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What is that makes a person with OCD obsess about them? If I get a thought that seems bizarre discount cleocin 150 mg overnight delivery, I just let it pass buy cleocin 150 mg cheap. If I had Obsessive Compulsive Disorder discount cleocin 150 mg otc, I would try to find some significance in the thought and somehow determine that I was a bad person buy cleocin 150mg amex, etc. Interestingly, the more one tries to get rid of such a thought, the more it intrudes. The classical example is telling someone without OCD not to think of a white bear for the next 5 minutes. In careful studies, this has been shown to cause the thought to come much more often, so telling OCD patients to force the thoughts out of their heads, just makes things worse. David: So what is the answer to ridding yourself of these obsessions? Next, tell them not to try to force the thoughts out of their heads, but just let them pass naturally. They are produced naturally by the brain, and if you have OCD, your normal filtering mechanism does not work so they get stuck. There are medications that may lessen considerably the thoughts, and even lighten your interpretation of them. In some patients, we use what are called "loop tapes. This lessens, greatly, the hold that the thoughts have on the person. Lee Baer has a great new book coming out called: The Imp of The Mind , due out in January 2001. David: I want to touch on one thing you said before we get to some audience questions. Earlier, you mentioned that we should let the obsessive thoughts pass naturally. Of course, people with OCD have great trouble with that. So, the problem is not that OCD patients have abnormal thoughts (we all do); it is their interpretation of the thoughts and their holding onto them, as if they have some intrinsic value. GreenYellow4Ever: Sometimes obsessive thoughts literally keep me awake for hours. Do you have any suggestions for how to deal with the "thought train" so that I can get some sleep? I would start with a careful evaluation; both medically and psychiatrically. Depression would be a common reason for sleep problems. Also, one needs to evaluate what medications you are taking, some can interfere with sleep. Often, just changing the time you take the medications may help. If you are laying there at night with little stimulation, that is a fertile time for the mind to get going with obsessive thoughts. The ones shown to be partially effective are, Anafranil (Clomipramine), Luvox (Fluvoxamine), Paxil (Paroxetine), Prozac (Fluoxetine), Celexa (Citalopram), and Zoloft (Sertraline). There is some evidence that Effexor is also helpful, but there are still no good studies. The medications generally need to be used at high dosages for three months, to evaluate if they will help or not. It is important for the patient to know this, since many psychiatrists give up on the medication after a month or so, and they also may be using low dosages. They are used to treating depression more than OCD, and depression often responds faster and with lower dosages. For information on specific medications, including side-effects, you can to go to the medications area. Jenike: If you use standard definitions, ruminations and obsessions are technically different. Ruminations generally make sense to the depressed person; while obsessions are usually experienced as nonsensical to many OCD patients. For example, a depressed patient may ruminate about how he cheated on his taxes twenty-five years ago and what a bad person he is, while a patient with OCD will have thoughts like, " I want to have sex with the Virgin Mary; or I want to kill my mother;" etc. Linlod: I have been struggling with molesting obsessions for awhile. It is a description of what we hope happens when you keep doing what makes you anxious, which is at first get more and more anxious, and after time, get used to whatever you fear. Almost all people with OCD will habituate to the anxiety eventually, and medications help a lot. Cognitive Behavioral Therapy, CBT is actually (in my opinion) the best treatment for OCD. Jenike: The difference between a psychotic thought and an obsession is that the psychotic person believes the thought, while the person with OCD knows that it is nuts, but has very strong feelings about it. With OCD, the person intellectually knows that his or her fear or obsession is not warranted, but the person still has a feeling inside that it is true. Even though, the cognitive part of your brain knows that, some people can be on the edge and occasionally believe that their obsessions are real, but most know the difference. You can click on this link and sign up for the mail list at the top of the page so you can keep up with events like this. Now onto more audience questions:mitcl: Have you ever heard of Eye Movement Desensitization and Reprocessing ( EMDR ) for helping treat OCD. I count everything and I am constantly saying prayers, so nothing "bad" will happen. You need to work with a good cognitive behavior therapist to develop a treatment plan. When you say that your mind goes constantly; it is probably generating obsessions. Then, the counting and praying are actually mental rituals that you do to lessen the anxiety caused by the obsessions. You need to have a plan to stop the rituals, and just feel the anxiety produced by the obsessions. Once your brain learns (and I mean learns) that you will not do rituals, it will tire of generating obsessions. Some of your mental rituals, are by now almost automatic, so you will have to make a conscious effort to cut them back. The first step is to list all the mental rituals, and then decide which ones to approach first.
Your brain is having something like a seizure of emotion cheap cleocin 150mg free shipping. David: It sounds almost like a "zero tolerance" rule purchase cleocin 150mg on line. George Lynn: Not really zero tolerance order cleocin 150mg with amex, but the parents need to draw the line and stick to it 150 mg cleocin mastercard. I would have a hard time with that, but I do tell my son that despite his issues, there is only so much we can or will do. And, of course, this depends on the age of the child - the older, the more in control he can be. The little ones just need a lot of love and structure. Thank you, Ginger, for this: ginger_5858: There is help for parents. There is a website for bipolar support groups online at http://www. The first thing is to get behaviorally clear with him about what takes things over the line. Hold out your arm and say, "Do not get any closer to me than that when you are upset. Beforehand arrangements should be made for possible inpatient evaluation, if that is necessary. When you are in the moment, I use a "battle plan" which I outline in my book. The most important thing is to stay in your power and your heart. Nonverbal anxiety from parents can make the situation worse. Finally, have friends you can speak to who understand! It is a good reason to move to a place where the police have college educations. Oftentimes, their sheer size and presence will get his attention. And there are a set of measured responses that follow from this if he is arrested. Finally, your local crisis center may have a child response team. It is a good idea to call and find out how it works. How does your approach to behavior management differ from positive behavior support? Kids with bipolar challenges are frantic for the encounter and they may either be too impulsive or too depressed (I call it "aggressive depression") to respond to positive measures. The areas of their brain involved are different, the amygdaloidal complex is unregulated in Bipolar Disorder. You need to be able to calm the limbic system in the Bipolar kids and this is why the massive show of force may be necessary. David: George, is the juvenile justice system the best place for these children? George Lynn: No, the juvenile justice system is not! They need most probably to have a lot of outpatient, non-shaming intervention, but given the crunch on resources, parents ability to get understanding from the juvenile system may have to happen. It makes no sense if a kid needs treatment--not punishment. Susan0: In some areas, most doctors refuse to believe that Bipolar Disorder occurs in kids. You have to do the upfront work to find a doctor who believes you and who is accessible. There is another aspect of the psychology of bipolar kids that needs to be mentioned. They can often pull back their behavior if the disincentives are great enough. Judges hate being put in this position and are usually eager for a non-punitive solution if a kid is diagnosed with Bipolar Disorder. You can click on this link, sign up for the mail list at the top of the page so you can keep up with events like this and take a look around. We have lots of information in the bipolar community. I invite you to look through the sites on the left hand column and also the conference transcripts from previous conferences. Josefina: We have a thirteen year old daughter, recently diagnosed as Bipoar, but she refuses to take bipolar medications. George Lynn: Josefina, med resistance is like having a kid with an eating disorder. You point (slyly) to how it will improve her social life. You may position incentives or events that you will not let her do unless she is on meds. Give her a lot of leeway and information, dealing with the major biggies of weight gain and zits. And get her talking with a female psychiatrist who is not you, but who will devise strategy with you. George Lynn: Truckdog, video-taping your child should be done at his request or he will just block it out. Denial is big in Bipolar Disorder, but if you and he agree on how significant the problem is, taping may help. David: Here are a few audience comments on the videotaping question: Susi: We found video taping the rages was THE best tool for diagnoses. Susan0: Videotaping our son was the only way we got him treated--we showed the doctor, but our son declined to watch--wisely. George Lynn: Yes, one thing parents can do is de-stigmatize it by describing it more as a seizure disorder than as a mental defect. Parents need to let go of their illusion that the child is normal. Hopefully our policymakers will understand this when they gab about violence prevention in kids. SpaceCowgirl: I am a 36 year old Bipolar mom with a 13 yr old Bipolar son and an 8 yr old ADHD daughter. I have had the worst luck in finding doctors that will listen, including my current doctor who thinks the internet causes more harm than good. How can I find a doctor for both my children and myself?
The results of the trials follow:(1) In a 6-week quality cleocin 150mg, placebo-controlled trial (n=149) involving two fixed olanzapine doses of 1 and 10 mg/day (once daily schedule) purchase 150mg cleocin with visa, olanzapine purchase 150mg cleocin with mastercard, at 10 mg/day (but not at 1 mg/day) cleocin 150 mg with amex, was superior to placebo on the PANSS total score (also on the extracted BPRS total), on the BPRS psychosis cluster, on the PANSS Negative subscale, and on CGI Severity. There was no clear advantage for the high dose group over the medium dose group. Examination of population subsets (race and gender) did not reveal any differential responsiveness on the basis of these subgroupings. In a longer-term trial, adult outpatients (n=326) who predominantly met DSM-IV criteria for schizophrenia and who remained stable on olanzapine during open label treatment for at least 8 weeks were randomized to continuation on their current olanzapine doses (ranging from 10 to 20 mg/day) or to placebo. The follow-up period to observe patients for relapse, defined in terms of increases in BPRS positive symptoms or hospitalization, was planned for 12 months, however, criteria were met for stopping the trial early due to an excess of placebo relapses compared to olanzapine relapses, and olanzapine was superior to placebo on time to relapse, the primary outcome for this study. Thus, olanzapine was more effective than placebo at maintaining efficacy in patients stabilized for approximately 8 weeks and followed for an observation period of up to 8 months. Monotherapy -- The efficacy of oral olanzapine in the treatment of acute manic or mixed episodes was established in 2 short-term (one 3-week and one 4-week) placebo-controlled trials in patients who met the DSM-IV criteria for Bipolar I Disorder with manic or mixed episodes. These trials included patients with or without psychotic features and with or without a rapid-cycling course. The primary rating instrument used for assessing manic symptoms in these trials was the Young Mania Rating Scale (Y-MRS), an 11-item clinician-rated scale traditionally used to assess the degree of manic symptomatology (irritability, disruptive/aggressive behavior, sleep, elevated mood, speech, increased activity, sexual interest, language/thought disorder, thought content, appearance, and insight) in a range from 0 (no manic features) to 60 (maximum score). The primary outcome in these trials was change from baseline in the Y-MRS total score. The results of the trials follow:(1) In one 3-week placebo-controlled trial (n=67) which involved a dose range of olanzapine (5-20 mg/day, once daily, starting at 10 mg/day), olanzapine was superior to placebo in the reduction of Y-MRS total score. In an identically designed trial conducted simultaneously with the first trial, olanzapine demonstrated a similar treatment difference, but possibly due to sample size and site variability, was not shown to be superior to placebo on this outcome. Approximately 50% of the patients had discontinued from the olanzapine group by day 59 and 50% of the placebo group had discontinued by day 23 of double-blind treatment. Response during the open-label phase was defined by having a decrease of the Y-MRS total score to(1) In one 6-week placebo-controlled combination trial, 175 outpatients on lithium or valproate therapy with inadequately controlled manic or mixed symptoms (Y-MRS >/=16) were randomized to receive either olanzapine or placebo, in combination with their original therapy. Olanzapine (in a dose range of 5-20 mg/day, once daily, starting at 10 mg/day) combined with lithium or valproate (in a therapeutic range of 0. Olanzapine (in a dose range of 5-20 mg/day, once daily, starting at 10 mg/day) combined with lithium or valproate (in a therapeutic range of 0. Agitation Associated with Schizophrenia and Bipolar I Mania The efficacy of intramuscular olanzapine for injection for the treatment of agitation was established in 3 short-term (24 hours of IM treatment) placebo-controlled trials in agitated inpatients from two diagnostic groups: schizophrenia and Bipolar I Disorder (manic or mixed episodes). Each of the trials included a single active comparator treatment arm of either haloperidol injection (schizophrenia studies) or lorazepam injection (bipolar mania study). Patients enrolled in the trials needed to be: (1) judged by the clinical investigators as clinically agitated and clinically appropriate candidates for treatment with intramuscular medication, and (2) exhibiting a level of agitation that met or exceeded a threshold score of >/=14 on the five items comprising the Positive and Negative Syndrome Scale (PANSS) Excited Component (i. In the studies, the mean baseline PANSS Excited Component score was 18. The primary efficacy measure used for assessing agitation signs and symptoms in these trials was the change from baseline in the PANSS Excited Component at 2 hours post-injection. Patients could receive up to three injections during the 24 hour IM treatment periods; however, patients could not receive the second injection until after the initial 2 hour period when the primary efficacy measure was assessed. The results of the trials follow:(1) In a placebo-controlled trial in agitated inpatients meeting DSM-IV criteria for schizophrenia (n=270), four fixed intramuscular olanzapine for injection doses of 2. All doses were statistically superior to placebo on the PANSS Excited Component at 2 hours post-injection. However, the effect was larger and more consistent for the three highest doses. There were no significant pairwise differences for the 7. Olanzapine for injection was statistically superior to placebo on the PANSS Excited Component at 2 hours post-injection. Olanzapine for injection was statistically superior to placebo on the PANSS Excited Component at 2 hours post-injection. Oral ZYPREXA is indicated for the treatment of schizophrenia. The efficacy of ZYPREXA was established in short-term (6-week) controlled trials of schizophrenic inpatients ( see CLINICAL PHARMACOLOGY ). The effectiveness of oral ZYPREXA at maintaining a treatment response in schizophrenic patients who had been stable on ZYPREXA for approximately 8 weeks and were then followed for a period of up to 8 months has been demonstrated in a placebo-controlled trial ( see CLINICAL PHARMACOLOGY ). Nevertheless, the physician who elects to use ZYPREXA for extended periods should periodically re-evaluate the long-term usefulness of the drug for the individual patient ( see DOSAGE AND ADMINISTRATION ). Acute Monotherapy -- Oral ZYPREXA is indicated for the treatment of acute mixed or manic episodes associated with Bipolar I Disorder. The efficacy of ZYPREXA was established in two placebo-controlled trials (one 3-week and one 4-week) with patients meeting DSM-IV criteria for Bipolar I Disorder who currently displayed an acute manic or mixed episode with or without psychotic features ( see CLINICAL PHARMACOLOGY ). Maintenance Monotherapy -- The benefit of maintaining bipolar patients on monotherapy with oral ZYPREXA after achieving a responder status for an average duration of two weeks was demonstrated in a controlled trial ( see Clinical Efficacy Data under CLINICAL PHARMACOLOGY ). The physician who elects to use ZYPREXA for extended periods should periodically re-evaluate the long-term usefulness of the drug for the individual patient ( see DOSAGE AND ADMINISTRATION ). Combination Therapy -- The combination of oral ZYPREXA with lithium or valproate is indicated for the short-term treatment of acute manic episodes associated with Bipolar I Disorder. The efficacy of ZYPREXA in combination with lithium or valproate was established in two placebo-controlled (6-week) trials with patients meeting DSM-IV criteria for Bipolar I Disorder who currently displayed an acute manic or mixed episode with or without psychotic features ( see CLINICAL PHARMACOLOGY ). ZYPREXA IntraMuscular is indicated for the treatment of agitation associated with schizophrenia and bipolar I mania. The efficacy of ZYPREXA IntraMuscular for the treatment of agitation associated with schizophrenia and bipolar I mania was established in 3 short-term (24 hours) placebo-controlled trials in agitated inpatients with schizophrenia or Bipolar I Disorder (manic or mixed episodes) ( see CLINICAL PHARMACOLOGY ). ZYPREXA is contraindicated in patients with a known hypersensitivity to the product. For specific information about the contraindications of lithium or valproate, refer to the CONTRAINDICATIONS section of the package inserts for these other products. Increased Mortality in Elderly Patients with Dementia-Related Psychosis -- Elderly patients with dementia-related psychosis treated with atypical antipsychotic drugs are at an increased risk of death compared to placebo. ZYPREXA is not approved for the treatment of patients with dementia-related psychosis ( see BOX WARNING ). In placebo-controlled clinical trials of elderly patients with dementia-related psychosis, the incidence of death in olanzapine-treated patients was significantly greater than placebo-treated patients (3. Risk factors that may predispose this patient population to increased mortality when treated with olanzapine include age >/=80 years, sedation, concomitant use of benzodiazepines or presence of pulmonary conditions (e. Cerebrovascular Adverse Events, Including Stroke, in Elderly Patients with Dementia-Related Psychosis -- Cerebrovascular adverse events (e. In placebo-controlled trials, there was a significantly higher incidence of cerebrovascular adverse events in patients treated with olanzapine compared to patients treated with placebo. Olanzapine is not approved for the treatment of patients with dementia-related psychosis. Hyperglycemia and Diabetes Mellitus -- Hyperglycemia, in some cases extreme and associated with ketoacidosis or hyperosmolar coma or death, has been reported in patients treated with atypical antipsychotics including olanzapine. Assessment of the relationship between atypical antipsychotic use and glucose abnormalities is complicated by the possibility of an increased background risk of diabetes mellitus in patients with schizophrenia and the increasing incidence of diabetes mellitus in the general population. Given these confounders, the relationship between atypical antipsychotic use and hyperglycemia-related adverse events is not completely understood.
Fall and winter seasonal affective disorder symptoms include: Loss of interest in once-pleasurable activitiesDifficulty thinking and concentratingSeasonal depression in the summer is somewhat different buy cleocin 150 mg otc. Rather than experiencing the marked low mood of depression purchase cleocin 150mg amex, more irritable characteristics may come out discount cleocin 150mg without a prescription. Typical spring and summer seasonal depression symptoms include:Irritability buy cleocin 150 mg visa, agitationLack of appetite, weight lossWhile some people think they have to "tough out" seasonal depression, there is no need for this as there are effective seasonal depression treatments available. Treatments for seasonal affective disorder include psychotherapy, antidepressant medication and SAD bright light therapy. While seasonal depression is thought to be related to biological factors, psychotherapy is still a treatment option. Therapy for seasonal depression disorder can both teach the patient about their illness as well as support the patient through depressive episodes. Psychotherapy can also treat any underlying condition that may be contributing to the seasonal depression. Medications are also used in seasonal depression treatment, particularly if the symptoms are severe. Medications typically used in seasonal depression treatment include:Modafinil (Provigil) ??? there is preliminary data suggesting a wakefulness promoting agent may be used to prevent fatigue during the day as well as decrease depressive symptoms. Bright light therapy is the most common seasonal depression disorder treatment. Bright light therapy attempts to increase the amount of "sunlight" received via a specialized light box. Patients spend a set period of time per day in front of their light box to treat seasonal depression. The way in which bright light therapy works, however, is unclear. According to the National Mental Health Association:Approximately 12 million women in the United States experience clinical depression each year. About one in every eight women can expect to develop clinical depression during their lifetime. The diagnostic criteria for depression in women is the same as for men, but women with depression more frequently experience guilt, anxiety, increased appetite and sleep, weight gain and comorbid eating disorders. Over the course of a lifetime, depression occurs in approximately 20% of women compared with 12% of men. Although the exact reason for this difference is not known, biological, life cycle and psychosocial factors may relate to the higher rate of depression in women. Hormones and depression in women may also be linked. Researchers have shown hormones directly effects the brain chemistry controlling emotions and mood. For example, depression in women is particularly common after giving birth, when hormonal and physical changes, along with the new responsibility of caring for a newborn, can be overwhelming. About 10%-15% of women will develop postpartum depression, a serious condition that requires active treatment. Some women may also be susceptible to a severe form of premenstrual syndrome (PMS) called premenstrual dysphoric disorder (PMDD). PMDD affects mood and is thought to occur due to the hormonal changes that happen around ovulation and before menstruation begins. The transition into menopause also seems to affect hormones and depression in women. Family or personal history of mood disordersLoss of a parent before the age of tenHistory of childhood physical or sexual abuseUse of an oral contraceptive, especially one with a high progesterone contentUse of gonadotropin stimulants as part of infertility treatmentPersistent psychosocial stressors (e. The diagnosis of depression requires the presence of depressed mood or diminished pleasure (anhedonia), plus four other symptoms for at least two weeks. Significant weight change or appetite disturbanceSleep disturbance (insomnia or hypersomnia)Recurrent thoughts of death, suicidalSymptoms should not meet criteria for a mixed episode (ie, for both manic and depressive episode). Symptoms are not better accounted for by bereavement (ie, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation). Diagnostic and Statistical Manual of Mental Disorder, Text Revision. Washington, DC: American Psychiatric Association; 2000. The presentation and course of depression in women is sometimes different to that of men (Table below). Seasonal depression is more common in women as are the symptoms of atypical depression (i. In addition, women more frequently have symptoms of anxiety, panic, phobia and eating disorders. Women also have a higher incidence of hypothyroidism, a condition that is one of the causes of depression in women. Finally, exogenous and endogenous gonadal steroids may have a greater impact on depression in women than depression in men. Association with stressful social eventsAtypical symptoms (such as oversleeping or overeating)Feelings of guilt and anxietyWomen attempt suicide more frequently while men successfully commit suicide more often. Association with eating disordersAssociation with substance useAssociation with thyroid disease, migrainesAssociation of antisocial, narcissistic and obsessive-compulsive personalitiesEffect of exogenous and endogenous gonadal steroids on moodDepression is a significant risk factor for suicidal behavior in both sexes. Depressed women more often attempt suicide, whereas men more often complete suicide. In fact, the male-to-female ratio for completed suicides is greater than four-to-one, possibly because women with depression frequently choose less lethal methods like poisoning. Significant risk factors for suicide by depressed women are listed below. This screening may provide an opportunity for lifesaving intervention for women in depression. Poisoning is the method employed in 70% of all suicide attempts by women; so initially, women with depression may only be prescribed one week of antidepressants at a time. Hospitalization is necessary for women with severe depression, psychosis, substance abuse, severe hopelessness or limited social support. Women with depression should also be hospitalized if they articulate or display a strong urge to act on suicidal thoughts or if they have a specific suicide plan that is likely to be successful. Estrogen-serotonin interactions: implications for affective regulation. Depression is a debilitating illness that one-in-eight women can expect to experience in their lifetime and is characterized by prolonged periods of a low, or depressed, mood. Female depression symptoms meet the same diagnostic criteria as those for men according to the Diagnostic and Statistical Manual of Mental Illness.
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