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Q.

"I have uneven thoughts, irritation, sleeplessness, lack of concentration and headaches. Mental illness runs in my family - should I seek treatment?"



A. All of the symptoms you mention are suggestive of depression depending on how severe the feelings are and how long you have felt them. If you have experienced them consistently for more than two weeks it might be a good idea to at least seek an evaluation. Usually, these symptoms are a reaction to an upsetting event, a loss of some kind, divorce, a death or other change in your life. Often depression runs in families. If so, you are at a higher risk for developing the condition. If you are concerned because the symptoms are not going away by themselves, seeing a mental health professional is the way to go. Cognitive behavioral therapy sometimes in combination with antidepressants, can return your feelings of well-being and give you important tools for dealing with your life circumstances. Antidepressants alone are not the answer without having the new ways of looking at your life and putting things in a proper perspective.



Q.

"Is hoarding a sign of mental illness and can treatment help?"



A. Yes, hoarding is a sign of mental illness (obsessive compulsive disorder, attachment disorder and depression). It is also associated with dementia and frequently affects the elderly. About one in 1000 people are affected, slightly more women than men but it crosses all races and socioeconomic groups equally. The mayo clinic defines hoarding as the “ excessive collection of items that have no value”, newspapers,stacked from floor to ceiling, trash, food kept in containers for months or years and the inability to discard them. The collections usually represent health and safety hazards and hoarders may also neglect their own health and proper hygiene. The situation goes way beyond “pack-rat” and helpful attempts to remove or clean the hoarders home are met with resistance and even belligerence. The mental illness allows them to remain in denial. Hoarders are attached to things not people and have limited insight into the problem and less desire to change it. If you suspect that you may be becoming a hoarder, get help as soon as possible. For anyone trying to help a hoarder you must gain their trust first, be patient and have low and slow expectations for change.



Q.

"Are alcohol blackouts and the behavior during a black out two separate things? Are you still conscious and fully aware of your actions but not able to store them in your long-term memory? Doesn’t alcohol just reduce your inhibitions and it does not “change” your personality (you just follow instinct and natural impulses) or is it totally different during a blackout?"



A. Alcoholic blackouts are most commonly triggered by consuming large amounts of alcohol over a short period of time. Sometimes people are conscious during the blackout but have no recall or only partial recall of their acts during them. These so called fragmentary blackouts usually respond to reminders if someone who witnessed the behavior brings them to mind. Full blackouts on the other hand, do not respond to reminders and the person may have no recall whatsoever of their actions while experiencing a blackout. During a blackout, a person has impaired judgement and a reduced ability to make good decisions. Frequently, their behavior is erratic and of a high risk nature like driving a car, engaging in unprotected sex, shop-lifting, vandalism and fighting both verbal and physical. Genetics can determine blackout susceptibility, some studies show up to 50% of drinking induced blackouts are genetically predetermined. Environmental risks include the previously mentioned drinking on an empty stomach, or drinking large amounts of alcohol in a short period of time. Blackouts are not the same as passing out after drinking too much because the person with the blackout is still functioning and appears to be conscious. Many researchers believe that blackouts are associated with a high tolerance to alcohol and indicate a predisposition to alcohol dependency or alcoholism. The only way to avoid blackouts completely is obviously not to drink. If a person does experience them they should interpret them as a warning to stop drinking and take responsibility and get help for this serious and potentially dangerous response to alcohol consumption.



Q.

"Can Chronic Fatigue Syndrome and depression be related and how are these conditions treated?"



A. Chronic fatigue syndrome (CFS) and depression share many of the same symptoms but are not necessarily related. Symptoms of each include poor sleep, loss of appetite, tiredness, reduced libido, low energy and depressed mood. Psychotherapy, particularly cognitive behavioral therapy as well as antidepressant medication are effective treatments of choice with depression. Causation in CFS however is different but may also respond to antidepressant medication. The risk here is that the root cause of CFS may be masked and the real illness will go undiagnosed and untreated effectively. CFS may be a result of undiagnosed medical problems such as lyme disease, hormonal disturbances etc. If you have tiredness not relieved by sleep, poor sleep, joint pains and a feeling of malaise or flu-like symptoms it could be CFS and a through medical work-up by someone who specializes in the diagnosis and treatment of CFS is recommended.



Q.

"Are alcohol blackouts and the behavior during a black out two separate things? Are you still conscious and fully aware of your actions but not able to store them in your long-term memory? Doesn’t alcohol just reduce your inhibitions and it does not “change” your personality (you just follow instinct and natural impulses) or is it totally different during a blackout?"



A. Alcoholic blackouts are most commonly triggered by consuming large amounts of alcohol over a short period of time. Sometimes people are conscious during the blackout but have no recall or only partial recall of their acts during them. These so called fragmentary blackouts usually respond to reminders if someone who witnessed the behavior brings them to mind. Full blackouts on the other hand, do not respond to reminders and the person may have no recall whatsoever of their actions while experiencing a blackout. During a blackout, a person has impaired judgement and a reduced ability to make good decisions. Frequently, their behavior is erratic and of a high risk nature like driving a car, engaging in unprotected sex, shop-lifting, vandalism and fighting both verbal and physical. Genetics can determine blackout susceptibility, some studies show up to 50% of drinking induced blackouts are genetically predetermined. Environmental risks include the previously mentioned drinking on an empty stomach, or drinking large amounts of alcohol in a short period of time. Blackouts are not the same as passing out after drinking too much because the person with the blackout is still functioning and appears to be conscious. Many researchers believe that blackouts are associated with a high tolerance to alcohol and indicate a predisposition to alcohol dependency or alcoholism. The only way to avoid blackouts completely is obviously not to drink. If a person does experience them they should interpret them as a warning to stop drinking and take responsibility and get help for this serious and potentially dangerous response to alcohol consumption.



Q.

"What are more common symptoms of severe depression?"



A. Clinical depression is severe depression. People with it note a marked contrast with their previous lives where feelings of well being normally predominate. The signs of clinical depression must exist for at least two weeks prior to making a diagnosis and symptoms include; problems sleeping, sadness, anxiety, loss of interest, problems concentrating at work or school, irritability, feelings of hopelessness and worthlessness and thoughts of death or suicide as a solution. Depression is not a transitory bad mood or a bad day. It lasts and interferes drastically with a person’s life and relationships. It can be genetic or a result of devastating losses such as death of a loved one, serious personal illness, loss of job or financial security. It can be treated with medication and cognitive behavioral therapy sometimes, hospitalization is indicated.



Q.

"What are the characteristics of Dependent Personality Disorder?"



A. People with Dependent Personality Disorder act anxious, nervous, clingy and fearful. They believe they are helpless, ask for constant reassurance and have trouble making decisions. They often seek out relationships in which they can be dependent and sometimes stay in harmful or abusive partnerships to avoid being alone, often quickly beginning another dependent relationship as soon as the last one ends. They believe they are unable to care for themselves and will remain submissive for fear of losing approval. They are not self-starters and in their fear of criticism or disapproval will put the needs of their caregivers above their own. Dependent Personality Disorder is first noticeable in young adults who find the demands of adulthood frightening and overwhelming. The problem is equally dispersed between men and women and it is thought that this condition may have biological origins and that overly strict, critical or domineering parenting can induce the symptoms. People with this condition often seek therapy in a crisis, but real change can occur only when the individual can accept the real source of their problem i.e. their own faulty belief system. Cognitive Behavioral Therapy and Assertiveness training can be helpful in reversing learned helplessness and giving the person more confidence.



Q.

"Can Chronic Fatigue Syndrome and depression be related and how are these conditions treated?"



A. Chronic fatigue syndrome (CFS) and depression share many of the same symptoms but are not necessarily related. Symptoms of each include poor sleep, loss of appetite, tiredness, reduced libido, low energy and depressed mood. Psychotherapy, particularly cognitive behavioral therapy as well as antidepressant medication are effective teatments of choice with depression. Causation in CFS however is different but may also respond to antidepressant medication. The risk here is that the root cause of CFS may be masked and the real illness will go undiagnosed and untreated effectively. CFS may be a result of undiagnosed medical problems such as lyme disease, hormonal disturbances etc. If you have tiredness not relieved by sleep, poor sleep, joint pains and a feeling of malaise or flu-like symptoms it could be CFS and a through medical work-up by someone who specializes in the diagnosis and treatment of CFS is recommended.



Q.

"What is Asperger’s Syndrome?"



A. Asperger’s Syndrome is a Developmental Disorder that is first noticeable in early childhood. It is difficult to diagnose and there is no cure. However, when the diagnosis is made early, before age 2, there are effective treatments and training programs that are helpful. Signs of Asperger’s can be seen in the first 12 months of a baby’s life. Asperger babies are often irritable, cry frequently and are difficult to comfort. They may not seem cuddly or responsive to the parent’s voice or touch. Verbal cooing and smiling in recognition of a parents face by 6-9 months or not using words by 16 months can be signs of Asperger’s. However, there is a range of normal development and one or two symptoms, in isolation, are not enough to confirm a diagnosis of Asperger’s. A trained mental health professional or your child’s pediatrician should be contacted with any concerns regarding your child’s verbal or social development. Older children with Asperger’s have a hard time with social interaction. They many not display appropriate reactions or facial expressions. They may have good language development but their conversations may seem odd unusual or hard to follow. They may develop particular interests in things to the exclusion of other interests i.e. human anatomy, dictionaries, airplanes, dinosaurs or other narrow topics that may appear intellectual but have become obsessive. The world view of Asperger’s children is different from other children and they have trouble making or keeping friends. They seem self-centered and easily annoyed. They have frequent meltdowns and seem clumsy. They often suffer from depression because they perceive their social isolation without understanding it. Psycological help is available for children and adults with this condition. Early diagnosis and treatment is best but anyone who suffers from this problem can find ways to deal with their world and find some level of happiness with the proper help.



Q.

"My daughter was diagnosed as bi polar when she was a teenager. At that time she was a rapid cycler with full blown manic outbreaks: rages, drinking, drugs, physical reactions, etc. She never accepted the diagnosis, always, blaming me for the multiple hospitalizations, etc. After a brief time moving from place to place, including sleeping in her vehicle at times, she seemed to calm down. Recently, she has entered an episode where she is very hostile, irratic, lying, and still blaming everything on her mother. Her children are living in fear of her outbreaks and are starting withdraw from others and even lying to maintain peace. Her husband is taking a medication for depression, but maintains a basically neutral demeanor when she is not around. Although the problems started in November, the behaviors increased significantly when she underwent some medical tests: sonogram, nuclear stress and cardiac catherization. Is it possible the chemicals used during these procedures could have triggered this swing? What would you recommend? It is impossible to even mention these changes to her and most people are terrified of her outrage episodes? Intervention is also very difficult because, she seems to be able to control when and to whom she acts out?"



A. The only way an adult with an emotional disorder or any illness, for that matter, can hope to improve is to take responsibility for their own treatment. Supportive parents, extended families and friends can help but not if the person with the diagnosis does nothing to help themselves or follow professional advice. Your question indicates that you have taken over the responsibilities belonging to your daughter and she reacts to that by blaming you. It is important for you to minimize the damage to yourself, and her children. Support groups for the families of bi-polar disorder, individual therapy to learn the boundaries of your ability to help, child protective services if you think the children are at risk, all can be useful and become part of a team effort to withstand the very difficult moments. But no fundamental change can be anticipated until a bi-polar person accepts their need for help.



Q.

"How can I tell if my child is abusing drugs and /or alcohol?"



A. Parents frequently express worry that their child may be using drugs or alcohol. It is never to early to ask these questions or to begin conversations about substance abuse with your children. Children with a history of untreated Attention Deficit Hyperactivity Disorder (ADD, ADHD) or family histories of depression and addiction are at particular risk. Signs to look for include mood changes, change of friends or social group, increased secrecy, missing money or other saleable objects around the home, poor school performance, truancy. The child may change his or her clothing style to appear more apart of the drug culture, breath mints or incense may be used to cover odors. If a parent suspects that their child is using drugs a trip to the pediatrician is advisable to do a urine test. Parents should not hesitate to directly ask their child the hard questions. If a child is being secretive and displaying signs of drug abuse the parent should not hesitate to look through the child’s room to look for evidence of the problem. Children who take drugs and abuse alcohol are often trying to be “cool” or rebelling in some way. It can also be a way for a child with depression or untreated ADD to self-medicate and these children are at special risk for addiction. Catching this problem early is the job and responsibility of parents so that needless complications of behavior and addiction are avoided.



Q.

"Please comment on ways to help children relieve stress during tests. With all the New York State requirements I’m worried my teenager will not do well because of the stress level."



A. Your question indicates that parents also often have stress about how well their children perform on tests. It is important not to convey your anxiety to your child by making it seem that any one grade or test result is a make or break point in his or her life. Some anxiety about tests can be a good thing because it can serve as a motivator to do the pre-test work that will make your child become a good test taker. The best way to approach a test is by looking at it as part of the learning process. Weeks and months are usually spent by classroom teachers preparing their students for the Regents Exams. A child who has worked to the best of his ability all along, ie. attended class, done his homework in an organized, purposeful and comprehensive way will have more confidence as the test approaches. Working on Regent’s preparatory books and taking sample tests will also be helpful. Hard work and good preparation are the best defense against test-taking anxiety. Then, when the test is presented to your child he must remind himself not to panic, take a moment to look the test over, understand the directions, breathe slowly and remember that he has worked hard and is now well prepared.



Q.

"My wife’s general practitioner & psychiatrist believe that she is manic depressive, but her sister has talked her out of taking any medications as she does not believe in doctors or medication. She now refuses to see her doctors and I am having great difficulty in coping with her wild mood swings & neglect of our children. I would appreciate your assistance."



A. Medication non-compliance is a relatively common problem in people with bi-polar disorder for a variety of reasons.  People may find the side effects of their medication intolerable or, they may discontinue taking medications as soon as they start to feel better. They might not be convinced that they have bi-polar disorder, believing that it is someone else’s fault that they are so unhappy and angry. Many people believe that it is a weakness to need medication or that there will be long term harmful physical consequences to taking the medications. Treatment of bi-polar disorder must address all of these issues in the initial stages of the diagnosis in order to insure better compliance. Treatment of bi-polar disorder with medication (usually lithium carbonate) is 80% successful and can return the person  with the diagnosis to a normal life.
Medication alone is not the answer, however, for people with bi-polar disorder. Treatment should also include learning new coping skills and finding out ways to predict their mood swings and what triggers them.  Also, spouses, parents ( in the case of children with the disorder) and other key family members might be brought into a patients’ therapy sessions  to insure that a consistent and accurate amount of information is provided and to allow the patient to work out with them ways for the family to help.  This allows everyone to be on the same page and thus more skilled in efforts to  support the patient.  Regular and frequent psychotherapy sessions increase the compliance rate in people with the disorder once they have formed a trusting relationship with their therapist. Untreated, bi-polar disorder is a roller-coaster ride for the person with it and for their family. It is the responsibility of anyone who is given this diagnosis to take it seriously and learn as much as they can about it so that they can prevent the often disastrous consequences of the disorder for themselves and their loved ones.



Q.

"Attachment Disorder, What is it?  What to expect?"



A. An Attachment Disorder has its origins in infancy.  It is the result of physical separation from parents due to inconsistent parenting, separations for long periods, legal removal as a result of neglect, physical abuse or alcohol and drug abuse. The trauma to the infant is not due to these things alone, although they create their own set of problems, but rather to the separation itself. The sound of the parents’ voice or even his or her smell and touch become familiar to the infant and are associated with comforting, nurturing, warmth and above all security. The loss of these things or the unpredictability of these things is extraordinarily disruptive to the child’s ability to develop trusting relationships and the damage can be life-long, preventing any successful relationship formation in the person’s life. Children who are adopted from orphanages, at the moment primarily from China, or who have had several foster placements from infancy may have had adequate physical care but no primary attachment to a consistent care-giver. Studies show that good physical care in the absence of a consistent, nurturing relationship with a parent or primary caregiver is not enough to prevent the development of an Attachment Disorder.  Children with this condition may appear distant, make poor eye contact and resist hugs or other emotional involvements. They often don’t experience normal separation anxiety. They may cry or fuss and seem inconsolable when there is no physical reason for their distress.  On the other hand, these children may be extremely gregarious and treat everyone they meet as a long lost loved one. They can be overly and inappropriately affectionate. Children with Attachment Disorder can develop the trust necessary to build relationships but it takes time.  Often lots of time. The treatment is time, patience, dedication and love from caregivers who don’t go away. Consistency, solid routines as they grow, loving limits and discipline are what it takes to reverse an Attachment Disorder. A good relationship with the child’s Pediatrician and a Developmental Psychologist can also help parents and the child through difficult times. Ideally, all the helping professionals in the child’s life should remain the same. Residential moves, changes of school or any lengthy separations from parents must be prepared for well in advance and perhaps avoided altogether in the early stages of the relationship. 



Q.

"Does my child have an Auditory Processing Disorder?"



A. Auditory processing is simply what your brain does when you ears hear sound. Your brain interprets that sound so that you can react accurately to it. As a child develops language, he is not just learning new words but he is also categorizing them, developing sentence structure, syntax and subtle nuances of meaning. A person who has normal verbal processing skills develops language that is fluid and in harmony with his thinking. Proper language development results in the child’s ability to learn, understand his world, receive and interpret social cues and develop behavioral controls. People with an Auditory Processing Disorder have difficulty understanding what they hear not because they can’t hear but because they can’t make sense out of what they hear. A child with Auditory Processing Disorder often looks like he or she is not paying attention but it is more than simple distractibility or ADHD; memory, concentration, carrying on a conversation, and learning are monumental tasks for a person who cannot make sense out of words or key phrases. They also often have behavioral problems because proper language allows us to internalize verbal directions and rules of everyday life. Although these children typically have normal intelligence they have difficulty with reading, reading comprehension, sequencing and math. They often require more time to process information and complete tasks. Vocabulary building and spelling ability also lag behind. Social skills suffer and these children frequently have trouble making friends because they don’t understand or have misunderstood what their peers are saying to them. Anger, frustration and depression can result from these deficits. These children often feel lonely and like they just don’t fit in. If you suspect that your child may be suffering from an Auditory Processing Disorder he or she should have a comprehensive speech and language evaluation, audiology exam to evaluate your child’s hearing and psychological evaluation to determine affected cognitive areas. Once a diagnosis is made, your child’s school will become involved to assure proper teaching techniques are used and to make special programming available. Often these children require speech and language tutors or extra time to finish their work, preferential classroom seating to reduce distractions and improve concentration as well as strategies to improve your child’ organizational and sequencing skills.



Q.

"How does daily organization and structure contribute to ADHD therapy?"



A. Once a valid diagnosis has been made with the help of a psychologist, the child’s teachers, pediatrician and family, several treatment methodologies will come into play. First of all medication, is often recommended because it has been found to be the most effective treatment for ADHD. However, a pill alone will not advance a child’s academic progress or social controls without a behavioral program that is consistently administered both at home and at school. The child must begin to take responsibility for improving his attention span,organization planning, judgement, academic performance and social interaction. Cognitive behavioral therapy and the use of positive reinforcement can greatly improve a child’s academic motivation and judgement. By using “thinking techniques” learned through cognitive behavioral therapy and “words” rather than impulsive actions the child can learn to delay his demands for instant gratification and reduce impulsive behavior. Cognitive behavioral therapy teaches a child to slow down and think things through calmly before acting. Positive reinforcement for meeting goals and a place to go both at home and in school where a child can sort things out for himself and take a time out from the imminent stress can improve confidence and eliminate “meltdowns”.Parents must be taught the value of creating a schedule, even if the child spends time between two parental households, with consistent expectations for doing homework,going to bed and getting up at the same time every day, keeping the backpack and bedroom well organized, having the things necessary for school ie paper, pens and pencils in good order and readily at hand go a long way toward decreasing the frustrations of ADHD. Parents must be willing to take a hands -on approach to their child’s academic, social and organizational tasks. Do home work together, clean his room together and organize his backpack together. This helps the child to feel less overwhelmed and more supported as he begins to reverse the effects of ADHD. Have some fun each night taking turns reading a story together. This will help your child value reading because it becomes a positive experience with his parent and makes reading fun. Often tutoring in reading and math are recommended to help the ADHD child catch up, speech and occupational therapy may also be helpful. Sometimes a child with ADHD may require special services ie. an aide or other accommodations to help him through his day.



Q.

"Is it possible for a person to be diagnosed  Bipolar & with a personality disorder in their 50’s? I have always had a problem with relationships and wondered if it was a result of this disorder."



A. Often bi-polar disorder, especially bi-polar II the less serious form,  can  unfortunately be undiscovered or misdiagnosed for years.  The nature of these disorders  is that people with them can go for long periods of time in a depressed and irritable state and are often treated simply for depression.  The manic phase of bi-polar disorder may be characterized  by irritability and poor judgement but also with feelings of elation, overconfidence, high energy etc.  People with the disorder are often not troubled by their symptoms during this phase although people around them may be.  The diagnosis of a Personality disorder can encompass many types of behavior and shares symptomatology with bi-polar disorder especially in the manic stage.  People with either or both can act impulsively, self-destructively, exhibt poor judgement , have trouble sleeping and seem to have blind spots as to how their behavior affects others.  Consequently, people with these problems often have difficulty with trust , believing that they need help and fail to develop close ties with family and friends.  There is often a lack of insight with both conditions which makes it hard for the sufferer to see their role in their own difficulties with keeping jobs, friends or good family relationships. It is possible for people to have both conditions ar the same time.    Therapy with such individuals is to help them to understand their problem, its effect on them and others and develop new ways of thinking so they become capable of  improving their lives.  Medication is also used in the case of the bi-polar disorders to help people avoid their extremes of mood fluctuation.



Q.

"I am a 37 year old female with four kids. I have recently had a lot of stress in my life - my father passed away due to cancer. I am on anti-depression medication but recently my hair started falling out as well as my joints are painful. Should I be worried?"



A. Alopecia or hair loss and painful joints can be stress related symptoms. Alopecia may be an auto-immune disorder with genetic underpinnings brought on by stress. Symptoms such as these should always be brought to the attention of your medical doctor for further diagnosis and treatment. However, the combination of grieving plus the raising of four children are presenting you with a great source of stress. The anti-depressant medication can be very helpful but brief, grief-focused psychotherapy could be beneficial as well in providing a trained professional who can objectively guide and support you  and give you strategies for successfully navigating yourself and your family through it.



Q.

"I have trouble making eye contact with other people. Why is that and what can I do about it?"



A. An ancient proverb says that the eyes are the window to the soul. We instinctively know that meeting someone’s gaze provides an instantaneous but none the less special connection to another human being. Many factors may be involved in your difficulty making eye contact. Among them are shyness, social phobia, social avoidance and even Asperger’s syndrome. Many individuals feel nervous when meeting new people. We want to make a good impression and we want people to like and admire us. All of the above mentioned problems have their start in childhood and probably have a genetic origin. Help comes in the form of learning desensitization and relaxation techniques as well as getting to the root cause, that is, an individual’s belief system. If a person believes that they are being judged and criticized in social settings they well may never feel comfortable and will find socializing difficult. They may avoid social or family gatherings and begin to feel isolated and alone. Techniques can be learned to confront this faulty thinking and replace negative self evaluations with positive ones. Over time the individual learns ways of thinking which allow positive social connections to develop. As a start make an effort to hold someone’s gaze to the silent count of five. Practice this and with guidance from a therapist who understands social phobias and shyness great improvement can be achieved.



Q.

"My 10 year old daughter is slightly overweight. I’ve recently noticed that she hides how much she is eating. Should I be concerned that she is developing an eating disorder?"



A. The development of eating disorders in pre-pubescent girls is a common phenomenon today. A child ,who is slightly overweight, and hiding how much she is eating, may be feeling ashamed of her weight and could be at risk of developing an eating disorder. Most girls who develop eating disorders at a young age have illogical ideas about nutrition and the reasons for their weight gain. A combination of genetic, social and familial causes must be examined. We know that there can be a genetic predisposition in families toward obesity. If that is the case, than a concerted effort shoud be maintained to see that family members understand their risk (for heart disease, diabetes etc.) and what is reasonable to do about it. A nutritionist can provide an at-risk family with nutrition ideas, meal plans and advice. Eating disorders are almost unknown in poor, third world countries. It is in developed, wealthy, western countries where eating disorders are at epidemic proportions. Our media and magazines are filled with “role-models” of skinny young women and pop-stars who set unrealistic body-image standards for young girls. Some families may put too much emphasis on thinness and body image. Mothers or older female relatives who are constantly dieting, exercising or talking about their weight will send the wrong message to younger females in the household. It is important for parents to avoid criticizing or commenting too frequently on their child’s weight or eating habits because this could cause a child to become secretive about eating. If you think your child is developing an eating disorder it is extremely important to bring your concern to the attention of your child’s health care professional. Early diagnosis and treatment are crucial to the prevention of a chronic and potentially fatal illness.



Q.

"I have a huge fear of making presentations in front of large audiences. My hands start to shake, feel weak. I’ve always been shy but need to overcome this fear, also lose confidence in these situations. My fears are getting worse. What could be done to help?"



A. Performance anxiety or stage fright is a common problem for public speakers, musicians, teachers or anyone who must stand in front of an audience large or small. Public speaking is dreaded by most people but anxiety and the uncomfortable and distracting physical side effects can be minimized and controlled. Those physical side effects are the result of an adrenaline release in response to a fight or flight reaction,i.e., a faulty and primitive belief that you are under attack by something. Symptoms include dry mouth, sweating, hyperventilation, shaking, nausea and increase in blood pressure. Usually, stage fright is the result of thinking that you are being judged harshly or negatively by your audience. So the first place to start is by changing that faulty belief system into something more positive, like believing that your audience is looking forward to what you will tell them, or that you are doing a service for them instead of focusing on yourself. Other ways involve practicing relaxations techniques such as guided imagery or deep breathing. Of course the best way to avoid anxiety is preparation and practice. Those who have to speak often usually desensitize themselves after a while and the anxiety lessens over time. Sometimes this crucial step is not given enough emphasis because the person may want to avoid the performance situation for as long as possible. For the most part, performance anxiety is isolated and in direct response to a specific event of public performance. However, it can be related to larger issues of social phobia and avoidance. Short-term psychotherapy can be helpful in increasing confidence and establishing healthy belief systems which can eliminate stage fright. Medications such as beta-blockers which block the effects of adrenaline can be helpful in extreme cases. These medications can have unwelcomed side effects and should only be used under direction of your physician.



Q.

"What is Panic Disorder and how is treated?"



A. Panic disorder is an anxiety disorder which can begin in the late teens or develop at any time in adulthood. It effects more women than men and may have a genetic basis. Untreated, it can be seriously incapacitating. People experiencing it for the first time often think they are having a heart attack or that they are going to die. Events and places associated with the attacks are feared or avoided since people assume it was the person or place which caused the problem. Symptoms include: heart palpitations, rapid shallow breathing, nausea, dizziness, sweating and fear of death. Often they occur “out of the blue” and are not necessarily related to any stressful or scary event taking place at the time of the panic attack. People who have had them live in dread of experiencing another and often avoid venues associated with the attacks increasing their social isolation and incapacitation. Panic attacks usually last 15-45 minutes. They are caused physiologically by an adrenaline surge which triggers a “fight or flight” response. This is a primitive physical defense system which we all have to protect us from life threatening circumstances. In Panic Disorder, the adrenaline surge is not a reaction to the circumstances we are experiencing but rather to the thoughts we are having at the moment. Treatment can involve various anti-anxiety medications and antidepressants which have an anti-anxiety effect. Cognitive Behavioral Therapy can help the individual understand and identify the thoughts which are causing him or her to “panic”. Initially a combination of medication and therapy are important to prevent or slow down the occurrence of the panic attacks and provide techniques which help to recognize the thoughts and faulty belief systems which are causing the panic attacks.


Dr. Woods' Roll in Wellness

Dr. Susan Woods, a licensed psychologist, has been in private practice in Schenectady since 1983. Dr. Woods received her masters degree from Columbia University and her Doctorate in Psychology from the University of Michigan. Her doctoral research concentrated on Attention Deficit and Hyperactivity Disorder. This research was one of the first studies to show that ADD/ADHD affected children who were medicated with Ritalin type medications were less likely to use illegal drugs, commit crimes or drop out of school than children who were not medicated. Her training included internships at children’s psychiatric hospitals, mental health clinics, family court and public schools.

Dr. Woods has a special interest in working with children, adolescents, and adults with ADD/ADHD, Eating Disorders, Bipolar Disorder, Depression and Anxiety, along with their families. Couples counseling is an important part of Dr. Woods’ practice as well. Separation and divorce can be destructive to every member of a family. Therapy aims to preserve the marriage if possible but if not to guide the couple and their children through this painful process in order to minimize its negative effects.

Dr. Woods provides a homey, comfortable office where children and adults alike can feel safe and secure in discussing their problems and goals in life.

Dr. Woods encourages an atmosphere where realistic change can occur while people regain the ability to take charge of their lives by thinking clearly through to reasonable and rational solutions to their problems.


This general Information is not intended to provide individual advice. Please make an appointment with a physician to discuss you particular situation and needs.
 

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