable if you examine the three major contributors biology genetics, your personal history, and the stressors in your world. Take a moment to summarize in Worksheet 2-4 what you believe are the most important origins and contributors to your depression or anxiety.

Worksheet 413Jasmines Thought Tracker

You can see how their thoughts contribute to the way they feel. All three of them look at this event in unique ways, and they feel differently as a result. Molly worries about the consequences of the accident and puts herself down. Because of the way she interprets the event, Molly's at risk for anxiety and depression. Tyler gets mad and cata-strophizes the fender-bender. He tends to have problems with anger and depression. On the other hand, Jasmine panics about the bash into the pole her reaction is the product of her frequent struggles with anxiety and panic.

Restoring Relationships

Yet, distressing emotions can get in the way of your attempts to improve your relationships. Such emotions can harm friendships, intimate relationships, and even relationships with co-workers or relative strangers. So, along with the obvious ways of working to alleviate your anxiety or depression, shoring up your relationships will also improve your moods. In this chapter, we review strengthening strategies that you can apply to almost any type of relationship. However, we emphasize intimate relationships because disruptions in these types of relationships cause the most harm and because repairing them is enormously beneficial to your mental health. In addition, we help you cope with the loss of a relationship because such an event can be quite traumatic and trigger intense feelings of anxiety and or despair.

Neurophysiology and Electrophysiology

The function and actions of neurons, nerves, neural tracts, and neural tissue can be evaluated by invasive and noninvasive techniques and are included in psy-chopharmacologic investigations. In animal subjects, current technology allows for single cell recording of electrical activity relevant to neurophysiologic function. Action potentials, excitatory postsynaptic potentials (EPSPs), inhibitory postsynaptic potentials (IPSPs), long-term potentiation (LTP), and kindling all are studied in response to psychopharmacologic agents. Sensory and motor nerve recording, in animal subjects and in human patients, also provide useful information in this context. Electromyography (EMG) can be used in human patients to evaluate muscular responses, for example, to muscle relaxants and in cases of anxiety and pain. Electrocardiography (ECG or EKG) is used to assess heart function and is relevant in the present context to evaluate side effects of psychopharmacologic agents, as an index of stress...

Borderline personality

The second of the more extreme personality disorders and one that has received considerable attention recently is the borderline personality. It is not very aptly named because it suggests that someone has a personality that is only acceptable in a borderline way. However, the borderline is between neurotic traits (extreme anxiety, emotional instability) and psychotic tendencies (as in schizophrenia). The keynote of this disorder is instability instability is all aspects of personality. Moods and emotions might swing from anxiety to depression to anger, all in the extreme. The person's view of themselves swings from huge self-aggrandisement to equally large self-abasement. Relationships with others are appalling, swinging from believing the other person to be wonderful to loathing and rejecting them to the full. Relationships (say, with a new therapist or a new At even more extreme moments, persons with the borderline personality disorder may engage in self-mutilation (usually cutting...

Cognitive behaviour therapies

The various types of cognitive behaviour therapy (CBT) were developed as a -way of achieving this, aimed at dealing with both behaviour and maladaptive beliefs. The simple aim of CBT is to bring about the control of unpleasant emo- tions and feelings by helping to provide patients with better ways of interpreting their experiences. To take a commonplace example, very anxious or very depressed people distort their thinking in ways that are, naturally enough, dominated by anxiety or depression. The cognitive behaviour therapist helps them to find ways of changing that type of thinking and so alleviate the anxiety or depression. Like many therapies, then, CBT is verbally based and deals with changing beliefs in order to change behaviour. Nevertheless, it is important to say that the successful performance of something is more effective for a person than simple changes in beliefs. For example, actually taking an examination successfully or going to a party or giving a speech without...

Reassurance and explanation

Reassurance needs to be used carefully, however. It is essential to elicit patients' specific concerns about their symptoms and to target reassurance appropriately. The simple repetition of bland reassurance that fails to address patients' fears is ineffective. If patients have severe anxiety about disease (hypochondriasis) repeated reassurance is not only ineffective but may even perpetuate the problem. A positive explanation for symptoms is usually more helpful that a simple statement that there is no disease. Most patients will accept explanations that include psychological and social factors as well as physiological ones as long as the reality of symptom is accepted. The explanation can usefully show the link between these factors for example, how anxiety can lead to physiological changes in the autonomic nervous system that cause somatic symptoms, which, if regarded as further evidence of disease, lead to more anxiety

Healing and energy work

The best available evidence suggests that reiki and spiritual healing may contribute to pain relief, promote relaxation, to improve sleep patterns, reduce tension, stress and anxiety, to provide emotional and or spiritual support, contribute to a sense of wellbeing, reduce side effects of chemotherapy and radiotherapy, and support the patient in the dying process

Combination Psychotropic Therapy

It is possible that combination treatment may enhance the effect of single drug treatment in patients with FGIDs, particularly those with more severe symptoms and or comor-bid psychological symptoms. Because of their high affinity for the cytochrome P450 system (particularly with paroxetine), the SSRIs should be used with caution if given with TCAs and benzodiazepines. Physicians can take advantage of this effect by adding a low dose SSRI when patients show an incomplete response to a TCA. A low dose TCA may more effectively treat pain-related symptoms, whereas the SSRI can be used to treat associated symptoms of anxiety. Fibromyalgia, a chronic somatic pain disorder that frequently coexists with FGIDs, is commonly treated with a combined regimen of an SSRI and TCA. Another possible therapeutic combination in patients with FGIDs is buspirone with an antidepressant, such as a TCA or SSRI. They can augment their beneficial effects so that higher doses can be avoided,

Psychological Reactions

In certain individuals, reactions to food may be psychological (Kelsay, 2003). This is a difficult type of ARF to diagnose because the mechanisms giving rise to such reactions are poorly understood. Individuals who are not confirmed to have ARF have higher rates of hypochondria, hysteria, somatization, and anxiety than those with ARF confirmed by food challenge. An individual who experienced a severe ARF may avoid the culprit food for fear of further reactions, and there is also some evidence that hypersensitiv-ity reactions to food may be triggered through central neural mechanisms so that, eventually, just the thought of ingesting the food can trigger allergic symptoms in the absence of antigen. Food allergy itself may lead to psychological distress, and studies of food allergic subjects report an altered quality of life for the individual and their family, with severe manifestations such as anaphylaxis resulting in a post-traumatic stress situation.

Discovering the Beginnings

In this chapter, we review the major causes of depression and anxiety biology, personal history, and stress. Many of our clients come to us believing that they're to blame for having succumbed to emotional distress. When they discover the factors that contributed to the origins of their problems, they usually feel less guilty, and getting rid of that guilt frees up energy that can be used for making important changes.

Making critical comparisons

Are you the richest, best-looking, or smartest person in the world Neither are we. There's always someone who has more of something than you do. Even if you're the best at something, that doesn't mean you're the best at everything. People have strengths and weaknesses, and if you do think you're the best at everything, you have a problem that's quite different from anxiety or depression.

Lifting Mood Through Exercise

Hy devote a whole chapter to exercise in a book that deals with anxiety and depression Well, because getting up and moving increases the naturally occurring feel-good endorphins in the human body. When endorphins, substances occurring naturally in the brain that are chemically similar to morphine, spread through your brain, you get a sense of well-being and pleasure. And it's hard to be depressed or anxious when you feel good inside.

Worksheet 68My Thought on Trial Worksheet

After you complete the Thought Court process, decide for yourself whether or not your thought is guilty of causing you unneeded emotional distress such as anxiety, depression, or other difficult feelings. Even if you conclude that your thought has some grain of truth, you're likely to discover that it's highly suspect of causing you more harm than good. In Thought Court, you don't judge your thought guilty only on the basis of beyond a reasonable doubt. Rather, we suggest you judge your thoughts on the preponderance of evidence in plain English, convict your thought if the evidence weighs heaviest on the guilty side.

Future Directions in Research Clinical Practice and Biofeedback Technology

These children learned to relax and incorporated this in their daily schedule. They also demonstrated decreases in anxiety and depression scores, even though these scores were in the normal range. Biofeedback may have helped them achieve a greater degree of psychological health.

Some Important Distinctions

Conditions for performance of a behavior. For example, clients could be requested to role play behaviors and asked whether similar or identical behaviors occur in other situations. Behavior surfeits are often related to behavior deficits. For example, aggression on the part of a child may be related to a lack of friendship skills. It is also important to distinguish response inhibitions from behavior deficits. Emotional reactions such as anxiety may interfere with desired behavior.

Similarities among Disorders of Motivation and Arousal

Among the various disorders of motivation and arousal discussed in this section there are obvious differences, but also underlying similarities. Dys-thymia and depression both involve a significant reduction in motivation and arousal associated with chronic feelings of hopelessness, as though an unsatisfying outcome to one's efforts were already determined. Anxiety disorders are characterized by an intensification of arousal often combined with avoidance of what is assumed to be an inevitably dangerous outcome. Bipolar disorder, in the manic phase, is marked by intense exaggeration of arousal and an often pathological intensity of certain motivations the depressive aspect, whether phasic or mixed, falls to the opposite extreme.

TSHRmediated Autoimmunity

Pathogenic autoantibodies to the TSHR disturb normal hypothalamus-pituitary-thyroid regulation of thyroid function 8-10 (Fig. 14.1). GD is characterized by hyperthyroidism, which often leads to tachycardia, anxiety, excessive sweating, and acute weight loss. On the other hand, autoimmune PM is characterized by hypothyroidism that can lead to physical and mental lethargy, bradycardia, and weight gain. Pathogenic antibodies (TSAbs) from patients with GD bind to TSHR and stimulate thyroid, but in PM, pathogenic antibodies (TSBAbs) block either the binding of TSH or TSH-mediated activation of thyroid cells. Unlike in HT, the primary cause of thyroid dysfunction in GD and PM is not due to glandular destruction but rather to physiological perturbation of thyroid function mediated by anti-TSHR antibodies. The important question is how one develops pathogenic antibodies against the thyroid. Since self-tolerance prevents development of autoimmune responses, breakdown in self-tolerance must...

Etiology Possible Causes And Modifiers

There are a number of other studies pointing to the importance of heredity. Familial risk for ADD ADHD and antisocial behaviors is higher among the relatives of children who have a conjoint diagnosis of both ADD ADHD and CD than among the relatives of children who are only ADD ADHD (219-225). Faraone et al. (222) found that the family members of probands with ADHD and ODD had a higher risk for ADHD and CD than the family members of probands with ADHD alone. However, the risk was lower for familial spread than in a group who were comorbid for both ADD ADHD and CD. Biederman et al. (226) report significant prevalence of mood, anxiety, and antisocial disorders in the first-degree relatives of ADHD children. Elsewhere, Biederman et al. (227) report an association between anxiety disorders and ADD ADHD, with the risk of anxiety disorders among the relatives of ADD ADHD children higher than that for the relatives of normal children (220,227).

Pain Suffering and Illness Behavior

This in turn can lead to certain patterns of illness behavior, which in turn determines the clinical presentation. Such behavior is a complex mixture of physiologic (eg, pain intensity severity or associated features), psychological (mental state, stress, mood, coping style, prior memories or experiences with pain, etc), and social factors (concurrent negative life events, attitudes, and behavior of family and friends, perceived benefits such as avoidance of unpleasant duties, etc). Thus individual attitudes, beliefs, and personalities, as well as the social and cultural environment, strongly affect the pain experience. Although the biological basis of these interactions is poorly understood, it is important to understand that the clinical presentation of chronic pain represents a dysfunction of a system that is formed by the convergence of biological, social, and psychological factors (the so-called biopsychosocial continuum). These factors not only...

Specific Investigations in Nonulcer Dyspepsia

Responses indicate symptoms associated with nine psychiatric constructs. These constructs are somatization, obsessive-compulsive behavior, feelings of inadequacy or inferiority (interpersonal sensitivity), depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoti-cism. SCL-90-R scores for a group of 73 controls and 92 patients with nonulcer dyspepsia are shown in Figure 30-1. There are significant differences for all scales and profound differences for the somatization and depression. It should be kept in mind that these measures are not diagnostic of any psychiatric disorder and responses must be considered within the context of the clinical scenario and psychosocial history.

Emotional Disturbance and Diffuse Brain Injury

Diamond, Barth, and Zillmer (1988) and others have suggested that psychological factors may be associated with head injury, which ultimately can complicate recovery. Along with the cognitive impairment noted in mild, moderate, and severe head injuries, emotional sequelae have been noted. Reported symptoms after head injury, both psychological and somatic, have included headache, fatigue, anxiety, emotional lability, and concentration impairment (Diamond et al., 1988). The results of a study that included 68 trau-matically brain-injured patients further supported the association between head injury and emotional symptoms (Dicesare, Parente, Anderson-Parente, 1990). The primary problems reported after head injury were obsessive-compulsive behavior, interpersonal sensitivity, depression, and phobic anxiety. The results of Dicesare et al.'s study were obtained from self-report measures, but the authors noted that the self-reports were consistent with the observations of family members....

Support Groups for Caregivers of Elderly Relatives

Generally, family caregivers report high levels of satisfaction with their group experience, and deeply regret the fact that the group must terminate after the prescribed number of sessions. This suggests that a short-term model of practice is inappropriate for a population that is dealing with a host of chronically stressful demands that change over time. Most family caregivers require continuing support, training, and guidance, in addition to a range of community services that can alleviate the objective burdens they shoulder. As Lavoie observed in 1995, To expect to change well-established behaviors such as personal coping styles, or deep-seated dynamics such as anxiety or depression over the illness of a loved one and the need to care for that person, by means of a limited number of group meetings with peers could seem like wishful thinking (p. 589). about the nature and meaningfulness of the mental health outcomes that have been gauged. Is it appropriate to reduce feelings of...

Discharge Instructions

Ideally, ambulatory surgery patients should be given their discharge instructions during the preoperative conference in the office. A variety of patient education tools (e.g., pamphlets, detailed written instructions, and videos) may be used to help educate patients about their operations and subsequent postoperative care.38 Verbal reinforcement of written instructions by the surgeon is an important component of patient education. Communications from the surgeon should be consistent with the other materials (e.g., pamphlets, brochures, and preprinted instruction sheets) provided to the patient. The instructions the patient is given before leaving the ASC must also be consistent with what the patient or family has previously been told, whether orally or in writing, by the surgeon. Providing careful perioperative instructions can yield several significant benefits, including increased patient satisfaction, improved outcomes, decreased patient anxiety, improved compliance, and even...

Possible Screening Applications

The controversy about screening populations for prevention activities derives from two concerns. First, an appreciable number of false positive results may occur, especially when screening populations with low prevalence of HIV infection, resulting in needless anxiety and other possible adverse consequences in an uninfected individual. Second, whether or not the test positive individual is infected, he or she may be adversely affected by social ostracism or exclusion from insurance or employment opportunities if the test result is revealed.

Nutritional and medicinal

Hundreds of herbal remedies are purported to have benefits in palliative care, including anticancer benefits as well as more general immune enhancing effects. Most of them do not have proven specific benefits but this could be due to the quality of the trials conducted. Possible interactions with active treatment and side effects necessitate caution in recommending their use. Careful discussion with a knowledgeable health professional is recommended. The evidence of clinical effectiveness of homoeopathy is mixed and scientific research into homoeopathy in cancer is in its infancy. Nevertheless, homoeopathy is used by patients in palliative care, and there is evidence that they find the approach helpful. The best available evidence suggests effectiveness of use for fatigue, hot flushes, pain including joint pain and muscle spasm, anxiety and stress, depression, quality of life including mood disturbance, radiotherapy, skin reactions, and ileus after surgery

The educational preparation for advanced practice

Historically, much of the debate about educational preparation for advanced practice was really about whether nurse practitioners were advanced practice nurses. When you take nurse practitioners out of the equation, in the UK there is little doubt that advanced practitioners should be educated to Master's level (Elcock 1996 Wright, 1997 Manley, 1997), a view which is now supported by the NMC (2005). There is a consensus that the key components of the role would be expert practitioner, educator, researcher and consultant (Elcock, 1996). This is because advanced practitioners are involved in the breaking down of existing professional barriers and redefining practice parameters and contributing to health policy. This level of critical thinking and decision-making, and analytical skills, can only be achieved through a Master's level educational preparation (Davies & Hughes, 2002). This is similar to the educational preparation in the USA (Mick & Ackerman, 2000), and in the Nordic...

Cardiovascular status

A raised heart rate is a common response to many types of stress (fever, anxiety, hypoxia, hypovolaemia). In shock, tachycardia is caused by catecholamine release, and is an attempt to maintain cardiac output by increasing heart rate in the face of falling stroke volume.

Comorbidity of Psychological Symptoms in FGIDs

A large proportion of patients with IBS or other functional bowel disorders have coexistent psychological disturbances, particularly those with severe symptoms or those seen in tertiary care referral centers. Psychosocial factors have been recognized to modify the illness experience and influence health care utilization and treatment outcome. These psychosocial factors include a history of emotional, sexual or physical abuse, stressful life events, chronic social stress, anxiety disorders, or maladaptive coping styles. However, the psychological profiles of individuals with IBS who have not sought health care for their GI symptoms are similar to those of healthy individuals. Thus, although psychosocial factors are not etiologic to IBS, they appear to influence health care seeking, illness behavior, and treatment response. Currently, the role of psychosocial factors and stress in FGIDs has been conceptualized in the following manner adverse life experiences (past and present) influence...

Psychological Interventions

Patients with the IBS who actively seek care by a physician have a high incidence of psychological disorders, specifically depression and anxiety. Because of this, a variety of psychological interventions have been used to treat the symptoms of IBS. Despite methodological flaws in most studies, there are some data to support the use of relaxation exercises, biofeedback, cognitive therapy, hypnotherapy, and psychotherapy (Talley et al, 1996). The IBS-related symptoms most likely to respond to psychological intervention include abdominal

Fetal heart rate and CTG

Low risk (low-risk pregnancy and normallabour) intermittent monitoring with a Pinard's stethoscope is said to be as effective as CTG monitoring. Structured intermittent monitoring involves listening immediately after a contraction for a minimum of 60 seconds and repeating this every 15 minutes in the first stage of labour (every 5 minutes in the second stage). It has been suggested that CTG monitoring in the low-risk group may lead to unnecessary intervention and increased anxiety.

The Self Blame Reality Scrambler

When sadness or anxiety clouds your thinking, you're likely to add to your distress by assuming full responsibility for your misery. You may accuse yourself of being inept, incapable, or inadequate and therefore fully culpable for all your suffering. When the Self-Blame Reality Scrambler is at work, you attribute all fault and blame to yourself. Doing so leads you to wallow in shame and self-loathing.

Distinguishing the past from the present

As you can see in Worksheet 7-8, Hannah developed the life-lens of perfectionistic. As a kid, she was harshly criticized when she wasn't perfect, so the lens helped her avoid some of that criticism. The lens was a healthy adaptation to her life at the time. But today, as an adult, her perfectionistic life-lens causes her anxiety, stress, and even depression when she fails. Furthermore, no one in her life is nearly as critical as her father was. So she doesn't need to be perfect to avoid harsh criticism today. Her perfectionistic lens distorts her vision. Hannah completes the Then and Now Exercise in Worksheet 7-12 in order to help her understand how her past experiences cause her to overreact to current triggers. Seeing this connection will help her change her life-lens.

After the Verdict Replacing and Rehabilitating Your Thoughts

In this section, we show you how to rehabilitate your guilty thoughts, one at a time. Rehabilitating your thoughts decreases feelings of depression and anxiety because rehabilitated thoughts are less distorted, judgmental, and critical. We call rehabilitated thoughts replacement thoughts because they replace your old malicious thoughts.

The origins of lifelenses

Hannah struggles with depression and anxiety. She takes the Problematic Life-Lenses Questionnaire shown in Worksheet 7-1 and identifies the life-lenses of intimacy-avoidant and entitled. She also realizes that she's perfectionistic but flips to feeling inadequate when she makes a mistake. Hannah reflects on her childhood for possible causes of her life-lenses. She then completes the Childhood Origins of Life-Lenses exercise shown in Worksheet 7-8 and reflects on her findings in Worksheet 7-9.

Getting a tittle help from a friend

KPLE Emma (see Emma Filled with anxiety earlier in this chapter) has taken her most malicious thought to Thought Court and found it guilty. Now she turns to Getting Help from a Friend ) to rehabilitate that thought. She thinks about her best friend, Louise. She imagines Louise coming to her with the same problem and concerns about her son. In other words, Louise is thinking Emma's most malicious thought and seeking advice (see Worksheet 6-11).

Mellowing Your Muscles

The following relaxation procedure is excerpted from our book, Overcoming Anxiety For Dummies (Wiley). Practice this procedure frequently until you can do it without looking at the instructions. This technique involves systematically tensing various muscle groups and holding that tension for a few moments perhaps five or ten seconds. Then you release the tension and allow relaxation to take over. The procedure starts with your hands and arms, moves through the neck, back, and face, and progresses down the legs and feet. Depression and anxiety disrupt sleep. Some people have trouble falling asleep, others wake up in the early morning hours and can't get back to sleep, and some people even have both problems. On the other hand, a few people with anxiety or depression sleep too much way too much and their sleep isn't refreshing.

Spending Time with Self Help Books

I Learn to Relax Proven Techniques for Reducing Stress, Tension, and Anxiety and Promoting Peak Performance, by C. Eugene Walker (Wiley, 2000) i Mastery of Your Anxiety and Panic, by David Barlow and Michelle Craske (Oxford University Press, 2005) i Overcoming Anxiety For Dummies, by Charles H. Elliott and Laura L. Smith (Wiley, 2002) i The Anxiety & Phobia Workbook, by Edmund J. Bourne (New Harbinger Publications, Inc., 2005)

Preparation for Surgery

Admission on the morning of surgery is becoming customary, although patients with high serum creatinine benefit from overnight preoperative intravenous hydration. Mechanical cleansing of the colon is undertaken the night before using magnesium citrate, and the patients are instructed in the use of incentive spirometry. When possible, family members as well as the patient are given a tour of the intensive care unit to help alleviate anxiety. Cardiac medications including beta-blockers and aspirin are continued, given with a sip of water on the morning of surgery. For antibiotic prophylaxis we use a first generation cephalosporin before the operation and continue at least three doses afterwards.

Value Judgments Accompanying the Concept of Disease

The current system envisions mental illnesses, like other illnesses, as conditions to be eliminated. Diseases, in our current understanding, rarely have value and meaning beyond that of deserving the most concerted efforts to eliminate them. The more internal, physical, and individual the diagnostic concepts and procedures, the less are abnormal actions perceived as addressing some aspect of a person's effort to position himself or herself in the world of social norms and moral expectations. An individual's complaints of depression and anxiety are not valued for their indexing a struggle with a personal decision or with a moral dilemma. They are merely ''symptoms'' that, when sufficiently aggregated, indicate a disease, and a disease is to be cured.

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