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Carbonell: The treatment for agoraphobia order carvedilol in india blood pressure medication good for kidneys, (lots of avoidances caused by fear of panic attacks) depends on getting better at managing the attacks cheap carvedilol generic blood pressure low symptoms, then gradually re-entering the feared situations buy carvedilol cheap online heart attack high. In your case, dealing with people - a little at a time. With PTSD, where there are flashbacks and recall of a traumatic event, effective treatment involves ways of dealing with the traumatic memories of the past. Mistymare4: My anxiety totally revolves around going in public and driving like work, grocery shopping etc.. David: Would you say that agoraphobia is the most difficult anxiety disorder to recover from? But I think the most difficult one is the one you have. Lexio: What if the fear of going crazy causes your panic attacks? So you need some coping techniques to help you pass the time until the attack passes. David: Here is a comment, then a question on generalized anxiety disorder:ogramare: Anxiety medications have pretty well eliminated my panic but I am left with a giant case of Generalized Anxiety Disorder (GAD). I can feel really nervous with no mental stimulation, no panic and no apparent reason. This may be off-topic for this discussion as I have not been here before. Carbonell: In my experience, when someone with GAD also has a history of panic, the generalized anxiety is usually a form of anticipatory anxiety. Physical tension, limiting your movements, all manner of "self protective" measures like these can maintain the generalized anxiety. Carbonell, for being our guest tonight and for sharing this information with us. And to those in the audience, thank you for coming and participating. We have a very large and active community here at Healthyplace. The weekend is almost here:)Our conference tonight is on "OCD: What Can Be Done To Help". Claiborn from the OCD (Obsessive-Compulsive Disorder) mail list where he responds to "ask-the-expert" questions. Claiborn is a member of the scientific advisory board of the Obsessive Compulsive Foundation. At his "day job" though, one of the things he does is provide cognitive-behavioral therapy to adult OCD sufferers. Very briefly, because maybe we have some visitors tonight who are learning about Obsessive-Compulsive Disorder for the first time, what is it and how do you know if you have it? Claiborn: OCD is well-named as it is a disorder where people have obsessions and/or compulsions. Obsessions are ideas thoughts, images, impulses, etc. Compulsions are things people do often, over-and-over, in a stereotyped way to reduce their distress. The disorder is diagnosed if a person is suffering from these and it takes up significant time or causes interference with functioning in life. Some children may get it as a reaction to strep infections. We also know that it is not caused by bad toilet training, as Freud used to think. David: You provide cognitive-behavioral therapy to help OCD sufferers.

Personality disorders are adaptive solutions in the given circumstances carvedilol 12.5mg overnight delivery 1 5. It is true that order 6.25mg carvedilol amex blood pressure medication bruising, as circumstances change purchase carvedilol 6.25mg amex blood pressure medication vasotec, these "solutions" prove to be rigid straitjackets, maladaptive rather than adaptive. But the patient has no coping substitutes available. No therapy can provide him with such a substitutes because the whole personality is affected by the ensuing pathology, not just an aspect or an element of it. How is the patient supposed to cope with the world then, a world that has suddenly reverted to being hostile, abandoning, capricious, whimsical, cruel and devouring just like it was in his infancy, before he stumbled across the magic of splitting? We discussed various aspects of narcissism in the workplace, including how to recognize a narcissist, what personality types can work with a narcissist and how to cope with a narcissistic employer. Welcome to and our chat conference on "Narcissism in the Workplace. And when is it time to toss in the towel and leave that troublesome job? Vaknin is not a therapist or medical doctor of any sort. However, he is an expert on the subject of narcissism and a self-proclaimed narcissist. Just so we are all clear on the subject, can you give us a brief overview of what narcissism is? Narcissists are driven by the need to uphold and maintain a false self. They use the False Self to garner narcissistic supply which is any kind of attention adulation, admiration, or even notoriety and infamy. Vaknin: It is close to impossible and that is the secret of their astounding success. They are adept at charming others, persuading them, manipulating them, or otherwise influencing them to do their bidding. He focuses on potential sources of supply and engulfs them with focused attention and simulated deep emotions. Only in later encounter, as time passes and the number of interactions grows, is it possible to tell that someone is a narcissist. Narcissists are preoccuopied with grandiose fantasies unrealistic plans. They are bullies and often resort to verbal and emotional abuse. They have no empathy and regard their co-workers as mere instruments objects, tools, and sources of adulation, affirmation, or potential benefits. Later, what kind of behaviors should a person expect from the: (1) narcissistic boss and (2) colleague? Vaknin: Workplace narcissists seethe with anger and resentment. The gap between reality and their grandiose flights of fancy (the "grandiosity gap") is so great that they develop persecutory delusions, resentment and rage. They are also extremely and pathologically envious, seeking to destroy what they perceive to be the sources of their constant frustration: a popular co-worker, a successful boss, a qualified or skilled employee. Narcissists at work crave constant attention and will go to great lengths to secure it - including by "engineering" situations that place them at the center. They are immature, constantly nagging and complaining, finding fault with everyone and everything, Cassandras who constantly predict impending doom. They firmly believe in teir own omnipotence and omniscience. They feel entitled to special treatment and are convinced that they are above Man-made laws, including the rules of their place of employment. They are very disruptive, poor team members, can rarely collaborate with others without being cantankerous and quarrelsome. They are control freaks and feel the compulsive and irresistible urge to interfere in everyting to micromanage and overrule others. David: If you work with or under a narcissist, it sounds like your work life might be a living hell.

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To assess the significance of gender over sexual orientation on reported psychological intimacy purchase generic carvedilol on-line arrhythmia that makes you cough, gender was substituted for sexual orientation in a second model buy cheap carvedilol 25 mg blood pressure goes up when standing. The four factors that contributed significantly to psychological in the first model did not change substantially in this second model buy 25mg carvedilol amex hypertension and exercise, and the gender of participants had a moderate effect on the results (B =. That finding is compatible with those of Parks and Floyd (1998), who argued that gender role identification of males and females is not as powerful a factor in shaping intimacy in friendship relationships as may be assumed. This study focused selectively on a sample of 108 heterosexual and same- gender partners in 216 relationships that had lasted an average of 30 years. The results suggested that factors within relationships themselves had a more powerful effect in shaping the meaning of psychological intimacy than did social and demographic factors. Perhaps, a reason that these relationships endured was that these factors nurtured a sense of psychological intimacy that contributed to relational stability. The data offer hypotheses for exploration and testing in future research on lasting relationships. In addition to the factors that had a shaping effect on psychological intimacy in recent years, subtle differences were found between lesbian and other participants. Differences based on gender and sexual orientation suggest a subtle interacting dynamic of these factors on psychological intimacy in relationships that last. We suggest that a mutually reinforcing dynamic between two women committed to personal and relational development may explain the subtle yet important differences between lesbian couples and the other couples in this study. We hope that these findings and our observations about them will be helpful to other researchers engaged in the study of lasting relationships. Source: Sex Roles: A Journal of ResearchBerscheid, E. Sexual exclusivity versus sexual openness in gay male male couples. Psychological merger in lesbian couples: A joint ego psychological and systems approach. A study of perceptions of rights and needs in interpersonal conflicts in homosexual relationships. Re-examining gender differences in same-genderfriendships: A close look at two kinds of data. Lesbian couples: The implications of sex differences in separation-individuation. Therapy for male couples experiencing relationship problems and sexual problems. Predicting marital unhappiness and stability from newlywed interactions. Attachment as an organizational framework for research on close relationships. Prototypes of intimacy and distance in same-sex and opposite-sex relationhips. Journal of Social and Personal Relationships, 4, 195-233. HyperRESEARCH: A tool for the analysis of qualitative data. A guide to conducting consensual qualitative research. Sex, power, and influence tactics in intimate relationships. Journal of Personality and Social Psychology, 51, 102-109. Self-disclosure: An experimental analysis of the transparent self New York: Wiley. Gender issues in heterosexual, gay male and lesbian couples. Relationship outcomes and their predictors: Longitudinal evidence from heterosexual married, gay male cohabiting, and lesbian cohabiting couples.

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Mary Fleming Callaghan: She still maintains a low body weight purchase carvedilol 6.25 mg line blood pressure x large cuff, but she has always been thin since the time she was little purchase carvedilol canada hypertension word parts. She certainly no longer evaluates every piece of food she puts into her mouth buy carvedilol zithromax arrhythmia. Bob M: Do you, and other family members, still worry about her Mary? Emily: Mary, was there ever a conclusion as to why Kathleen became sick with an eating disorder? Mary Fleming Callaghan: I think it was because she was so immature emotionally. She could avoid the stresses of teenage life if she stayed little and protected by family. Bob M: So now, we at least have an understanding of the family dynamics. Can you give us some insight into your experiences with the various doctors and hospitals and eating disorders treatment programs your daughter went through. What was YOUR experience with these people and institutions? Mary Fleming Callaghan: Twenty years ago, it was entirely different than it is today. They had to find a scapegoat, so the family was convenient, especially mothers. Of the twelve doctors and therapists that Kathleen had over the years, we found two that we could work with. I think you have to be honest with them and not allow them to send you on a guilt trip. Parents should do what these parents are doing here tonight. They should try to find out as much as they can about the disorder and go from there. You can view the transcripts on eating disorders here. I am interested, how much money did you spend out of your pocket and through insurance to get to the point of recovery? And many parents are also dealing with the stress of money problems. Now, and especially at the time your daughter was in the throws of her eating disorder? I have always felt tremendous sympathy for the parents of bulimics. Bob M: Put yourself in this position know a girl who has an eating disorder. Bob M: Thank you Mary for coming tonight and sharing your insights and hard-learned lessons with us. Amy is the webmistress of the site and really does a wonderful job. There is so much information on eating disorders there. Good evening Amy and welcome to the Concerned Counseling website. Can you start by telling us a bit more about your eating disorder and how it started? I am in recovery for Anorexia and have been suffering with it for approximately 11 years (since I was about 16). There are a number of " anorexia causes " that I feel played a role... Compulsive exercise type is driven by the compulsion to over-exercise to burn calories and energy.

These events included psychomotor slowing order carvedilol paypal heart attack 60, difficulty with concentration/attention purchase carvedilol now arrhythmia 10, speech disorders/related speech problems and language problems cheap carvedilol 6.25 mg free shipping blood pressure medication omeprazole. The most frequently reported neuropsychiatric events in pediatric patients during adjunctive therapy double-blind studies were somnolence and fatigue. The most frequently reported neuropsychiatric events in pediatric patients in the 50 mg/day and 400 mg/day groups during the monotherapy double-blind study were headache, dizziness anorexia, and somnolence. No patients discontinued treatment due to any adverse events in the adjunctive epilepsy double-blind trials. In the monotherapy epilepsy double-blind trial, 1 pediatric patient (2%) in the 50 mg/day group and 7 pediatric patients (12%) in the 400 mg/day group discontinued treatment due to any adverse events. The most common adverse event associated with discontinuation of therapy was difficulty with concentration/attention; all occurred in the 400 mg/day group. Sudden Unexplained Death in Epilepsy (SUDEP) During the course of premarketing development of TOPAMAX^ (topiramate) Tablets, 10 sudden and unexplained deaths were recorded among a cohort of treated patients (2,796 subject years of exposure). Although this rate exceeds that expected in a healthy population matched for age and sex, it is within the range of estimates for the incidence of sudden unexplained deaths in patients with epilepsy not receiving TOPAMAX^ (ranging from 0. Hyperammonemia and Encephalopathy Associated with Concomitant Valproic Acid Use Concomitant administration of topiramate and valproic acid has been associated with hyperammonemia with or without encephalopathy in patients who have tolerated either drug alone. Clinical symptoms of hyperammonemic encephalopathy often include acute alterations in level of consciousness and/or cognitive function with lethargy or vomiting. In most cases, symptoms and signs abated with discontinuation of either drug. This adverse event is not due to a pharmacokinetic interaction. It is not known if topiramate monotherapy is associated with hyperammonemia. Patients with inborn errors of metabolism or reduced hepatic mitochondrial activity may be at an increased risk for hyperammonemia with or without encephalopathy. Although not studied, an interaction of topiramate and valproic acid may exacerbate existing defects or unmask deficiencies in susceptible persons. In patients who develop unexplained lethargy, vomiting, or changes in mental status, hyperammonemic encephalopathy should be considered and an ammonia level should be measured. In the double-blind monotherapy epilepsy study, a total of 4/319 (1. As in the general population, the incidence of stone formation among topiramate treated patients was higher in men. Kidney stones have also been reported in pediatric patients. An explanation for the association of TOPAMAX^ and kidney stones may lie in the fact that topiramate is a carbonic anhydrase inhibitor. The concomitant use of TOPAMAX^ with other carbonic anhydrase inhibitors or potentially in patients on a ketogenic diet may create a physiological environment that increases the risk of kidney stone formation, and should therefore be avoided. Increased fluid intake increases the urinary output, lowering the concentration of substances involved in stone formation. Hydration is recommended to reduce new stone formation. Paresthesia (usually tingling of the extremities), an effect associated with the use of other carbonic anhydrase inhibitors, appears to be a common effect of TOPAMAX^. Paresthesia was more frequently reported in the monotherapy epilepsy trials and migraine prophylaxis trials versus the adjunctive therapy epilepsy trials. In the majority of instances, paresthesia did not lead to treatment discontinuation. The major route of elimination of unchanged topiramate and its metabolites is via the kidney. Dosage adjustment may be required in patients with reduced renal function (see DOSAGE AND ADMINISTRATION ). In hepatically impaired patients, topiramate should be administered with caution as the clearance of topiramate may be decreased. Patients taking TOPAMAX^ should be told to seek immediate medical attention if they experience blurred vision or periorbital pain.

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