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A. Cole. Florida Institute of Technology.

I was terrified beyond description the first time I gave this talk in June of 1991 generic 20mg female cialis otc. It seemed as if emotional memories of what it felt like to be stoned to death by an angry mob were assaulting my being order 10 mg female cialis overnight delivery. I went ahead with it anyway generic female cialis 10 mg without prescription, because it is what I needed to do for myself. I needed to own the Truth that I had come to believe in, the Truth that worked for me to allow me to find some happiness, peace, and Joy in my life. I found that other people found Joy and peace in my message also. So, now, I share this message with you, the reader of this book, in the hopes that it will help you to remember the Truth of who you are, and why you are here. This information is not meant to be absolute or the final word - it is meant as an alternative perspective for you to consider. A Cosmic Perspective that just might help to make life an easier, more enjoyable experience for you. The chicken in the story believes the world is coming to an end. People with chronic anxiety actually feel like the sky is already falling and only seconds away from hitting them. Professionals define chronic anxiety as Generalized Anxiety Disorder, which is an anxiety disorder that is characterized by excessive anxiety and worry about a variety of topics (such as work, school, family, and health). These anxious feelings must arise more days than not for at least six months. People suffering from chronic anxiety feel unable to control their fears. For an official diagnosis, six of the GAD symptoms on the checklist below must be experienced. Headaches, muscle aches, stomach achesTrembling, twitching, and feeling shakyExcessive sweating, feeling light-headedNausea, diarrhea, or other abdominal distressFeeling on edge or wound upSweating, cold/clammy handsWhen considering treatment of chronic anxiety, the first step is to see a doctor to take a history and to consider any physical condition(s) that could be causing the symptoms of anxiety. There are a lot of medical conditions that can cause or mimic anxiety, so it is very important to get a complete exam that includes blood work. In the book, +?? The Anxiety And Phobia Workbook,+?? Edmund J. Make sure you are getting proper sleep (eight hours a night). Basically people with chronic anxiety need to learn how to self-soothe. This significant idea for the management of chronic anxiety involves relaxation of the body, proper self-care, and learning how to change your thinking. For example, you can examine the likelihood of a feared event actually happening. In using this approach, you should consider the fact that most people with chronic anxiety significantly overestimate the probability that such an event could really occur. They also underestimate their practical ability to deal with a feared event even if the anxiety-producing situation should happen. They don+??t realize how strong they really are as problem solvers. So +??If the sky falls, hold up your hands+?? (Spanish proverb). And perhaps you can catch white clouds and rainbows and place them gently on the earth. About the author: Jill Cohen, LCSW provides counseling and therapy services around Ardmore, PA. Her specialties include treatment of anxiety disorders, eating disorders and depression. Published 8/00: Sex Roles: A Journal of ResearchThis research focused on the meaning of psychological intimacy to partners in heterosexual and same-gender relationships that have lasted for an average of 30 years. In-depth interviews were used to explore the meaning of intimacy to 216 partners in 108 relationships. The participants were whites, blacks, and Mexican-Americans, with Catholic, Jewish, and Protestant religious backgrounds; they were employed in both blue-and white collar occupations. Psychological intimacy was defined as the sense that one could be open and honest in talking with a partner about personal thoughts and feelings not usually expressed in other relationships. Factors that had a significant role in shaping the quality of psychological intimacy in the last 5 to 10 years of these relationships (recent years) were the absence of major conflict, a confrontive conflict management style between partners, a sense of fairness about the relationship, and the expression of physical affection between partners. Women in same-gender relationships, compared to their heterosexual and gay counterparts, were more likely to report that psychologically intimate communication characterized their relationships. The findings are important for understanding factors that contribute to psychological intimacy in long-term relationships and how the gender roles of partners may shape the quality of psychologicalintimacy in heterosexual and same-gender relationships. This paper explores the meaning of psychological intimacy from the perspectives of 216 partners in 108 heterosexual and same-gender relationships that have lasted an average of 30 years. The paper adds to the existing literature on relational intimacy. Most previous studies of intimacy have sampled younger participants in relationships that have not lasted as long as those in this study. Our research focused on the meaning of psychological intimacy among partners in middle and old age. In contrast to the white, middle class samples utilized in many studies, we focused on couples in long-term relationships who were diverse in terms of race, educational level, and sexual orientation. Most research on relational intimacy has employed quantitative methodology; we used in-depth interviews to explore the meaning of psychological intimacy from the perspective of each partner in these relationships. The research on which this paper is based started 10 years ago and was conducted in two phases. In the second or current phase, we recoded the interview data so as to analyze them from both a qualitative and quantitative perspective. The goal of the paper is to develop an understanding of factors that contributed to reported psychological intimacy in recent years, defined as the last 5 to 10 years of these relationships. What does being psychologically intimate mean to individual partners (i. What factors are associated with the quality of psychological intimacy during the recent years of these relationships? The paper is organized as follows: Perspectives on defining psychological intimacy are discussed, which is followed by a review of recent empirical studies of intimacy, and the theoretical framework for the current study. The research methodology of the current study is summarized.

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Some 8 million to 14 million Americans suffer from depression each year discount 20mg female cialis visa. As many as one in five Americans will suffer at least one episode of major depression during their lifetimes purchase female cialis paypal. About 12 million children under 18 suffer from mental disorders such as autism order female cialis pills in toronto, depression and hyperactivity. Two million Americans suffer from schizophrenic disorders and 300,000 new cases occur each year. Nearly one-fourth of the elderly who are labeled as senile actually suffer some form of mental illness that can be effectively treated. Suicide is the third leading cause of death for people between the ages of 15 and 24. People suffering from mental illnesses often do not recognize them for what they are. About 27 percent of those who seek medical care for physical problems actually suffer from troubled emotions. Mental illnesses and substance abuse afflict both men and women. Alcohol, Drug Abuse and Mental Health Administration indicate men are more likely to suffer from drug and alcohol abuse and personality disorders, while women are at higher risk of suffering from depression and anxiety disorders. The personal and social costs that result from untreated mental disorders are considerable--similar to those for heart disease and cancer. According to estimates by the Substance Abuse and Mental Health Services Administration (SAMHSA), Institute of Medicine, the direct costs for support and medical treatment of mental illnesses total $55. Emotional and mental disorders can be treated or controlled, but only one in five people who have these disorders seek help, and only four to 15 percent of the children suffering severe mental illnesses receive appropriate treatment. This unfortunate reality is further complicated by the fact that most health insurance policies provide limited mental health and substance abuse coverage, if any at all. Medications relieve acute symptoms of schizophrenia in 80 percent of cases, but only about half of all people with schizophrenia seek treatment. Fewer than one-fourth of those suffering from anxiety disorders seek treatment, even though psychotherapy, behavior therapy and some medications effectively treat these illnesses. Fewer than one-third of those with depressive disorders seek treatment. Yet, with therapy, 80 to 90 percent of the people suffering from these diseases can get better. Researchers have made tremendous progress in pinpointing the physical and psychological origins of mental illnesses and substance abuse. Scientists are now certain that some disorders are caused by imbalances in neurotransmitters, the chemicals in the brain that carry messages between nerve cells. Studies have linked abnormal levels of these neurotransmitters with depression and schizophrenia. Researchers have used PET to show that the brains of people suffering from schizophrenia do not metabolize the sugar called glucose in the same way as the brains of healthy people. PET also helps physicians determine if a person suffers from schizophrenia or the manic phase of manic-depressive illness, which can have similar symptoms. Refinements of lithium carbonate, used in treating manic-depressive (bipolar) disorder, have led to an estimated annual savings of $8 billion in treatment costs and lost productivity associated with bipolar disorder. Medications are helpful in treating and preventing panic attacks among patients suffering severe anxiety disorders. Studies also indicate that panic disorders could be caused by some underlying physical, biochemical imbalance. Studies of psychotherapy by the National Institute of Mental Health have shown it to be very effective in treating mild-to-moderate depression. Scientists are beginning to understand the biochemical reactions in the brain that induce the severe craving experienced by cocaine users. Through this knowledge, new medications may be developed to break the cycle of cocaine craving and use. Although these findings require continued research, they offer hope that many mental disorders may one day be prevented. Depression is the most commonly diagnosed emotional problem. Almost one-fourth of all Americans suffer from depression at some point in life, and four percent of the population have symptoms of depression at any given time. But if that emotion continues for long periods, and if it is accompanied by feelings of guilt and hopelessness, it could be an indication of depression. The persistence and severity of such emotions distinguishes the mental disorder of depression from normal mood changes. People who suffer serious depression say they feel their lives are pointless. They doubt their own abilities and often look on sleep as an escape from life. Many think about suicide, a form of escape from which there is obviously no return. Other symptoms that characterize depression are sleeplessness, loss of self-esteem, inability to feel pleasure in formerly interesting activities, loss of sexual drive, social withdrawal, apathy and fatigue. Depression can be a response to stress from a job change, loss of a loved one, even pressures of everyday living. The problem can be debilitating, but it is not insurmountable and no one should have to suffer its symptoms. With treatment, people with depression can recover and lead full lives. Psychiatrists have a number of effective treatments for depression -- usually involving a combination of psychotherapy and antidepressant medications. The discovery of such emotional triggers allows persons to change their environment or their emotional reactions to it, thereby alleviating the symptoms. Psychiatrists have a full range of antidepressant medications which they often use to augment psychotherapy for treating depression. Almost all depressed patients respond to psychotherapy, medication, or a combination of these treatments. Some depressed patients cannot take antidepressant medications, however, or may experience a depression so profound that it resists medication. Others may be at immediate risk of suicide, and with these patients the medications may not act quickly enough. Fortunately, psychiatrists can help these patients with electroconvulsive therapy (ECT), a safe and effective treatment for some serious mental disorders. In this treatment, the patient receives a short-acting general anesthetic and a muscle relaxant followed by a painless electric current administered for less than a second through contacts placed on the head. Many patients report significant improvement in their mood after only a few ECT treatments. Fear is a safety valve that helps us recognize and avoid danger. It increases our reflexive responses and sharpens awareness.

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While the results indicate that more vigilance is necessary during the peripartum period in cases of SSRI use buy discount female cialis 20mg online, the data do not imply any particular SSRI should be avoided in women of reproductive age cheap female cialis 20 mg with mastercard. The authors conclude that the signal is stronger for paroxetine buy female cialis 20mg visa, which they say should either not be used during pregnancy or used at the lowest effective dose. I certainly would not rule out using paroxetine in women of reproductive age on the basis of this report, with the possible exception of a woman with immediate plans to become pregnant or a woman with recurrent disease. A reduction in the appropriate use of these drugs in depressed pregnant women would be a serious problem because relapse of recurrent depression during pregnancy is exceedingly common, and depression during pregnancy is the strongest predictor of risk for postpartum depression. Reducing the dose or discontinuing the antidepressant around the time of labor and delivery increases the risk of relapse, although some women may tolerate this approach, particularly if the drug is reinstituted immediately post partum. Physicians should remain vigilant and carefully plan their treatment approach in pregnant patients with depression. The data may, in fact, be a signal that a problem exists. But a signal should be a beacon that guides the clinician. In this case, we have more fog than we have clarification of an already complicated situation. The report concluded that "third-trimester exposure to therapeutic doses of fluoxetine... Information in the report, while comprehensive and technically correct in most cases, might easily be misconstrued by women and their families. The report provides a summary and review of existing data, with a thorough review of the animal and human literature on reproductive safety of fluoxetine. It does not adequately address the clinical context in which fluoxetine or other selective serotonin reuptake inhibitors (SSRIs) are used. The report criticizes much of the literature regarding reproductive safety of fluoxetine, which is understandable because controlled studies of exposures to any medication during pregnancy are not done for ethical reasons. Conclusions regarding reproductive safety of medications come from various sources, such as case series, postmarketing surveillance registries, and teratovigilance programs. These sources can sometimes provide large enough numbers of drug exposures to allow for useful conclusions regarding reproductive safety. The report also addresses the risk for "perinatal toxicity," which typically includes symptoms of jitteriness and autonomic reactivity in the newborn. Enough literature has accumulated suggesting that third-trimester exposure to SSRIs may be tied to an increased risk of transient symptoms as noted above. Most reports have not associated such exposure with adverse longer-term sequelae. Fluoxetine is the only SSRI for which we have long-term neurobehavioral data, including follow-up of exposed children through ages 4-7 years. No differences in long-term neurobehavioral outcome between exposed and un ]exposed children were noted. One of the greatest failures of the NTP report is that an important confounding factor with regard to outcome of SSRI use in pregnancy is neglected: maternal mood. In the recent literature, one can find the same "toxicity," such as lower Apgar scores or obstetric complications, in children of mothers who have untreated depression during pregnancy. Failure to address this adequately in the report is a significant omission. Fluoxetine is used to treat a serious illness; it is not a potential environmental toxin, such as those reviewed by other NTP panels. The report does not indicate that decisions about whether to use fluoxetine during pregnancy are clinical choices made by patients in the context of some risk-benefit analysis made collaboratively between the patient, her family, and the physician. My colleagues and I have described high rates of relapse in women with a history of recurrent major depression who discontinue antidepressants in pregnancy. Depression during pregnancy is associated with compromised fetal and neonatal outcomes-risks that are not reflected in the report. Discontinuation of antidepressant medication near the end of pregnancy appears to increase the risk for postpartum depression. The panel notes in the report that it recognizes that any risks of fluoxetine need to be weighed against the risks of untreated disease. But this brief statement embedded in a lengthy document that describes fluoxetine as "a reproductive toxin" is inadequate. One has to wonder how this report will impact what actually goes on as patients make decisions about using these compounds. While using SSRI antidepressants during pregnancy appears relatively safe, it appears there are some risks to the baby. With increasing recognition and treatment of depression in women during their childbearing years, more patients and their physicians are faced with the dilemma of whether to use antidepressants in pregnancy. The literature over the last decade has been relatively consistent regarding the absence of teratogenic effects associated with the use of selective serotonin reuptake inhibitors (SSRIs). The data have not been so straightforward regarding the potential risk for perinatal syndromes when these drugs are used during pregnancy. An increasing number of studies have described syndromes occurring during the perinatal period in babies whose mothers used SSRIs. Symptoms ascribed to perinatal exposure to SSRIs have included tremulousness, increased motor activity, jitteriness, and heightened startle. One trial suggested that fluoxetine (Prozac, Sarafem) exposure during the latter part of pregnancy through labor and delivery was associated with higher rates of special care nursery admissions for what the authors called "poor neonatal adaption. Studies that have evaluated the effects of SSRIs on neonatal outcome have suffered from consistent methodologic limitations, the most notable being the failure to blind investigators evaluating the infants with regard to in-utero drug exposure and the failure to take into account the potential impact of maternal mood disorder on acute neonatal outcome. In a study published last month, 34 healthy, full birthweight newborns were evaluated in a prospective trial; 17 mothers took SSRIs during pregnancy and 17 were unexposed. The investigators noted that exposed newborns exhibited significantly more tremors, heightened levels of motor activity and tremulousness, and fewer changes in behavioral state during an hour-long observation period, compared with unexposed newborns (Pediatrics 113[2]:368-75, 2004). While this is an important study, in which the evaluators were blinded, it is limited by its small sample size. Though both groups were matched for maternal use of cigarettes, alcohol, and marijuana during pregnancy, alcohol use was not insignificant, and four women on SSRIs used marijuana while pregnant. Most notably, the study failed to include an assessment of maternal mood during pregnancy and did not control for the impact of maternal depression on the outcome variables measured. The authors acknowledge the negative impact that maternal depression can have on neonatal outcome, though they do not acknowledge adequately how the failure to measure maternal depression in their study could have confounded it greatly. They note that maternal depression, "through its action as a stressor, may have an impact on fetal development through its effect on the hypothalamic-pituitary-adrenal axis, adrenocorticotropic hormones, and b-endorphins," and that infants of depressed mothers are at risk for physical anomalies and birth complications, delayed habituation of fetal heart rates, higher neonatal cortisol levels, higher levels of indeterminate sleep, and elevated norepinephrine levels. But that study was also limited by a small sample size and the failure to prospectively assess maternal mood during pregnancy. While data from the latest study are welcome, the recommendation to lower or discontinue antidepressants proximate to delivery is worrisome-not only because of the potential negative impact of depression during pregnancy on neonatal well-being, but because maternal depression also increases the risk for postpartum depression. We remain at a point where the literature fails to take into account one of the strongest predictors of newborn neurobehavior, namely maternal mood during pregnancy. 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.

Brent order genuine female cialis, now a professor of psychiatry at the University of Pittsburgh School of Medicine purchase female cialis 20 mg on line, realized he had no good answer discount female cialis amex. When analyzed after death, the brains of people who committed suicide show a low level of a metabolite of seratonin, a neurotransmitter that is involved in the control of impulses. But although a seratonin deficiency may mark a heightened risk of suicide -- as much as 10 times what is normal -- that discovery is useless to clinicians, since it would require patients to undergo a spinal tap. As they search for genetic commonality, researchers are drawn to those rare, unlucky families who have suffered from rashes of suicide. Among the Old Order Amish, researchers from the University of Miami found that half the suicides of the last century -- they numbered only 26 -- could be traced to two extended families, and 73 percent of them could be traced to four families that made up only 16 percent of the population. The clustering could not be explained by mental illness alone, since other families carried risks for mental illness but no risk for suicide. The successive studies have shed little light on what differentiates them from their more resilient neighbors -- and whether the differences are sociological, psychological, or genetic, said one suicidologist. Most specialists say that many factors interact to cause suicide. When you have a family history that is quite profound, how do you rule out the fact that you have one deceased parent and a second parent bereaved? Alan Berman, president of the American Society for Suicide Prevention. When his mother shot herself in a hotel room, Boyd said, the family splintered in their reactions: Although his father bitterly criticized her act, his brother Michael immediately said he wanted to be with her, and shot himself, at 16, a month later. He died in a boarding house at age 36, after drinking toxic chemicals. Boyd said he has made three suicide attempts himself. As he embarked on his most recent study, Brent was already searching for a secondary trait -- something beyond mental illness -- that connects suicidal families. His results, he said, encourage him on the genetic route. They attempted suicide, on average, eight years before their counterparts with less of a family history. Although they looked at secondary traits such as abuse, adversity, and psychopathology, researchers found that the most predictive trait by far was "impulsive aggression. Edwin Shneidman, the 85-year-old founder of the American Association of Suicidology, said the field has perennially been riven by "conceptual turf wars" -- but that at the moment, biochemical explanations may hold sway over sociological, cultural, or psychodynamic theories. Common sense tells us that French is not inherited," Shneidman said. These days, he feels confident enough to contemplate the interesting possibility of one more generation of Boyds. A person who has depression does not think like a typical person who is feeling good. Their illness prevents them from being able to look forward to anything. They can only think about now and have lost the ability to imagine into the future. They do not think of the people around them, family or friends, because of their illness. They are consumed with emotional, and many times, physical pain that becomes unbearable. But, we do know that depression is a treatable illness. Please remember - Depression, plus alcohol or drug use can be lethal. Many times people will try to alleviate the symptoms of their illness by drinking or using drugs. There is an increased risk for suicide because alcohol and drugs decrease judgement and increase impulsivity. This is a warning to people that something is terribly wrong. We know that many people suffering from depression can hide their feelings, appearing to be happy. But, can a person who is contemplating suicide feign happiness? But, most of the time a suicidal person will give clues as to how desperate he/she is feeling. A person may "hint" that he/she is thinking about suicide. For example, they may say something like, "Everyone would be better off without me. It is estimated that 80% of people who died of suicide mentioned it to a friend or relative before dying. Other danger signs are having a preoccupation with death, losing interest in things one cares about, giving things away, having a lot of "accidents" recently, or engaging in risk-taking behavior like speeding or reckless driving, or general carelessness. Some people even joke about completing suicide - it should always be taken seriously. We know that suicide tends to run in families, but it is believed that this is due to the fact that depression and other related depressive illnesses have a genetic component, and that if they are left untreated (or mistreated), it can result in suicide. But talking about suicide or being aware of a suicide that happened in your family or to a close friend does not put you at risk for attempting it, if you are healthy. The only people who are at risk are those who are vulnerable in the first place - vulnerable because of an illness called depression or one of the other depressive illnesses. People who suffer from depression are afraid that others will think they are "crazy," which is so untrue. Alcoholism is a good example - no one ever wanted to talk openly about that, and now look at how society views it. They talk of the effect it has had on their lives and different treatment plans. And everyone is educated on the dangers of alcohol and on substance abuse prevention. Suicide is so misunderstood by most people, so the myths are perpetuated. Stigma prevents people from getting help, and prevents society from learning more about suicide and depression. If everyone were educated on these subjects, many lives could be saved.