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There are about 300 cases of pregnancy exposure to citalopram (Celexa) and approximately 250 for paroxetine (Paxil) acne 19 years old purchase accutane 5 mg with visa, sertraline (Zoloft) acne 7 months postpartum purchase 10 mg accutane fast delivery, or fluvoxamine (Luvox) combined acne 8th ave generic 40 mg accutane with amex, accumulated from one study acne information buy accutane australia. Although these are in the same class as fluoxetine acne practice discount accutane 40 mg buy, conclusions that we make must be based on data for that specific medicine, not the class. Another critical issue: We have very few good data on the risk of long-term neurobehavioral effects associated with prenatal exposure to psychiatric medications. One study of children followed through age 6 found no differences between those exposed to fluoxetine or tricyclics in utero and those not exposed to an antidepressant. Data suggesting that the rates of perinatal toxicity or low birth weight are higher in babies exposed to fluoxetine in utero are profoundly flawed. Interestingly, women with similar illness histories who are given the same information regarding reproductive safety of these drugs often make very different decisions about how to proceed. For example, a woman who is on bupropion (Wellbutrin), for which we have almost no reproductive safety data, would be best served by switching to a drug like fluoxetine or even imipramine. We never discontinue antidepressants around the time of labor because depression during pregnancy is one of the strongest predictors of postpartum depression. The potential for antidepressant withdrawal symptoms in babies born to women on antidepressants is a theoretical concern, but there is nothing more than a rare anecdote suggesting that such symptoms are something about which we need to be concerned. Depakote) taken during pregnancy carry a significant risk of producing birth defects in the baby, but alternatives are available. Two of the agents widely used to treat bipolar illness are established teratogens. Sodium valproate is associated with a risk as high as 8% for major congenital malformations, most notably, neural tube defects and cardiac malformations, according to recent data from the North American Antiepileptic Drug (AED) Pregnancy Registry. This increased risk for major organ malformations associated with first trimester exposure to these compounds raises concerns about the possible risk of longer term neurobehavioral sequelae associated with prenatal exposure. Several studies published over the last few years have consistently shown an association between developmental delay and an increased risk for behavioral problems associated with in utero exposure to anticonvulsants, particularly sodium valproate (Depakote). This growing literature has suggested associations between in utero exposure and higher rates of problems ranging from mild behavioral disruption in school, attention-deficit disorder, and other behavioral problems characterized by hyperactivity, autistic-like behaviors, and problems with learning, speech delay, and gross motor delay. One study of 52 children exposed to anticonvulsants in utero found that 77% had developmental delay or learning difficulties when followed up at a mean age of 6- m years; 80% had been exposed in utero to sodium valproate (J. In another prospective study, children born to women with epilepsy were assessed between ages 4 months and 10 years. The risk of adverse outcomes, including developmental delay, was higher among those exposed to sodium valproate than carbamazepine (Tegretol). Most of the cases were children born to women who received sodium valproate doses that were greater than 1,000 mg/day (Seizure 2002;11:512-8). These studies were not ideally designed and have inherent methodologic limitations. Eventually, we will have long-term prospective data on children exposed in utero to anticonvulsants. These data will come from the North American AED Registry. Until then, however, the findings of these studies are consistent enough to indicate that in utero exposure to anticonvulsants may have neurotoxic effects; this appears to be the case particularly with sodium valproate monotherapy and polytherapy. The potential for neurobehavioral sequelae is an issue that has not been adequately factored into the risk-benefit decision for treating women with epilepsy or bipolar disorder during pregnancy. For women with epilepsy, the situation is more difficult, since seizures during pregnancy are associated with particularly bad perinatal outcomes. But for bipolar disorder, we have a spectrum of treatment options. Often women and their physicians choose to discontinue a psychotropic drug in the first trimester, and they assume that therapy can safely be reintroduced during the second trimester. Still, the data on potential behavioral toxicity, particularly with sodium valproate, should make one pause before reinstituting treatment with sodium valproate during the second and third trimester - Mand the data should raise the question of whether this is an appropriate medicine to be using at any point during pregnancy in women with bipolar illness. The goal is to keep women emotionally well during pregnancy and to avoid relapse during pregnancy. Prenatal exposure to a drug is sometimes necessary to sustain well-being of patients. Nevertheless, recent data have indicated that the risk of polycystic ovarian syndrome is increased in women treated with sodium valproate. When this finding is considered with the teratogenicity data for sodium valproate and its possible longer term neurobehavioral sequelae, one has to reconsider the wisdom of using this medication in reproductive-age women, particularly since some of the treatment alternatives for bipolar illness are either less teratogenic or appear to be nonteratogenic. Reproductive-age women who want to become pregnant or who are already pregnant should consult their physicians about alternative treatment strategies that can be continued throughout pregnancy. Such alternatives are lithium or lamotrigine (Lamictal), both of which may be used with or without one of the older typical antipsychotics, which do not appear to be teratogenic. Our goal is to avoid exposure to a drug with known teratogenicity with respect to organs, and quite probably, with respect to behavior. Lee Cohen is a psychiatrist and director of the perinatal psychiatry program at Massachusetts General Hospital, Boston. He is a consultant for and has received research support from manufacturers of several SSRIs. He is also a consultant to Astra Zeneca, Lilly and Jannsen - manufacturers of atypical antipsychotics. Early data shows that lamotrigine (Lamictal) may be safe for treating bipolar women who are pregnant. As the use of anticonvulsants to treat bipolar illness has grown over the past decade, so has the number of women successfully treated with these medications who have questions about whether they should discontinue these drugs before they attempt to conceive, or what to do if they are already pregnant. The anticonvulsants that have been most widely used for bipolar illness are sodium valproate and carbamazepine, and more recently, gabapentin (Neurontin), lamotrigine (Lamictal), oxcarbazepine (Trileptal), and tiagabine (Gabitril). Until recently, there have been few reproductive safety data available on the newer anticonvulsants. Many women and their physicians are caught in a particularly vexing bind because two of the mainstays of bipolar therapy, lithium and sodium valproate (Depakote), are known teratogens, though the teratogenicity of these two compounds is particularly different. The risk associated with first-trimester exposure ranges from a relatively modest 0. The latter is based on recent findings from the Antiepileptic Drug Registry at Massachusetts General Hospital (Am. But the data that are accumulating on lamotrigine, approved in June for maintenance treatment of bipolar disorder, provide some welcome news for reproductive-aged women with bipolar disorder. An interim report on cases collected by the lamotrigine pregnancy registry maintained by the manufacturer, GlaxoSmithKline, since September 1992 indicates that the drug does not appear to be teratogenic. The report does note, however, that the sample size is not large enough to make definitive conclusions. As of March, the pregnancy registry had collected information on more than 500 first-trimester exposures in women treated with Lamictal for bipolar illness and for epilepsy, which did not demonstrate an increase in major birth defects associated with first-trimester exposure, supporting earlier reports. The risk of teratogenicity was significantly increased with first-trimester exposure to the combination of lamotrigine and sodium valproate (more commonly used for epilepsy), but not with lamotrigine monotherapy: Among the 302 pregnancies exposed to monotherapy in the first trimester, there were 9 (3%) major birth defects, compared with 7 (10. The clinical implications of these long-awaited data on lamotrigine are relatively clear and present an opportunity to navigate the tricky course of maintaining euthymia across pregnancy and minimizing exposure to drugs that might be harmful to the fetus. For example, sodium valproate can be deferred for a medicine such as lamotrigine in some patients, particularly those who do not respond to or who have not tolerated lithium. Although lamotrigine has not demonstrated efficacy for the treatment of acute mania, the anticonvulsant can be combined with medicines that are helpful in treating this phase of bipolar disorder. Such adjunctive medicines include high-potency typical antipsychotics like haloperidol or trifluoperazine. Unfortunately, the reproductive safety data available for the newer atypical antipsychotic olanzapine (Zyprexa)--efficacious for both acute mania and for prophylaxis against recurrent mania--are exceedingly sparse. Clinicians are left with the task of trying to minimize exposure to medicines we know very little about, such as olanzapine, and to medicines we know a lot about that appear to be particularly harmful to the fetus, such as sodium valproate (Depakote). Lamotrigine is the only one of the newer anticonvulsants for which there are enough exposed cases to allow for some reliable quantification of teratogenic risk. Manufacturers of the other anticonvulsants have not established independent registries. The Antiepileptic Drug Registry at Massachusetts General Hospital is collecting data on a spectrum of newer anticonvulsants, but to date the numbers are too small for any conclusions, except on lamotrigine (Lamictal). One caveat with respect to use of lamotrigine lies in the very small but quantifiable risk of Stevens-Johnson syndrome associated with lamotrigine therapy. To reduce risk, the manufacturer recommends titrating patients gingerly, by no more than 25 mg weekly. More safety data on older antipsychotics make them first choice for use during pregnancy. Women typically have been counseled to avoid using psychiatric medications during pregnancy because of known or unknown risks of prenatal exposure to these medications. But data suggest that pregnancy does not protect women from new onset or relapse of psychiatric disorders. This is particularly true for women who have disorders such as schizophrenia or bipolar illness, which is also now treated with antipsychotics, according to Dr. Lee Cohen, director of the perinatal psychiatry program at Massachusetts General Hospital, Boston. Therefore, women with schizophrenia who stop their antipsychotics are at a great risk for relapse, at which point they frequently pursue behaviors that can be harmful to them and their fetuses, he noted. The newer atypical antipsychotics are becoming first-line treatment for many people with schizophrenia because they do not have some of the side effects of the older medications and they appear to result in better acute and long-term responses. They are also increasingly being used for a range of other psychiatric disorders, including obsessive-compulsive disorder, posttraumatic stress disorder, anxiety disorders, and depression. But most of the available reproductive safety data come from literature on the typical antipsychotics and are several decades old, he pointed out. These data suggest that there is no increased risk of congenital malformations associated with first-trimester exposure to high-potency antipsychotics like haloperidol (Haldol) or midpotency antipsychotics like perphenazine (Trilafon). There also appear to be no safety issues when these drugs are used in labor and delivery or postpartum, and there is literature suggesting that these agents are not problematic when used during lactation, said Dr. Cohen, also associate professor of psychiatry, Harvard Medical School, Boston. He and his associates also recommend that they not breast-feed while on an atypical agent until better safety data become available. Some patients do not respond to treatment with typical antipsychotics but respond only to an atypical agent. The manufacturer of olanzapine has developed a registry of fewer than 100 women exposed to this drug during pregnancy. Typical agents are increasingly being used for psychiatric disorders in women who may be more likely to bear children, such as those with anxiety or mood disorders, compared with those with schizophrenia. As a result, "we may be seeing more women on these drugs becoming pregnant, because they have less of an impact on fertility than the older drugs, which increase prolactin secretion," he pointed out. With the exception of risperidone, which causes relatively high rates of hyperprolactinemia, ziprasidone, quetiapine, olanzapine, and clozapine are prolactin-sparing compounds. An option for a woman with bipolar disease who is taking an atypical antipsychotic is to switch her to lithium during pregnancy. Source: This article originally appeared in ObGyn News. More information is needed regarding medications used to treat ADHD during pregnancy and while nursing. Learn about the effects of ADHD medications during pregnancy. Over the past decade, adults have been increasingly diagnosed with attention-deficit hyperactivity disorder (ADHD), including many women in their childbearing years. ADHD patients can be successfully treated with medications such as stimulants, the mainstay of treatment, followed by tricyclic antidepressants and bupropion (Wellbutrin). Women who have been stabilized on one of these medications and want to become pregnant often come to see us with questions about whether they should remain on the drug. What we advise these patients depends in part on the severity of their disorder. For these women, the risk of not being treated does not justify fetal exposure to a drug that we do not know much about or even a drug for which we have reassuring reproductive safety data. The more difficult clinical scenario is with women who unequivocally have severe ADHD that, if left untreated, could dramatically interfere with their functioning and potentially affect the outcome of their pregnancy. Stimulants such as methylphenidate (Ritalin) do not appear to be teratogenic as a class. But there are some data suggesting an association between in utero exposure to psychostimulants and poor fetal or neonatal outcomes, such as small for gestational age or intrauterine growth retardation. These data, however, are not from reports of women with ADHD, but largely from women abusing stimulants such as amphetamines who had other risk factors for poor neonatal or fetal outcomes. This makes it difficult to discern the independent risk associated with fetal exposure to stimulants. For women who need treatment in pregnancy, we often recommend a switch to a tricyclic antidepressant because of the robust data supporting the efficacy of these agents for treating ADHD and solid data supporting their reproductive safety. These data include studies showing no increased rate of major congenital malformations with first-trimester exposure. A switch to a tricyclic antidepressant would also be preferable for a woman on Wellbutrin despite evidence supporting its effectiveness in treating ADHD. Because there are only sparse data on its reproductive safety, we discourage use of this drug during pregnancy. Wellbutrin is a pregnancy category B compound, meaning that it has been categorized as fairly safe in pregnancy. However, this categorization is based on limited information that does not indicate a risk but is insufficient to rule risk out entirely. There are some data suggesting that selective serotonin reuptake inhibitors (SSRIs) are effective for ADHD in some people, but most studies do not show efficacy.

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Fortunately acne out- purchase generic accutane from india, Texas has a law requiring detailed reporting on the use of shock therapy skin care 911 best purchase accutane. As your story pointed out acne 14 dpo buy cheap accutane 20 mg line, vulnerable elderly women are the primary targets acne jacket accutane 10 mg order amex. Since introducing my bill acne under skin order accutane 20 mg with mastercard, I have met with and heard from scores of human "after-shock" victims who were treated like lab rats and now suffer permanent new afflictions such as memory loss, learning disabilities and seizure disorders. Few people are properly warned of the known dangers of shock treatment. People with different types of eating disorders take such concerns to extremes, developing abnormal eating habits that threaten their well-being and even their lives. This eating disorder information answers the question "What are eating disorders? They refuse to eat, exercise compulsively, and develop unusual eating habits such as refusing to eat in front of others; they lose large amounts of weight and may even starve to death. Bulimia Nervosa: Those with bulimia nervosa (often referred to as just bulimia) eat excessive quantities of food, and then purge their bodies of the food and calories by using laxatives, enemas, diuretics, vomiting and/or exercising. Often acting in secret, they feel disgusted and ashamed as they binge, yet relieved of tension and negative emotions once they have purged. Research emphasizes the importance of preventing problematic eating behaviors from evolving into full-fledged eating disorders. Anorexia and bulimia, for example, usually are preceded by very strict dieting and weight loss. Binge eating disorder can begin with occasional bingeing. According to eating disorders information provided by the National Institute of Mental Health, adolescent and young women account for 90 percent of cases. Older women, men and boys can also develop disorders ( Eating Disorder Facts: Who Gets Eating Disorders? An increasing number of ethnic minorities are also falling prey to these devastating illnesses. People sometimes have eating disorders without their families or friends ever suspecting they have a problem. Aware their behavior is abnormal, but perhaps not understanding why, people with anorexia, bulimia or binge eating may withdraw from social contact, hide their behavior and deny their eating patterns are problematic. Making an accurate diagnosis requires the involvement of a licensed psychologist or other appropriate health professional. Certain psychological factors predispose people to developing eating disorders. Dysfunctional families or relationships are one factor. Personality traits are commonly noted in research and other literature as also contributing. Most people with eating disorders suffer from low self-esteem, perfectionism, feelings of helplessness and intense dissatisfaction with the way they look. Physical factors, such as genetics, also may play a role in putting people at risk. Some examples are:Family members or friends may repeatedly tease people about their bodies, not aware this can be harmful. Individuals may be participating in gymnastics or other sports that emphasize low weight or a certain body image. Negative emotions or traumas such as rape, abuse, or the death of a loved one can also trigger eating disorders. Unfortunately, once people start engaging in abnormal eating behaviors, the problem can perpetuate itself. Eating disorder information and research indicates eating disorders are one of the psychological problems least likely to be treated. In fact, the National Institute of Mental Health estimates one in ten anorexia cases ends in death from starvation, suicide or medical complications like heart attacks or kidney failure. Inflammation of the esophagus (esophagitis)Cessation of menstruationOther problems associate with obesity or starvationEating disorders are also associated with other mental illnesses. Researchers are unsure whether the eating disorder causes the mental illness or vice versa. What is clear, however, is that people with eating disorders suffer higher rates of other mental illness - including depression, anxiety disorders and substance abuse - than other people. Through eating disorders therapy, psychologists play a vital role in the successful treatment of anorexia, bulimia and binge eating. They are integral members of the multidisciplinary team required to provide patient care and can be one of the sources of eating disorder information. Other members of this team include:Physician: to provide medical information, to rule out medical illnesses, determine any harm done to the person with the eating disorder, and provide medical attention, if necessary; prescribe medication, if necessaryNutritionist: to help assess, provide information on healthy eating, and improve nutritional intakeOnce the physician has ruled out medical complications, and possibly a nutritionist has been consulted, a psychologist identifies important issues needing attention. He will use the information gathered from the patient and others, including family members, to develop a treatment plan. To ensure lasting improvement, psychologists and patients must work together to explore the psychological issues underlying the eating disorder. Most eating disorders can be treated successfully by appropriately trained health and mental health care professionals. However, for many patients, treatment may need to be long-term and must initially include learning information about eating disorders. The longer abnormal eating patterns continue, the more deeply ingrained they become and the more difficult they are to treat. However, research indicates the prospects for long-term recovery are good for most people who seek help from appropriate professionals. Qualified therapists, such as licensed psychologists with experience in this area, can help those who suffer from eating disorders regain control of their eating behaviors and their lives. Eating disorders are serious emotional and physical problems that can have life-threatening consequences for both women and men. The following is a list of eating disorders and their symptoms. First on the eating disorders list is Anorexia Nervosa. Anorexia is characterized by self-starvation and excessive weight loss. The following are common anorexia symptoms:Refusal to maintain body weight at or above a minimally normal weight for height, body type, age, and activity levelIntense fear of weight gain or being "fat"Feeling "fat" or overweight despite dramatic weight lossLoss of menstrual periodsExtreme concern with body weight and shapSecond on our list of eating disorders is Bulimia nervosa, which centers around the bingeing and purging of food. Bulimia includes eating excessive amounts of food in short periods of time (often in secret), then getting rid of the food and calories through vomiting, enemas, laxative abuse, or over-exercising. Common symptoms include:Repeated episodes of bingeing and purgingFeeling out of control during a binge and eating beyond the point of comfortable fullnessPurging after a binge, typically by self-induced vomiting, abuse of laxatives, diet pills, diuretics, excessive exercise, or fastingHTTP/1. Eating disorders are serious and potentially life-threatening mental illnesses. By honestly answering the questions on the Eating Attitudes Test, you can find out if you should be professionally screened for an eating disorder. If you are looking for a shorter evaluation tool, take the eating disorders quiz. Eating Attitudes Test: About YouIf not enrolled in school, level of education completed:Ethnic/Racial Group: African AmericanDo you participate in athletics at any of the following levels:Please check a response for each of the following statements:1. Have gone on eating binges where I feel I may not be able to stop6. Particularly avoid food with a high carbohydrate content (bread, rice, potatoes, etc. Am preoccupied with the thought of having fat on my body22. Feel uncomfortable after eating sweetsPlease respond to each of the following Eating Attitudes Test questions:1. Have you gone on eating binges where you feel that you may not be able to stop? Have you ever made yourself sick (vomited) to control your weight or shape? Have you ever used laxatives, diet pills or diuretics (water pills) to control your weight or shape? NoTo score the Eating Attitudes Test follow this guide:For all items except #25 on the Eating Attitudes Test, each of the responses receives the following value:For item #25, the responses receive these values:After scoring each item on the Eating Attitudes Test, add the scores for a total that will help answer the question, "do I have an eating disorder? If you responded yes to any of the five YES/NO items on the bottom of the EAT, we also suggest that you discuss your responses with a counselor or your doctor. This eating disorder quiz is designed to help assess whether you may have an eating disorder. This eating disorder quiz will also help you reflect on the impact an eating disorder is having on your life. An eating disorder is a serious and possibly fatal mental illness and those with an eating disorder may not even know they have it. This quiz is designed to detect anorexia, bulimia, and binge eating disorders and may also detect if you are at risk for one of these eating disorders. For a longer evaluation tool, take the Eating Attitudes Test. Keep in mind this eating disorders quiz is not a substitute for a professional diagnosis. Any concerns about eating problems should be taken up with an eating disorder treatment professional. Honestly answer each of the questions in the following eating disorders quiz. Use the eating disorder quiz assessment at the bottom of the eating disorder quiz to evaluate your risk for an eating disorder. Are you inexplicably fatigued or cold in temperature? Do you avoid foods because of the fat, carbohydrate, or sugar content in them? Are you secretive or do you lie about your eating practices, do you think they are abnormal? Do you find you seek approval from people, and/or have a hard time saying "no" and/or a perfectionist, or an overachiever? Do you think you are not good enough, stupid, and/or worthless or people are always judging you in a negative way? Do you think life would be better and/or people would like you more if you were thin/thinner? Do you eat, self-starve, restrict, binge, purge, and/or compulsively exercise when you are feeling lonely, badly, or when you are feeling emotional pressures? While eating, self-starving, binging and/or purging do you feel comforted, relieved, like emotional pressures have been lifted, or like you are in more control? Do you feel guilty following a binge and/or purge episode, after eating or during and/or after periods of restriction/self-starvation? When eating do you ever feel out of control or like you will lose control; do you try to avoid eating because of this fear? Do you find that you bruise easily, have a very high tolerance for pain, and/or you are extremely noise sensitive? Do you spend a lot of time obsessively cooking for others, reading recipes, and/or studying nutritional information on food? Do you use self-injury (cutting yourself, burning yourself, pulling out your own hair) as a way to cope with things? Would you worry about a friend or family member that came to you with similar weight-loss/coping methods? Each of these eating disorder quiz questions can indicate an eating disorder if answered "yes" or "constantly. Print and take this quiz, along with your answers, and discuss the outcome with your health professional. Answering more than three questions with "maybe" or "often" should also be discussed with a health professional. Those answers indicate you may have an eating disorder or be at risk for developing an eating disorder. There are almost as many types of treatment for eating disorders as there are types of eating disorders themselves. This is because different eating disorders require different approaches and the severity of the eating disorder may dictate the treatment method chosen. The key lies in finding the right type of eating disorder treatment that works best for the individual. Help for anorexia and bulimia is generally available at medical care facilities, through private practitioners and through community or faith-based groups. Treatment types include:Acute, medical care, typically through a hospitalOngoing psychiatric care, possibly including medicationInpatient or outpatient programs, typically eating disorder specializedNutritional counselingPsychological counselingGroup therapy / Self-pacedMedical treatment for eating disorders, particularly acute, inpatient admission, is not generally required. The exception is when an eating disorder is so severe that the physical damage must be handled immediately, as in the case of an esophageal tear in a bulimic ( bulimia side effects ) or in the case of severe starvation in an anorexic ( anorexia health problems ). Medical treatment of an eating disorder that includes prescription medication is needed more frequently. In this case, medications are prescribed, generally by a psychiatrist and may be intended to help treat the eating disorder itself or any possible co-occurring mental illnesses, such as depression, which is common in those with anorexia or bulimia. Medications used in the treatment of eating disorders typically include:Selective serotonin reuptake inhibitors (SSRIs) - the preferred type of antidepressant; thought to help decrease the depressive symptoms often associated with some eating disorders. Fluoxetine (Prozac)Tricyclics (TCAs) - another type of antidepressant thought to help with depression and body image.

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With anorexia nervosa (AN) acne 2 weeks before period order cheap accutane online, there is less research and the treatment phase is longer skin care qvc accutane 10 mg buy low cost, but 60-70% of patients recover with treatment from a high quality eating disorders treatment facility acne free severe generic 20 mg accutane otc. Many patients recover after quite a number of relapses skin care lounge buy cheap accutane 5 mg on line. Bob M: What is the best form of treatment when it comes to making a significant or lasting recovery? Garner: The best studied treatment for both Anorexia and Bulimia is cognitive behavioral treatment (talk and behavioral modification therapy) acne 9 months after baby purchase accutane 20 mg without a prescription. However, for patients under 18, family therapy must be part of whatever treatment is offered. Garner from folks who want to know, is hospitalization the most effective way to deal with an eating disorder, followed by intensive outpatient therapy or can you just get therapy on a weekly basis? Garner: I do not think that hospitalization is necessary or desirable for most patients- intensive outpatient treatment or day hospitalization has replaced inpatient treatment for the most part. Most bulimic patients benefit from outpatient therapy and severe eating disorders usually require something more than weekly, outpatient therapy. Rhys: How does one become a strong anti-dieter and not gain weight? Garner: It is, that is why most people decide on some level to opt for trying to continue to suppress their weight. Modest weight gain may occur even in treatment for bulimia. Peppa: What if you really have no other issues and the eating disorder is just in you? Most people with eating disorders can do very well with treatment. Bob M: This is the second time you have used the term "quality treatment". Garner: It means treatment that emphasizes both the nutritional rehabilitation as well as dealing with psychological issues. This does not mean, encouraging patients to restrict their food intake to low levels of calories (e. What do you recommend for those 19-25 year olds who are working through the developmental issues of separating from their parents? What is the best way to help parents understand what is happening? Often the person with the disorder is stuck having to tell their family alone. So how do they go about telling them in order that they can believe her and support her? Garner: I agree that family therapy should not be limited to those below 18 yrs- it is just that it is mandatory for those who are living at home or who are financially dependent of their family. Garner has touched on an area that I am dealing with now. I have uncovered some severe trauma in my childhood years well into my teens. Could this be the reason I have been dealing with this eating disorder for 26 years? Although I have been in a recovery program since April, I feel like this will never end. Garner: Often an eating disorder gets worse when the traumatic issues are uncovered; however, this should subside soon. Treatment should assist you in identifying the issues and then, move beyond them. Garner: Then there is something wrong with your parents. Would they do the same thing if you were taking drugs, engaging in other self-harm?? Garner: Unfortunately, parents can be inept and it is unfortunate that you are suffering. It is possible to consult school counselors or sometimes, even if parents are in denial, they will agree to allow their teenager seek treatment. JerrysGrlK: What about people over 25 with a eating disorder? How do you overcome the fear and take the first step to get help? Garner: Knowing that eating disorders can be cured is reassuring. A phone call to an experienced therapist, just to ask about what treatment involves, is the first step. Garner: As I said earlier, it is impossible for you to make headway with the personality disorder or other significant problems as long as you are bingeing or vomiting or starving. Some people find that their so-called personality disorder goes away once they stop the aforementioned symptoms. So, tackle the eating disorder and see what is left. I personally have experienced that naivety of parents with children who have eating disorders and other mental health problems. There are some parents out there unfortunately who do not let their children get help. My suggestion would be to speak with a school counselor, someone associated with your church or synagogue, call your family doctor. See if these people will call your parents and try and make an impact. Garner just sent me a great comment: "How do we make parents competent? Is there is significant difference in the way anorexia and bulimia are treated, Dr. Anorexia and bulimia nervosa share many features in common, so it is not surprising that approaches to therapy for both disorders overlap to a significant degree. Common approaches are recommended for both disorders to address characteristic attitudes about weight and shape. Education about regular eating patterns, body weight regulation, starvation symptoms, vomiting and laxative abuse, is a strategic element in the treatment of both disorders. Finally, similar behavioral methods are also required, particularly for the binge eating /purging subgroup of anorexia nervosa patients. Nevertheless, there are differences in the treatment recommendations made for these two eating disorders. This may partially reflect differences in the personalities, background and training of the main contributors to the literature for these two eating disorders. However, key distinctions can be made between these disorders based on motivation for treatment and weight gain as a target symptom, both requiring variations in the style, pace, and content of therapy. Bob M: So then, the key question, if weight concerns are the major issue, and people with eating disorders always talk about the "voices" they hear about how "fat" they are, what is the most effective way of ending those concerns. What should people who want to recover be concentrating on when it comes to that issue? Garner: The topic of body weight is approached from an entirely different perspective for anorexia and bulimia nervosa. Experts in the treatment of bulimia nervosa recommend that bulimia nervosa patients should be told that in most cases treatment has little or no effect on body weight, either during treatment itself or afterwards. In anorexia nervosa, this reassurance is not available since weight gain is a major aim of treatment. The significance of this contrast cannot be overemphasized. I do not know how to actually make those voices go away. The first study I did 20 years ago attempted to solve this. Rather, you need to ignore the voices, kind of like a color blind person learning to ignore false signals about color. Bob M: And when a person feels a relapse or difficult period coming on, what are the most effective ways to deal with that? Garner: It should be stressed that vulnerability to eating disorder symptoms can continue for many years, even if there is recovery from eating symptoms. A valuable strategy in avoiding relapse is remaining alert to areas of potential vulnerability. These include vocational stress, holidays, and difficult interpersonal relationships as well as major life transitions. Patients may become distressed if they continue to gain weight. Patients without any overt symptoms may remain quite sensitive about weight and shape. They need to be prepared for encounters with people who may have seen them at a low body weight. During the termination phase of treatment, patients need to practice adaptive cognitive responses to well intentioned comments like "I see you have gained weight" or "my, how you have changed". Patients may even need to be prepared for occasional callous comments about their weight. Vulnerability to relapse increases during periods of psychological distress. Susceptibility to relapse may also increase with positive life-changes and enhanced self- confidence. Fresh relationships, career advancement, increased physical fitness and overall improvement in self-confidence can activate latent beliefs like "now that things are going so well, maybe I can lose a bit of weight and things will be even better". Patients need to be reminded that weight loss is enticing and insidious in its effects. Initial results may be positive; however, the adverse impact on mood and eating are inevitable over time. OMC: Why do you think there is no cure for such a deadly disease as anorexia, although it has been researched for generations? Garner: Many patients do completely recover from anorexia, just like with other disorders. It has only been carefully researched for the past 20 years. ZZZ I SHOULD DIE: Which type of eating disorder would you say is the hardest for a person to recover from? Garner: Anorexia-- when the person is at a very low weight and is B/V. Starvation effects make it very hard to relate to others and to focus on any aspect of treatment. Garner regarding eating disorders being viewed as an addiction. So many individuals with these disorders seem to sell themselves out to the fact that it is a disease or an addiction and that they are untreatable. Even recently, I have had family members say that I have only gotten worse over the last five years. But the truth is I had to go to the bottom to rebuild my way back up. ZZZ I SHOULD DIE: I have had an eating disorder for as long as I can remember. I was abducted at the age of 5 by a stranger and raped among other things. I want to quit throwing up, and I have gone as long as 3 weeks, but I always go to another destructive behavior and then back to throwing up and laxatives. Garner think that nutritional advice is a part of the psychotherapeutic process? On the subject of relapsing and when to return to treatment: People with eating disorders should have a low threshold for returning to treatment. It is not uncommon for patients to believe that a return to treatment would be a humiliating or unacceptable admission of failure. Common beliefs that interfere with re-initiating therapy are: "I should be able to do this on my own now; if I am having problems again, it means recovery is hopeless; the therapist will be disappointed or angry". Since patients commonly delay the reinitiating of treatment too long, a conservative approach is a good policy. If patients are not sure whether they should return for a follow-up consultation, this means that they should. Sometimes therapists need to define their role as a "family doctor" for eating disorders. Regular "check-ups" are prudent, and meetings at the earliest sign of relapse are the best protection against escalation of symptoms. Remain alert to warning signs of relapse: It is useful to review early signs of relapse with particular attention to weight or shape preoccupation, binge eating, precipitous weight gain, gradual or rapid weight loss and loss of menstrual periods. Patients need to ask themselves periodically: "Am I thinking too much about weight? HelenSMH: I was wondering, I received treatment called ECT (Electro Convulsive Therapy) for major depression. I was wondering should/can ECT help with eating disorders?

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Thoughts of suicide are serious at any age and require prompt attention acne blemishes accutane 5 mg buy low price. When panic disorder seriously interferes with school acne topical medications safe accutane 40 mg, socializing with friends acne while pregnant accutane 20 mg buy free shipping, or daily activities acne 38 weeks pregnant discount accutane 5 mg line, your child needs help skin care and pregnancy discount accutane 20 mg on-line. If panic attacks happen more than a few times in a month, or if an attack is very severe, get professional help. The symptoms may not go away or may get worse without professional help. Get emergency care if your child or teenager has ideas of suicide, harming him- or herself, or harming others. American Psychiatric Association - Facts for Families, No. Detailed info on diagnosis and treatment of panic disorder and phobias in children and adolescents. Panic attacks can occur in the context of several psychiatric conditions. A panic attack is a time-limited intense episode in which the individual experiences feelings of dread accompanied by physical sensations. Panic attacks usually average a couple of minutes but can last as long as 10 minutes and occasionally longer. Some really feel that they are about to die or have a serious medical problem. Children may also be less articulate in describing their symptoms. Excessive perspirationNumbness in extremitiesChoking sensation or shortness of breathFeeling that one is not entirely in realityFear that one is going to dieFear that one will become insane or lose control. Panic Disorder is more likely to start in late adolescence or in adulthood. The incidence of panic disorder with or without agoraphobia is lower than the incidence of simple phobia in children and adolescents. Biederman and colleagues diagnosed panic disorder in 6% and agoraphobia in 15% of children and adolescents referred to a pediatric psychopharmacology clinic. Many of the children with panic disorder also had agoraphobia. The children with panic or agoraphobia had a high rate of co-morbid depression, and other anxiety disorders. However they also had a high incidence of disruptive behavior disorders such as Conduct Disorder and ADHD. The course of the panic disorder and agoraphobia appeared to be chronic. Studies of adult panic disorder indicate that there is a high incidence of suicidal behavior, especially when it is accompanied by depression. Adults with panic disorder have an increased incidence of substance abuse. Thus one must look closely for the presence of other psychiatric disorders and make sure that the child or adolescent gets treatment. A child with panic disorder should have a careful medical screening. It may be appropriate to screen for thyroid problems, excessive caffeine intake, diabetes and other conditions. Some sensitive individuals might have a panic-like reaction to certain asthma medications. Treatment of panic disorder: Both medication and therapy have been used effectively. In children and adolescents with mild or moderate anxiety, it makes sense to start first with psychotherapy. If this is only partially effective, medication may be added. In children with severe anxiety or with co-morbid disorders, one might start therapy and medications simultaneously. These would include SSRI medications (such as fluoxetine, fluvoxamine, sertraline, and paroxetine. Other medications used include beta blockers such as propranolol, the tricyclics (such as Nortriptyline ), and occasionally the benzodiazepines (such as clonazepam. One might teach the individual to use deep abdominal breathing and other relaxation techniques. Once real medical causes have been ruled out, the individual should remind himself that the symptoms are frightening but not dangerous. The person should learn to label the episode as a panic attack and understand it as an exaggeration of a normal reaction to stress. The person should not try to fight the episode, but should simply accept that it is happening and is time limited. Some learn to go outside themselves and rate the symptoms on a scale of 1-10. The individual should be encouraged to stay in the present and notice what is going on in the here and now. If agoraphobia is present, the child should make up a hierarchy of fear-inducing situations. With help from parents and therapists, the child should move up the hierarchy of feared situations. Many do not cause significant life impairment and thus would not meet criteria for a formal psychiatric diagnosis. However, a much larger number, 22% had milder phobic symptoms. Girls had a higher rate than boys, and African Americans had a higher rate than Caucasians. Individuals with more severe phobias were more likely to have other psychiatric diagnoses than those with milder phobias. The therapist should work with a parent or other responsible adult to gradually desensitize the child to the feared object. Biederman, J et al, Panic Disorder and Agoraphobia in Consecutively Referred Children and Adolescents, Journal of the American Academy of Child and Adolescent Psychiatry, Vol. Is your child having emotional or behavioral problems? Here are signs to look for and advice on where to get help. Parents are usually the first to recognize that their child has a problem with emotions or behavior. Still, the decision to seek professional help can be difficult and painful for a parent. The first step is to gently try to talk to the child. These steps may resolve the problems for the child and family. Following are a few signs which may indicate that a child and adolescent psychiatric evaluation will be useful. Hyperactivity; fidgeting; constant movement beyond regular playing. Persistent disobedience or aggression (longer than 6 months) and provocative opposition to authority figures. Inability to cope with problems and daily activities. Depression shown by sustained, prolonged negative mood and attitude, often accompanied by poor appetite, difficulty sleeping or thoughts of death. Intense fear of becoming obese with no relationship to actual body weight, purging food or restricting eating. Aggressive or non-aggressive consistent violation of rights of others; opposition to authority, truancy, thefts, or vandalism. Strange thoughts, beliefs, feelings, or unusual behaviors. American Academy of Child & Adolescent PsychiatryWe have 2468 guests and 4 members onlineDetailed information on teen depression - signs, causes, treatment of teenage depression and how to help a depressed teen. Many parents miss the symptoms of teen depression in their own children. Teens who are depressed may seem irritable more than down, which can cause parents to simply write off the symptoms as "normal" adolescent growing pains. As a concerned parent, there are many things you can do to help a depressed teen. There are as many misconceptions about teen depression as there are about teenagers in general. Yes, the teen years are tough, but most teens balance the requisite angst with good friendships, success in school or outside activities, and the development of a strong sense of self. Occasional bad moods or acting out is to be expected, but depression is something different. And although depression is highly treatable, experts say only 20% of depressed teens ever receive help. Unlike adults, who have the ability to seek assistance on their own, teenagers usually must rely on parents, teachers, or other caregivers to recognize their suffering and get them the treatment they need. Teenagers face a host of pressures, from the changes of puberty to questions about who they are and where they fit in. The natural transition from child to adult can also bring parental conflict as teens start to assert their independence. Making things even more complicated, teens with depression do not necessarily appear sad and weepy. As the American Academy of Child and Adolescent Psychiatry notes, "Though depression is more often associated with withdrawal than aggression, its symptoms can include irritability and rage. While some "growing pains" are to be expected as teenagers grapple with the challenges of growing up, dramatic, long-lasting changes in personality, mood, or behavior are red flags of a deeper problem. SIGNS AND SYMPTOMS OF DEPRESSION IN TEENSSadness or hopelessnessIrritability, anger, or hostilityTearfulness or frequent cryingLoss of interest or enjoyment in activitiesChanges in eating and sleeping habitsRestlessness and agitationFeelings of worthlessness and guiltLack of enthusiasm and motivationFatigue or lack of energyDifficulty concentrating and making decisionsDepression in teens can look very different from depression in adults. The following symptoms of depression are more common in teenagers than in their adult counterparts:Irritable or angry mood - As noted above, irritability, rather than sadness, is often the predominant mood in depressed teens. A depressed teenager may be grumpy, hostile, easily frustrated, or prone to angry outbursts. Unexplained aches and pains - Depressed teens frequently complain about physical ailments such as headaches or stomachaches. If a thorough physical exam does not reveal a medical cause, these aches and pains may indicate depression. Extreme sensitivity to criticism - Depressed teens are plagued by feelings of worthlessness, making them extremely vulnerable to criticism, rejection, and failure. However, teens with depression may socialize less than before, pull away from their parents, or start hanging out with a different crowd. The effects of teenage depression go far beyond a melancholy mood. Many problematic behaviors or attitudes in teenagers are actually indications of depression. See the table below for some of the ways in which teens "act out" or "act in" in an attempt to cope with their emotional pain:Problems at school Depression can cause low energy and concentration difficulties. In teens, this may lead to poor school attendance, a drop in grades, or frustration with schoolwork in a formerly good student. Running away from home Many depressed teens run away from home or talk about running away. Drug and alcohol abuse Teens may use alcohol or drugs in an attempt to "self-medicate" their depression. Unfortunately, substance abuse only makes things worse. Low self-esteem Depression can intensify feelings of ugliness and unworthiness. Eating disorders Anorexia, bulimia, binge eating, and yo-yo dieting are often signs of unrecognized depression. Internet addiction Teens may go online to escape from their problems. But excessive computer use only increases their isolation and makes them more depressed. Self-injury Cutting, burning, and other kinds of self-mutilation are almost always associated with depression. Reckless behavior Depression in teenagers may appear as dangerous or high-risk behaviors rather than, or in addition to , gloominess. Examples include reckless driving, out-of-control drug use, and unsafe sex. Violence Some depressed teens (usually boys who are the victims of bullying) become violent. As in the case of the Columbine school massacre, self-hatred and a wish to die can erupt into violence and homicidal rage. Suicide Teens who are seriously depressed often think, speak, or make "attention-getting" attempts at suicide. Suicidal thoughts or behaviors should always be taken very seriously. An alarming and increasing number of teenagers attempt and succeed at suicide. According to the Centers for Disease Control and Prevention (CDC), suicide is the third leading cause of death for 15- to 24-year-olds. For the overwhelming majority of suicidal teens, depression or another psychological disorder plays a primary role.



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