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Panic attack

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A panic attack is the abrupt onset of intense fear or discomfort that reaches a peak within minutes. A panic attack is the abrupt onset of intense fear or discomfort that reaches a peak within minutes and includes at least four of the following symptoms:

  • Palpitations, pounding heart, or accelerated heart rate
  • Sweating
  • Trembling or shaking
  • Sensations of shortness of breath or smothering
  • Feelings of choking
  • Chest pain or discomfort
  • Nausea or abdominal distress
  • Feeling dizzy, unsteady, light-headed, or faint
  • Chills or heat sensations
  • Paresthesia (numbness or tingling sensations)
  • Derealization (feelings of unreality) or depersonalization (being detached from oneself) Listen to this podcast.
  • Fear of losing control or “going crazy”
  • Fear of dying

Some people experience what is referred to as limited-symptom panic attacks, which are similar to full-blown panic attacks but consist of fewer than four symptoms.

Although anxiety is often accompanied by physical symptoms, such as a racing heart or knots in your stomach, what differentiates a panic attack from other anxiety symptoms is the intensity and duration of the symptoms. Panic attacks typically reach their peak level of intensity in 10 minutes or less and then begin to subside. Due to the intensity of the symptoms and their tendency to mimic those of heart disease, thyroid problems, breathing disorders, and other illnesses, people with panic disorder often make many visits to emergency rooms or doctors’ offices, convinced they have a life-threatening issue.

Panic attacks can occur unexpectedly during a calm state or in an anxious state. Although panic attacks are a defining characteristic of panic disorder, it is not uncommon for individuals to experience panic attacks in the context of other psychological disorders. For example, someone with social anxiety disorder might have a panic attack before giving a talk at a conference and someone with obsessive-compulsive disorder might have a panic attack when prevented from engaging in a ritual or compulsion.

Panic attacks are extremely unpleasant and can be very frightening. As a result, people who experience repeated panic attacks often become very worried about having another attack and may make changes to their lifestyle so as to avoid having panic attacks. For example, avoiding exercise so as to keep their heart rate low, or avoiding certain places.

In the past it might have taken months or years and lots of frustration before getting a proper diagnosis. Some people are afraid or embarrassed to tell anyone, including their doctors or loved ones about what they are experiencing for fear of being seen as a hypochondriac. Instead they suffer in silence, distancing themselves from friends, family, and others who could be helpful. Other people suffering from panic attacks don’t know they have a real and highly treatable disorder. It is our hope that through increased education, people will feel more empowered to discuss their symptoms with a healthcare professional and seek appropriate treatment.

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Post- Traumatic Stress Disorder (PTSD) counseling

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Trauma can be of various forms, some of which are to be worked with a thorough professional therapist. Post traumatic stress disorder is a form of anxiety disorder. It can occur after you’ve been traumatized after witnessing or experiencing a traumatic event that involved death or injury threat. o diagnose post-traumatic stress disorder, your doctor will likely:

  • Perform a physical exam to check for medical problems that may be causing your symptoms
  • Do a psychological evaluation that includes a discussion of your signs and symptoms and the event or events that led up to them
  • Use the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association

Diagnosis of PTSD requires exposure to an event that involved the actual or possible threat of death, violence or serious injury. Your exposure can happen in one or more of these ways:

  • You directly experienced the traumatic event
  • You witnessed, in person, the traumatic event occurring to others
  • You learned someone close to you experienced or was threatened by the traumatic event
  • You are repeatedly exposed to graphic details of traumatic events (for example, if you are a first responder to the scene of traumatic events)

You may have PTSD if the problems you experience after this exposure continue for more than a month and cause significant problems in your ability to function in social and work settings and negatively impact relationships.

Treatment

Post-traumatic stress disorder treatment can help you regain a sense of control over your life. The primary treatment is psychotherapy, but can also include medication. Combining these treatments can help improve your symptoms by:

  • Teaching you skills to address your symptoms
  • Helping you think better about yourself, others and the world
  • Learning ways to cope if any symptoms arise again
  • Treating other problems often related to traumatic experiences, such as depression, anxiety, or misuse of alcohol or drugs
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Agitation

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Agitation is an unpleasant state of extreme arousal. An agitated person may feel stirred up, excited, tense, confused, or irritable. Agitation can come on suddenly or over time. It can last for a few minutes, for weeks, or even months. Pain, stress, and fever can all increase agitation. Agitation by itself may not be a sign of a health problem. But if other symptoms occur, it can be a sign of disease. Agitated, aggressive, frustrated, angry, stubborn, restless – adjectives that are often used interchangeably to illustrate comparable clinical presentations, but words that can bear very different meanings to different people. It is well documented in the literature that individuals with cognitive disorders regularly suffer from a plethora of neuropsychiatric sequelae during their illness course. Syndromes such as depression, anxiety, and agitation are common, and agitation is frequently considered the most disruptive as it is often associated with increased rates of institutionalization. Specific diagnostic criteria for depression and anxiety in certain cognitive disorders such as Alzheimer’s disease have been outlined in the literature. However, agitation remains an ambiguously defined term that is often muddled by the individual’s, caretakers, or provider’s interpretation of the clinical manifestations. Creating a standardized, validated diagnostic definition of agitation in individuals with cognitive disorders could prove beneficial to clinical and research environments seeking to advance treatment options, as well as, facilitate accurate communication among clinicians and patients and their support.

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Child Psychiatry evaluation/follow up

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Evaluation by a child and adolescent psychiatrist is appropriate for any child or adolescent with emotional and/or behavioral problems. Most children and adolescents with serious emotional and behavioral problems need a comprehensive psychiatric evaluation.

Comprehensive psychiatric evaluations usually require a few hours over one or more office visits for the child and parents. With the parents’ permission, other significant people (such as the family physician, school personnel, or other relatives) may be contacted for additional information.

The comprehensive evaluation frequently includes the following:

  • Description of present problems and symptoms
  • Information about health, illness and treatment (both physical and psychiatric), including current medications
  • Parent and family health and psychiatric histories
  • Information about the child’s development
  • Information about school and friends
  • Information about family relationships
  • Interview of the child or adolescent
  • Interview of parents/guardians
  • If needed, laboratory studies such as blood tests, x-rays, or special assessments (for example, psychological, educational, speech and language evaluation)

The child and adolescent psychiatrist then develops a formulation. The formulation describes the child’s problems and explains them in terms that the parents and child can understand. The formulation combines biological, psychological, and social parts of the problem with developmental needs, history, and strengths of the child, adolescent, and family.

Time is made available to answer the parents’ and child’s questions. Parents often come to such evaluations with many concerns, including:

  • Is my child normal? Am I normal? Am I to blame?
  • Am I silly to worry?
  • Can you help us? Can you help my child?
  • What is wrong? What is the diagnosis?
  • Does my child need additional assessment and/or testing (medical, psychological etc.)?
  • What are your recommendations? How can the family help?
  • Does my child need treatment? Do I need treatment?
  • What will treatment cost, and how long will it take?

Parents are often worried about how they will be viewed during the evaluation. Child and adolescent psychiatrists are there to support families and to be a partner, not to judge or blame. They listen to concerns, and help the child or adolescent and his/her family define the goals of the evaluation. Parents should always ask for explanations of words or terms they do not understand.

When a treatable problem is identified, recommendations are provided and a specific treatment plan is developed. Child and adolescent psychiatrists are specifically trained and skilled in conducting comprehensive psychiatric evaluations with children, adolescents, and families.

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Obsessive-compulsive disorder (OCD)

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Obsessive-compulsive disorder is a form of anxiety denoted by unnecessary and repetitive thoughts, feelings, ideas, sensations (obsessions), or behaviors that drive them to do something.  Mostly the person carries out the behaviors to avoid the obsessive thoughts, but this only provides with temporary relief. Obsessive-compulsive disorder (OCD) is an anxiety disorder in which time people have recurring, unwanted thoughts, ideas or sensations (obsessions) that make them feel driven to do something repetitively (compulsions). The repetitive behaviors, such as hand washing, checking on things or cleaning, can significantly interfere with a person’s daily activities and social interactions.

Many people have focused thoughts or repeated behaviors. But these do not disrupt daily life and may add structure or make tasks easier. For people with OCD, thoughts are persistent and unwanted routines and behaviors are rigid and not doing them causes great distress. Many people with OCD know or suspect their obsessions are not true; others may think they could be true (known as poor insight). Even if they know their obsessions are not true, people with OCD have a hard time keeping their focus off the obsessions or stopping the compulsive actions.

A diagnosis of OCD requires the presence of obsession and/or compulsions that are time-consuming (more than one hour a day), cause major distress, and impair work, social or other important function. About 1.2 percent of Americans have OCD and among adults slightly more women than man are affected. OCD often begins in childhood, adolescence or early adulthood; the average age symptoms appear is 19 years old.

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Autism

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Autism is a lifelong, non progressive neurological disorder typically appearing before the age of three years. Autism is a spectrum disorder. The symptoms and characteristics of autism can present themselves in a wide variety of combinations, from mild to severe. What Is Autism?

Autism is a complex neurobehavioral condition that includes impairments in social interaction and developmental language and communication skills combined with rigid, repetitive behaviors. Because of the range of symptoms, this condition is now called autism spectrum disorder (ASD). It covers a large spectrum of symptoms, skills, and levels of impairment. ASD ranges in severity from a handicap that somewhat limits an otherwise normal life to a devastating disability that may require institutional care.

Children with autism have trouble communicating. They have trouble understanding what other people think and feel. This makes it very hard for them to express themselves either with words or through gestures, facial expressions, and touch.

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Anxiety

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Anxiety is denoted by excessive worrying, uneasiness, apprehension and fear about future uncertainties based on real or imaginary events, which might affect both psychological and physical health. Often, counseling is sufficient to help overcome your anxiety, but medication management is necessary if anxiety is of severe nature or biological factors are involved. But you may experience anxiety that is persistent, seemingly uncontrollable, and overwhelming. If it’s an excessive, irrational dread of everyday situations, it can be disabling. When anxiety interferes with daily activities, you may have an anxiety disorder.

Anxiety disorders are real, serious medical conditions – just as real and serious as physical disorders such as heart disease or diabetes. Anxiety disorders are the most common and pervasive mental disorders in the United States.

The term “anxiety disorder” refers to specific psychiatric disorders that involve extreme fear or worry, and includes generalized anxiety disorder (GAD),  panic disorder and panic attacks, agoraphobia, social anxiety disorder, selective autism, separation anxiety, and specific phobias.

Obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) are closely related to anxiety disorders, which some may experience at the same time as depression.

Irritable Bowel Syndrome, also called IBS, is characterized by abdominal pain, cramping, bloating, gas, constipation, and diarrhea

Depression is a condition in which a person feels discouraged, sad, hopeless, unmotivated, or disinterested in life in general for more than two weeks and when the feelings interfere with daily activities. Major depression is a treatable illness that affects the way a person thinks, feels, behaves, and functions. At any point in time, 3 to 5 percent of people suffer from major depression; the lifetime risk is about 17 percent.

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Depression

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Depression is denoted by low esteem and low mood levels, and significant loss of interest or pleasure in normally enjoyable activities. Often, counseling is sufficient to help overcome your anxiety, but medication management is necessary if anxiety is of severe nature or biological factors are involved. Depression (major depressive disorder) is a common and serious medical illness that negatively affects how you feel, the way you think and how you act. Fortunately, it is also treatable. Depression causes feelings of sadness and/or a loss of interest in activities once enjoyed. It can lead to a variety of emotional and physical problems and can decrease a person’s ability to function at work and at home.

Depression symptoms can vary from mild to severe and can include:

  • Feeling sad or having a depressed mood
  • Loss of interest or pleasure in activities once enjoyed
  • Changes in appetite — weight loss or gain unrelated to dieting
  • Trouble sleeping or sleeping too much
  • Loss of energy or increased fatigue
  • Increase in purposeless physical activity (e.g., hand-wringing or pacing) or slowed movements and speech (actions observable by others)
  • Feeling worthless or guilty
  • Difficulty thinking, concentrating or making decisions
  • Thoughts of death or suicide

Symptoms must last at least two weeks for a diagnosis of depression.

Also, medical conditions (e.g., thyroid problems, a brain tumor or vitamin deficiency) can mimic symptoms of depression so it is important to rule out general medical causes.

Depression affects an estimated one in 15 adults (6.7%) in any given year. And one in six people (16.6%) will experience depression at some time in their life. Depression can strike at any time, but on average, first appears during the late teens to mid-20s. Women are more likely than men to experience depression. Some studies show that one-third of women will experience a major depressive episode in their lifetime.

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Schizophrenia/ Psychotic Features

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Schizophrenia is a chronic and severe mental disorder that affects how a person thinks, feels, and behaves. People suffering from schizophrenia may feel like they have lost touch with reality. Although schizophrenia is not as common as other types of mental disorders, its symptoms can be hazardous.

Symptoms of schizophrenia usually start between ages 16 and 30. In rare cases, children have schizophrenia too.

The symptoms of schizophrenia fall into three categories: positive, negative, and cognitive.

Positive symptoms: “Positive” symptoms are psychotic behaviors not generally seen in healthy people. People with positive symptoms may “lose touch” with some aspects of reality. Symptoms include:

  • Hallucinations
  • Delusions
  • Thought disorders (unusual or dysfunctional ways of thinking)
  • Movement disorders (agitated body movements)

Negative symptoms: “Negative” symptoms are associated with disruptions to normal emotions and behaviors. Symptoms include:

  • “Flat affect” (reduced expression of emotions via facial expression or voice tone)
  • Reduced feelings of pleasure in everyday life
  • Difficulty beginning and sustaining activities
  • Reduced speaking

Cognitive symptoms: For some patients, the cognitive symptoms of schizophrenia are subtle, but for others, they are more severe and patients may notice changes in their memory or other aspects of thinking. Symptoms include:

  • Poor “executive functioning” (the ability to understand information and use it to make decisions)
  • Trouble focusing or paying attention
  • Problems with “working memory” (the ability to use information immediately after learning it)
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Hyperactive Disorder (ADD/ADHD)

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Attention Deficit Hyperactivity Disorder is an ordinary condition that affects children, adolescents and adults. We have psychiatrists who offer medication management for ADHD treatment, and counseling is also advisable for the affected person/family. Attention-deficit/hyperactivity disorder (ADHD) is a brain disorder marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.

  • Inattention means a person wanders off task, lacks persistence, has difficulty sustaining focus, and is disorganized; and these problems are not due to defiance or lack of comprehension.
  • Hyperactivity means a person seems to move about constantly, including in situations in which it is not appropriate; or excessively fidgets, taps, or talks. In adults, it may be extreme restlessness or wearing others out with constant activity.
  • Impulsivity means a person makes hasty actions that occur in the moment without first thinking about them and that may have high potential for harm; or a desire for immediate rewards or inability to delay gratification. An impulsive person may be socially intrusive and excessively interrupt others or make important decisions without considering the long-term consequences.

Inattention and hyperactivity/impulsivity are the key behaviors of ADHD. Some people with ADHD only have problems with one of the behaviors, while others have both inattention and hyperactivity-impulsivity.Most children have the combined type of ADHD.

In preschool, the most common ADHD symptom is hyperactivity.

It is normal to have some inattention, unfocused motor activity and impulsivity, but for people with ADHD, these behaviors:

  • are more severe
  • occur more often
  • interfere with or reduce the quality of how they functions socially, at school, or in a job
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