Category Archives: Mental Health

Trauma and Stressor-Related Disorders: DSM-V Diagnostic Codes




Trauma and Stressor-Related Disorders: New category

The trauma and stressor related disorders category is a new chapter in the DSM-V. This category now includes post traumatic stress disorder, acute stress disorder, reactive attachment disorder (RAD), adjustment disorders and the new diagnostic category, disinhibited social engagement disorder (DSED). In the previous DSM-IV-TR, acute stress disorder and posttraumatic stress disorder were included in the anxiety disorders category. These disorders are now included in the same diagnostic category in the DSM-V because of their common roots in external events.

Trauma and Stressor-Related Disorders: Overview

Besides being placed in the new category, a significant change includes the necessity for the stressor criterion for posttraumatic stress disorder and acute stress disorder to be met. The stressor or traumatic event can be either directly or indirectly experienced or witnessed by an individual receiving a diagnosis of either post traumatic stress disorder or acute stress disorder. The traumatic event can be experienced by a family member or friend, having a significant effect on the individual receiving the diagnosis.

The term trauma usually refers to a significant response to a very distressing experience such as a terrible accident, sexual assault, abuse, combat or exposure to natural or human disasters. Stressful events can be either emotionally or physically harmful or both and can involve either a single experience or repetitive events over a period of time. Traumatic events can affect different people in very different ways, but have the overall experience of threatening their physical, emotional or spiritual welfare. The trauma is always experienced as overwhelming the individual’s ability to cope.

Some of the more common traumatic events have included sexual and physical assault, robbery, combat, terrorist attacks being kidnapped and taken hostage, being tortured, disasters, child abuse, automobile accidents and life-threatening illnesses. Traumatic events may also include witnessing a person’s death or serious injury through violence, war, accidents or natural disasters.




Prevalence:

The prevalence rate of traumatic related disorders is very high among the general population in the United States. The lifetime prevalence rate among men is 3.6% with a rate of 9.7% among women. The rate among children does not seem to be currently available although it is recognized that children who have experienced traumatic events are also at very high risk of developing posttraumatic stress disorder. The prevalence rates of acute stress disorder are between 6% and 94% depending upon the type of stressor involved. It is estimated that approximately 1% of children under the age of five have some degree of reactive attachment disorder. Children who are placed in foster care or are orphaned are at a much higher risk of developing reactive attachment disorder. Adjustment disorders are estimated to be between 2% and 8% in community-based samples of children, adolescents and among the elderly.

Diagnosis:

The onset of traumatic stress related disorders also increases the risk of associated mental health disorders such as anxiety, depression, sleeping and eating disorders, problems with substance use and suicidal ideation. It is also common for individuals diagnosed with a traumatic or stress related disorder to also have symptoms of somatic symptom disorder and/or attention deficit hyperactivity disorder and impulse control disorders. Many children who survived traumatic events are also misdiagnosed as having attention deficit hyperactivity disorder. Children diagnosed with reactive attachment disorder are also frequently mistaken for children with attention deficit hyperactivity disorder or oppositional defiant disorder and frequently have behavioral problems during childhood and throughout their adolescent years.

Important information:

It is important for mental health counselors and clinicians to understand that with the new category of traumatic stress related disorders that the most fundamental feature is trauma rather than anxiety serving as the precipitant to the development of the disorder.
Specific information and treatment information related to each of the individual diagnosis within the category of trauma and stress related disorders follows on subsequent pages.

Trauma and Stressor-Related Disorders: DSM-V Diagnostic Codes

313.89 (F94.1) Reactive Attachment Disorder
Specify if: Persistent
Specify current severity: Severe

313.89 (F94.2) Disinhibited Social Engagement Disorder

Specify if: Persistent
Specify current severity: Severe

309.81 (F43.10) Posttraumatic Stress Disorder (includes Posttraumatic Stress Disorder for Children 6 Years and Younger)

Specify whether: With dissociative symptoms
Specify if: With delayed expression

308.3 (F43.0) Acute Stress Disorder

___.__ (___.__) Adjustment Disorders

Specify whether:
309.0 (F43.21) With depressed mood
309.24 (F43.22) With anxiety
309.28 (F43.23) With mixed anxiety and depressed mood
309.3 (F43.24) With disturbance of conduct
309.4 (F43.25) With mixed disturbance of emotions and conduct
309.9 (F43.20) Unspecified
309.89 (F43.8) Other Specified Trauma-and Stressor-Related Disorder
309.9 (F43.9) Unspecified Trauma-and Stressor-Related Disorder

Diagnostic Information and Criterion for Trauma and Stressor-Related Disorders adapted from the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition American Psychological Association by Paul Susic Ph.D. Licensed Psychologist



Schizophrenia Spectrum and Other Psychotic Disorders DSM-5 Diagnostic Codes:





Schizophrenia Spectrum and Other Psychotic Disorders DSM-5 Diagnostic Codes: Overview

Psychiatric diagnosis that fall within the category of schizophrenia spectrum and other psychotic disorders are characterized by abnormalities in one or more of the following five categories: hallucinations, delusions, disorganized thinking, disorganized or abnormal motor behavior (including catatonia) negative symptoms. This section includes information related to each of the specific schizophrenia spectrum and other psychotic disorders included in the DSM-5. These include delusional disorder, brief psychotic disorder, schizophreniform disorder, schizophrenia, schizoaffective disorder, substance/medication-induced psychotic disorder, psychotic disorder due to another medical condition and catatonia.

Psychotic disorders involve a variety of both positive and negative as well as some related cognitive symptoms. Positive symptoms involve thoughts and behaviors that you would not usually expect while negative symptoms involve the absence of expected experiences. Some of the basic positive symptoms include hallucinations and delusions, as well as thinking or movement disorders in which the individual seems to lose touch with reality. Hallucinations are sensory experiences such as visual and auditory hallucinations, olfactory hallucinations, gustatory hallucinations (tasting), or tactile or somatic hallucinations in which a person feels things that are not really there or do not seem to have an actual physical stimulus. Delusions are rigid beliefs that do not seem to have any basis in reality and from which an individual cannot be persuaded otherwise. Auditory hallucinations seem to be the most common and tactile hallucinations are frequently associated with withdrawal or intoxication from substances. Olfactory and gustatory hallucinations often indicate a possible underlying medical problem. Disorganized thoughts often referred to as thought disorder involves disruptions in thinking in such a way that communication becomes difficult. Disorganized or abnormal motor behavior frequently referred to as movement disorder, includes agitation, recurrent motions or an inability to respond or move in relation to specific stimuli such as with catatonia.

Negative symptoms within the schizophrenia spectrum category include a lack of motivation, pleasure or engagement in what are believed to be normal activities of daily living or the normal experiencing of emotion. Problems with cognitive symptoms are usually related to having a difficulty with executive functioning, memory or attention.

Schizophrenia Spectrum and Other Psychotic Disorders: Prevalence

According to the APA (2013) psychotic disorders are fairly uncommon, citing prevalence rates of disorders within the schizophrenia spectrum category to range from 0.2% to 0.7%. These do not account for any cross-cultural considerations that are not identified in the DSM-5 but seem to be commonly found in specific cultures throughout the world.




Individuals who experience psychotic disorders have various characteristics and experiences. For about 50% of the individuals diagnosed within this category, they experience a lifelong struggle of trying to maintain their symptoms and a modest level of functioning in their lives. A small minority of individuals who have a later age of onset and frequently a higher level of functioning, seem to be able to manage their symptoms more adequately over their lifetime.

The presence of positive symptoms of psychosis does not always indicate the presence of a psychotic disorder. Medical conditions and substance use and abuse can also lead to the onset and often the exacerbation of psychotic symptoms. In many or most cases, it is probably better for a mental health clinician to refer clients with psychotic symptoms for a thorough medical examination.

Cause and Treatment:

At the present time, researchers have not determined the cause of schizophrenia and other psychotic disorders. Medical conditions and substance use as well as other mental health conditions can lead or contribute to the severity of schizophrenia spectrum and other psychotic disorders. Studies have found a strong genetic connection among individuals with schizophrenia spectrum disorders and have identified various physiological conditions associated with psychosis. Individuals with first-degree relatives who have a condition within the schizophrenia spectrum may be as much as 10 times higher risk of developing the symptoms of psychotic disorders. Neuroscientific researchers have found that individuals with schizophrenic spectrum disorders have different brain structures and physiological components from those who do not.

The main focus of the treatment of schizophrenia and related disorders includes medications for the relief of symptoms and the management of relapse. Psychological interventions are used to promote coping, and for preventing relapse, providing assistance through supportive measures to attain the highest level of functioning in an individual’s activities of daily life.

The same treatment principles seem to apply to all disorders within the schizophrenic spectrum. In the acute phase, clinicians will try to manage the most acute symptoms through medication management and supportive services. Following the medication management of the acute symptoms, clinicians may then focus more on psychosocial treatments to reduce stress and assist the client and their families through psychoeducation and supportive services to maintain a relatively higher managed level of psychosis that allows them to function at the highest level possible in their lives. Finally, as they continue with their medications, clinicians can then attend to preventing relapse through psychological treatments which include skills training, psychoeducation, cognitive behavioral therapy, family interventions, supported employment and other psychological support services within the treatment community. Strong therapeutic relationships have been identified to be very important in assisting and promoting more positive attitudes and compliance with medications.

Please see below the specific schizophrenia spectrum and other psychotic disorders diagnostic codes as well as important diagnostic and treatment information.

Schizophrenia Spectrum and Other Psychotic Disorders DSM-5 Diagnostic Codes:

301.22 (F21) Schizotypal (Personality) Disorder

297.1 (F22) Delusional Disorder

Specify whether: Erotomanic type, Grandiose type, Jealous type, Persecutory type, Somatic type, Mixed type, Unspecified type

298.8 (F23) Brief Psychotic Disorder

Specify if: With marked stressor(s), Without marked stressor(s), With postpartum onset

295.40 (F20.81) Schizophreniform Disorder

Specify if: With good prognostic features, Without good prognostic features

295.90 (F20.9) Schizophrenia

___.__ (__.__} Schizoaffective Disorder
Specify whether:

295.70 (F25.0) Bipolar Type

295.70 (F25.1) Depressive Type

___.__ (__.__) Substance/Medication-Induced Psychotic Disorder

Note: See the criteria set and corresponding recording procedures for substance-specific codes and ICD-9-CM and ICD-10-CM coding.
Specify if: With onset during intoxication, With onset during withdrawal

___.__ (__.__) Psychotic Disorder Due to Another Medical Condition
Specify whether:

293.81 (F06.2) With Delusions

293.82 (F06.0) With Hallucinations

293.89 (F0 61) Catatonia Associated With Another Mental Disorder (Catatonia Specifier)

293.89 (F06.1) Catatonia Disorder Due to Another Medical Condition

293.89 (F06.1) Unspecified Catatonia
Note: Code first 781.99 (R29.818) other symptoms involving nervous and musculoskeletal systems.

298.8 (F28) Other Specified Schizophrenia Spectrum and Other Psychotic Disorder

298.9 (F29) Unspecified Schizophrenia Spectrum and Other Psychotic Disorder

Diagnostic Information and Criterion for Schizophrenia Spectrum and Other Psychotic Disorders adapted from the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition American Psychological Association by Paul Susic Ph.D. Licensed Psychologist


Obsessive-Compulsive and Related Disorders: DSM-5 Diagnostic Codes




Obsessive-Compulsive and Related Disorders: Introduction

Conditions which fall within the category of Obsessive-Compulsive and Related Disorders all share some key features of obsessions and compulsions. Obsessions are recurrent, persistent and intrusive anxiety provoking thoughts or images resulting in subsequent repetitive behaviors referred to as compulsions. Obsessions may include thoughts, feelings, ideas and sensations that compel a person to do specific behaviors or compulsions. Some of the more common obsessions include excessive counting, ruminating about physical flaws, hoarding and picking at one’s skin. Some of the resulting rituals which are common among individuals diagnosed with obsessive-compulsive disorder frequently include recurrent handwashing, frequently checking doors and locks and avoidance of specific situations. For an individual to be considered for a diagnosis of obsessive-compulsive disorder it must be disruptive to their daily existence and functioning. Disorders listed in this category all share the common feature of excessive preoccupation along with the subsequent engagement in repetitive behaviors.

Changes from the DSM-4 TR to the DSM-5:

There were significant changes from previous editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM). Obsessive-compulsive disorder was previously classified in the DSM-4 TR as an anxiety disorder. The new DSM-5 has created a standalone chapter separate from the other anxiety disorders. This also follows revisions within the ICD 10 CM which also classifies OCD separately from anxiety disorders. However, there should never be any confusion as to the close relationship between obsessive-compulsive disorders and anxiety disorders. When the separation of obsessive-compulsive disorder from anxiety disorders was anticipated prior to the publication of the new DSM-5, psychiatrists supported the move significantly more often than other mental health clinicians, with only 40% to 45% of other mental health professionals supporting the move to the new category. Many psychologists, counselors and other mental health professionals did not support the change because of the fact that most treatment protocols for obsessive-compulsive disorder are also similar for anxiety and other related disorders. As is the case with most anxiety related disorders and depression, comorbidity is frequently the rule rather than the exception.




Some of the new disorders that fall within this category include excoriation (skin picking) disorder, substance/medication -induced obsessive compulsive and related disorder, hoarding disorder and obsessive-compulsive and related disorder due to another medical condition. Also, the diagnosis of trichotillomania (hair pulling disorder) was moved from the DSM-4 TR classification of impulse control disorders to this new classification of Obsessive-Compulsive and Related Disorders in the DSM-5.

Diagnosis:

An important aspect of diagnosis is to differentiate obsessive-compulsive disorder from other mental health disorders by the key features of obsessive preoccupation and repetitive behaviors. Once this has been accomplished, diagnosis can proceed.

Diagnosis of obsessive-compulsive disorder can be challenging in that there is a high level of comorbidity with other diagnosis. It is very common for a person with this diagnosis to also exhibit

symptoms of anxiety disorders and depression; eating disorder; somatoform disorder; hypochondriasis; impulse-control disorder, especially kleptomania; and attention deficit hyperactivity disorder (ADHD). Also, there is a significant amount of literature considering the comorbidity between obsessive-compulsive disorder and Tourette’s syndrome.

Prevalence:

It has been estimated that as many as one in 100 or 2 to 3 million adults currently have obsessive-compulsive disorder. Among children it is estimated that nearly one in 200 or 500,000 children and adolescents may receive this diagnosis. These estimates do not include other related disorders. Hoarding is believed to affect about 4% of the general population. Trichotillomania may affect as many as 2.5 million Americans, and as many as 3.8% of college students are believed to exhibit symptoms of excoriation.

Treatment for Obsessive-Compulsive and Related Disorders:

The most commonly reported treatments include a combination of medication and psychological treatments. Some studies have found cognitive behavioral therapy to be more effective than treatment with drugs or often has been found to be an appropriate replacement after the initial symptoms have been reduced. The International Obsessive-Compulsive Disorder Foundation has recommended exposure and response prevention (ERP), which is a type of cognitive behavioral therapy and has concluded that this type of therapy may reduce the symptoms by as much as 60% to 80% for active participants in therapy.

General information on obsessive-compulsive disorder can be found on subsequent pages along with information specific to each diagnosis within the new DSM-5 category of Obsessive-Compulsive and Related Disorders.

Obsessive-Compulsive and Related Disorders DSM-5 Diagnostic Codes:

300.3 (F42) Obsessive-Compulsive Disorder
Specify if: Tic-related

300.7 (F45.22) Body Dysmorphic Disorder
Specify if: With muscle dysmorphia

300.3 (F42) Hoarding Disorder
Specify if: With excessive acquisition

312.39 (F63.2) Trichotillomania (hair pulling disorder)

698.4 (L96.1) Excoriation (skin picking) Disorder

294.8 (F06.8) Obsessive-Compulsive and Related Disorder Due to Another Medical Condition
Specify if: With obsessive-compulsive disorder-like symptoms, With appearance preoccupations, With hoarding symptoms, With hair pulling symptoms, With skin picking symptoms.

300.3 (F42) Other Specified Obsessive-Compulsive and Related Disorder

300.3 (F42) Unspecified Obsessive-Compulsive and Related Disorder

Diagnostic Information and Criterion for Obsessive-Compulsive and Related Disorders adapted from the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition American Psychological Association by Paul Susic Ph.D. Licensed Psychologist



Unnecessary Medication Use Associated With Dementia Diagnosis




Introduction to the study:

A recent study conducted at the University of Sydney has found that inappropriate and unnecessary medications seem to be routinely prescribed for newly diagnosed dementia patients. This longitudinal research study of 2,500 people was conducted in collaboration with the University of Kentucky and Yale University and published in the Journals of Gerontology: Medical Sciences.

Estimates of people currently living with dementia is approximately 50 million worldwide. In Australia the estimate is approximately 425,000 costing the country more than $15 billion per year and is currently the second leading cause of death.




Study and Conclusions:

The lead author, Dr. Danijela Gnjidic, NHMRC Dementia Leadership Fellow and Senior Lecturer from the Faculty of Pharmacy and Charles Perkins Centre at University of Sydney stated that “Our study found that following a diagnosis of dementia in older people, medication use increased by 11 per cent in a year and the use of potentially inappropriate medications increased by 17 percent”. She went on to say, “These medications are typically recommended for short term use but are commonly used long term by people with dementia,”

Some of the more common unnecessary and inappropriate medications are pain pills, sleep aids, depression medications and drugs for acid reflux referred to as proton pump inhibitors

A number of reasons were given to account for this including a lack of time in the patient and physician encounters, inappropriate guidelines, difficulty in setting goals with the patient and difficulty in the communication and comprehension of the patient.
She stated, “These findings are of major concern and highlight the importance of weighing up the harms and benefits of taking potentially unnecessary medications as they may lead to increased risk of side effects such as sedation or drowsiness, and adverse drug events such as falls, fractures and hospitalization.” She felt that increased efforts need to be made to support the recognition and potential use of medications that are inappropriate to minimize harm to patients.
Finally, Dr. Gnjidic concluded that “For Australians living with dementia and their caregivers (who commonly are responsible for managing medications for people with dementia), the key is to communicate closely with general practitioners, pharmacists and other health professionals to make informed decisions and to practice good medicine management techniques to minimize the risk of side effects.” Also, she commented that “Deprescribing unnecessary medications may improve an individual’s quality of life and can reduce unnecessary healthcare cost.”

Adapted by Paul Susic Ph.D. Licensed Psychologist from article at ScienceDaily: Dementia Diagnosis Linked to Unnecessary Medication Use dated Apr. 19, 2018

Story Source:

Materials provided by University of Sydney. Note: Content may be edited for style and length.

Journal Reference:

Danijela Gnjidic, George O Agogo, Christine M Ramsey, Daniela C Moga, Heather Allore. The impact of dementia diagnosis on patterns of potentially inappropriate medication use among older adults. The Journals of Gerontology: Series A, 2018; DOI: 10.1093/gerona/gly078



Generalized Anxiety Disorder: What is it exactly?




Generalized Anxiety Disorder: An Overview

Generalized anxiety disorder is a form of anxiety that is chronic, lasts for at least six months and is not accompanied by obsessions, phobias or panic attacks. A person with generalized anxiety disorder experiences constant worry and anxiety without all the comorbid symptoms of other anxiety disorders. To be given a diagnosis of this anxiety disorder, you must be focused on two or more specific, stressful life experiences such as significant concern related to work, finances, relationships or other issues most days for a minimum of six months. Individuals with generalized anxiety disorder often spend a lot of time worrying and tend to have several or many significant concerns. However, it is very difficult to manage any control over your worries and anxiety when you have this disorder. Also, the worries tend to be significantly out of proportion to the actual threat involved.




If you have generalized anxiety disorder, you will most often have at least three of the following six symptoms, most days for a minimum of six months:

• Irritability
• difficulty concentrating
• difficulties with sleep
• being fatigued easily
• feeling restless
• tension in the muscles

Another important aspect of generalized anxiety disorder is that you will experience a significant level of distress and impairment in daily activities related to work, school and social experiences.

Most often, before a physician will diagnose you as having this anxiety disorder he/she will have ruled out most possible medical causes of chronic anxiety such as thyroid problems, drug-induced anxiety and hyperventilation. Generalized anxiety disorder also often occurs at the same time as depression. A competent psychologist or mental health clinician will quickly try to distinguish whether the anxiety should be treated as the primary or secondary disorder. It is often difficult to tell which came first.

This anxiety disorder can develop at any age. Among children and adolescents, the focus of worries will tend to be related to school or performance in sports. The source of concern among adults can be related to a variety of circumstances. It is believed that generalized anxiety disorder affects approximately 4% of the population in the United States and may be slightly more common among women (55% to 60%) than men.

Generalized anxiety disorder is not usually associated with any specific phobias. However, Aaron Beck M.D., has suggested that the disorder may be related to some “basic fears” of a broad-based nature. They may include:

• fear of being unable to cope
• fear of failure
• fear of disease and death
• fear of abandonment or rejection
• fear of losing control

Generalized anxiety disorder may be exacerbated by any circumstance that increases your perception of danger or seems threatening. The underlying cause is unknown although it is believed to be related to some combination of heredity and experiences in childhood such as excessive expectations of parents, fears of abandonment or rejection by others.

Treatment for Generalized Anxiety Disorder:

Cognitive Behavioral Therapy

Often some form of cognitive behavioral therapy is used to treat generalized anxiety disorder. Utilizing this type of psychotherapy involves identifying themes of worry and fearful self-talk which is then challenged and replaced by more positive, constructive thoughts. More realistic, positive thoughts are used to replace counterproductive thoughts which are then practiced and internalized over time. Cognitive behavioral therapy may also utilize guided imagery to replace negative with more positive themes of mental imagery.

Medication

Medications may be recommended for generalized anxiety disorder in moderate to severe cases. These medications may involve the use of both anxiety medications and antidepressants. Frequently, the anxiety medication Buspar may be used. At other times SSRI antidepressants may be used such as Luvox, Zoloft, Paxil or Serzone either alone or in conjunction with| Buspar.

Relaxation Training

Relaxation training for generalized anxiety disorder usually involves some type of deep breathing and relaxation techniques to reduce the generalized worry and feeling of anxiety. Also, a consistent exercise program may also be included.

Problem-solving

Problem-solving usually takes the form of systematically working through and solving issues in our lives that seem to be a focus of worries. The focus becomes on solutions as opposed to the worries themselves. If there is no practical solution to a problem, the focus then becomes on ways to cope with the situation rather than continuing to worry about it. Sometimes, we may need to learn to accept things that we cannot change.

Distraction

Distraction can also be used at times to help cope with worries that are not amenable to treatment with cognitive behavioral therapy or problem-solving. Distraction may involve diverting your attention to other activities such as listening to music, talking on the telephone, exercising, cooking, reading or solving puzzles.

Personality and Lifestyle Changes

Intervention along these lines tend to focus on the use of methods usually described to assist with panic disorder such as increased downtime, stress management, regular exercise, and eliminating stimulants and sweets from your diet. It may also involve resolving problems with others, changing attitudes toward perfectionism, a need to please others or an excessive need to feel in control.

By Paul Susic Ph.D. Licensed Psychologist


Prozac Medication: The Benefits, Side Effects and Dosages




Prozac Medication: An Overview

Prozac is a medication used to treat depression, obsessive-compulsive disorder, bulimia, and frequently severe symptoms of premenstrual syndrome. Prozac is within the drug classification referred to as selective serotonin reuptake inhibitors (SSRI’s), which is believed to help maintain a elevated level of the neurotransmitter serotonin in the brain.

Serotonin is a neurotransmitter in the brain which is believed to affect moods. This neurotransmitter is usually quickly reabsorbed after its initial release from neurons in the brain. It is believed that excess serotonin between the neurons is blocked by medications such as Prozac from being taken back up into the releasing neurons resulting in increased levels of serotonin in the brain.

Prozac is most often prescribed to treat depression of the moderate to severe variety which interferes with daily functioning and most often is referred to as major depression. The symptoms of major depression include low mood and low energy, changes in sleeping habits and appetite, decreased sex drive, feelings of guilt or worthlessness, difficulty concentrating, slowed thinking, and suicidal thoughts. However, Prozac can be taken for a variety of other mental health disorders including obsessive-compulsive disorder, premenstrual dysphoric disorder as well as others. It is most often prescribed for adolescents, adults and the elderly but may occasionally be prescribed for children.

Prozac Medication for Obsessive- Compulsive Disorders:

In addition to being used for the treatment of depression, Prozac is also used to treat obsessive-compulsive disorder. Obsessions are thoughts that won’t go away, and compulsions are repetitive behaviors and actions which are done to relieve anxiety often associated with the obsessions. Prozac is used at times to also treat bulimia which is a binge eating disorder which involves deliberate vomiting and has also been used to treat other eating disorders including obesity.

Premenstrual Dysphoric Disorder:

Under the brand name Serafem which includes the active ingredients in Prozac, this depression medication is sometimes prescribed for premenstrual dysphoric disorder (PMDD), which is often referred to as premenstrual syndrome (PMS) including mood changes such as anxiety, depression, persistent anger, irritability, and mood swings. There are various physical problems associated with PMDD, including bloating, breast tenderness, headache and joint muscle pain. Symptoms usually tend to begin about 1 to 2 weeks before a woman’s premenstrual period. They are frequently severe enough to interfere with a woman’s daily activities, functioning and relationships.

Prozac Medication: Precautions

You should always be open and honest with your doctor when your taking Prozac. Always give a complete medical history, including liver problems, kidney disease, seizures, heart problems, allergies and history of diabetes. This depression medication has been known to make individuals dizzy or drowsy, making it necessary to be cautious when engaging in activities that require alertness such as driving or using heavy machinery. Alcohol should be limited when on this medication. Caution is also advised if you have diabetes, alcohol dependence or liver disease. Also, caution should be taken when this medication is being used by the elderly as they are more sensitive to the effects of the drug. This drug should only be used if necessary if an individual is pregnant as the medication passes into the breast milk. Because of the possible risk to the infant, breast-feeding while on this medication is not recommended. Consultation with your physician about the benefits and risks of Prozac used during pregnancy and breast-feeding is imperative. Obviously, you should never share your Prozac with others.




Important Facts About This Depression Medication

It has been noted that there can be some very serious and at times even fatal reactions to occur when Prozac is taken at the same time as some other antidepressants such as the MAO inhibitors. Also, you need to be careful when taking high doses of Prozac over a prolonged period of time. If you are taking any other medications for depression or any other prescription or nonprescription drugs you need to notify your physician before beginning on Prozac.

Prozac Side Effects:

Although the Prozac side effects seem to be less than some of the earlier generation antidepressant medications such as desipramine, amitriptyline and nortriptyline, there are still side effects that you need to be aware of. Some of the more common side effects of Prozac are sweating, dry mouth, drowsiness, headache, insomnia and nausea. Some of the side effects that are less likely but at times even more severe are loss of appetite and unusual weight loss, uncontrollable movements such as tremors, decreased interest in sex, flu-like symptoms, and either unusual or severe mood changes. Even less likely but even more potentially serious Prozac side effects include trouble swallowing, vision changes, white spots and swelling on the mouth and tongue, painful and/or prolonged erection and changes in sexual ability. The most severe side effects associated with Prozac are irregular and fast heartbeat, and fainting. Allergic reactions to Prozac are relatively rare but may include itching, rash, swelling, trouble breathing and dizziness. If you notice any reactions after beginning treatment with Prozac, you need to notify your pharmacist or physician immediately. A more complete listing of Prozac side effects follows.

The Most Common Prozac Side Effects:

Abnormal vision, abnormal ejaculation, abnormal dreams, increased anxiety, reduced sex drive, dry mouth, dizziness, flushing, flulike symptoms, headache, gas, impotence, itching, insomnia, loss of appetite, nervousness, nausea, sinusitis, rash, sleepiness, sweating, sore throat, upset stomach, tremors, yawning, vomiting, weakness

Less Common Prozac Side Effects:

Agitation, abnormal taste, weight gain, sleep disorders, bleeding problems, confusion, chills, weight gain, ringing in the ears, palpitations, loss of memory, increased appetite, high blood pressure, frequent urination, ear pain, emotional instability

There have been other very rare side effects reported while taking Prozac. If you develop any unexplained or new symptoms after initiating treatment with this depression medication you need to contact your physician immediately.

Drug Interactions:

In addition to the Prozac side effects mentioned above, there are also concerns for negative food and drug interactions when taking this antidepressant medication. As mentioned previously, Prozac should never be taken at the same time as you are taking MAO inhibitors. This can cause a very serious medication interaction. Also, when Prozac is taken with other medications the effect may be increased, decreased or altered in other ways. You should always check with your doctor when Prozac is taken with the following medications:

Alprazolam (Xanax)
Carbamazepine (Tegretol)
Clozapine (Clozaril)
Diazepam (Valium)
Digitoxin (Crystodigin)
Drugs that impair brain function, such as sleep aids and narcotic painkillers
Flecainide (Tambocor)
Haloperidol (Haldol)
Lithium (Eskalith)
Other antidepressants (Elavil)
Phenytoin (Dilantin)
Pimozide (Orap)
Tryptophan
Vinblastine (Velban)
Warfarin (Coumadin)

Special Warnings if You are Pregnant or Breast-feeding:

Prozac has not been adequately studied for its effects on pregnancy. If you are pregnant or plan to become pregnant in the near future, you need to talk with your physician as soon as possible to determine whether you should continue taking this depression medication. Prozac is known to appear in breast milk, so breast-feeding is obviously discouraged when taking this drug.

Prozac Dosage:

It is most common for your Prozac dosage to be taken once or twice a day and should be taken exactly as prescribed by your physician. It needs to be taken regularly to be effective. If it is possible, you should take your Prozac dosage at the same time every day.

Some patients have found that it can take as much as four weeks to feel any significant effects and get some relief from their depression. Doctors will also commonly maintain the treatment regimen for about nine months after the first initial three-month treatment trial. Some individuals who experience obsessive-compulsive disorder may not feel the full effects for as much as five weeks.

The Recommended Prozac Dosage:

The most common starting dosage of Prozac is 20 mg daily taken in the morning. Your physician may increase your dose after several weeks if there has been no improvement in symptoms. Elderly people with kidney and liver disease, and any other individual taking other medications may have their dosage adjusted by their doctor.

When taking a dosage of Prozac over 20 mg, the doctor may ask you to take it once a day in the morning or may ask that you to take two smaller doses in the morning and also at noontime.

The usual Prozac dosage for depression ranges between 20 mg and 60 mg. For obsessive-compulsive disorder, the usual dosage of Prozac ranges from 20 mg to 60 mg per day, although at times a maximum of 80 mg may be prescribed. The usual dosage of Prozac for bulimia nervosa is 60 mg taken in the morning. As with other disorders, the doctor may start at a lower dosage and increase to this level over a period of time. The most common Prozac dosage for premenstrual dysphoric disorder is 20 mg per day.

For some individuals who have been treated successfully with the daily form of Prozac, their doctor may switch them to a long acting form sometimes referred to as Prozac weekly. Your physician may ask you to skip your daily doses for seven days and then take your first weekly capsule.

If you miss your dose of Prozac you should take it as soon as you remember. If a significant time has passed however, you should skip that dosage and resume your normal dosage schedule.

Over dosage of Prozac:

Prozac like all medications, needs to be taken as recommended. Dosages more than the recommended amount can be dangerous and even fatal. Also, combining Prozac with certain other medications or drugs may cause symptoms of over dosage. If you suspect an overdose, you need to contact your doctor or go to an emergency room immediately.

The most common symptoms of Prozac over dosage include rapid heartbeat, nausea, seizures, vomiting and sleepiness. Some of the less common symptoms of Prozac over dosage include stupor, sweating, rigid muscles, low blood pressure, mania, coma, delirium, fainting, high fever and irregular heartbeat.

By Paul Susic Ph.D. Licensed Psychologist


Cognitive Behavioral Therapy for Depression, Anxiety and Insomnia?




Cognitive Behavioral Therapy: History

Cognitive behavioral therapy was founded by the psychiatrist Aaron Beck M.D. in the 1960’s. As he was conducting research on psychoanalysis he noticed that an internal dialogue seemed to be taking place as patients thought through and discussed their problems. Beck is considered to be the founding father of cognitive behavioral therapy. Albert Ellis Ph.D. on the other hand, was a psychologist who was the original creator of the conventional cognitive therapies and some of the basic principles underlying cognitive behavioral therapy.

Albert Ellis Ph.D. and Rational Emotive Therapy

In the mid-1950’s, Albert Ellis Ph.D. began to recognize some very important principles associated with thinking and behaviors, which he then applied to his brand of psychotherapy referred to as rational emotive therapy. He discovered that people would develop strong beliefs which would affect their emotional reactions and functioning. He recognized that certain beliefs could be very irrational resulting in individuals becoming depressed, anxious or contributing to other self-destructive behaviors.

When he began to formulate his ideas in about 1955, the role of thinking or cognition had not been addressed in any significant way by the field of psychology. He developed the therapeutic modality of rational emotive therapy in reaction to the inadequate explanations and techniques of behaviorism and psychoanalysis. He concluded that the inadequacy of psychoanalysis and behaviorism resulted from a deficiency in conceptualizations of emotional disturbance and personality. He concluded that by ignoring the role of thinking or cognition in emotional disturbance, both therapeutic models failed to explain the development and maintenance of dysfunctional thinking patterns.




Aaron Beck M.D. and Cognitive Behavioral Therapy

Following upon the therapeutic model of Albert Ellis Ph.D. and his rational emotive therapy, Aaron Beck M.D. also began recognizing the importance of thinking or cognition in individual’s distress and dysfunction in their daily lives. He began to see that the connection between feelings, emotions and thoughts were crucial in understanding reactions and behaviors.

He also began to recognize that patients were not always aware of their emotions and thoughts and were very incapable of identifying how their thoughts affect their behaviors. He began to recognize that when an individual is upset for example, their thought process is generally negative, destructive and frequently impractical. It became very apparent to Dr. Beck that individual’s thoughts played a huge role in understanding and being able to overcome life’s challenges.

As he continued to develop his therapeutic model, Dr. Beck began to consider that these skewed thinking processes were actually the result of what he considered to be automatic, involuntary thoughts, and that people have a tendency to accept them as true without considering any other alternatives. His cognitive behavioral therapy model began to emphasize the transformation of automatic thoughts by questioning their validity and whether they were an actual reflection of reality. He began to recognize that as an individual considers the existence of and then reduces or alters their destructive, self-critical or catastrophic thoughts, their sense of despair, worry, or depression would gradually decrease, and they would begin to live a more positive and satisfying life.

Literally thousands of studies have confirmed the effectiveness and validity of cognitive behavioral therapy. Many studies have suggested that cognitive behavioral therapy is more effective than medication alone in treating such conditions as insomnia and depression. It now seems to be the treatment model of choice for most psychologists, psychiatrists and other mental health clinicians. Part of its beauty is that it seems to be a very common-sense approach to treatment and can be used for almost any maladjusted behavior, where thoughts and ideas play a crucial role in the development and maintenance of dysfunctional patterns of thought and behavior.

An Overview of Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is a relatively short-term psychotherapy model. It is a practical, results oriented approach to coping with a multitude of dysfunctional disorders including anxiety, depression, posttraumatic stress disorder, panic attacks, obsessive-compulsive disorder, social phobia, bipolar disorder, substance abuse, schizophrenia, eating disorders and anger issues as well as many others. Its goal is to help people to change the way they think and feel about specific situations in life as well as to change their resulting reactions and behaviors.

The therapy involves altering an individual’s attitudes and behavioral patterns by focusing on their thoughts, underlying beliefs, attitudes, and visual imagery. Cognitive behavioral therapy combines cognitive and behavioral psychotherapies and places an emphasis on the meaning ascribed to experiences and thought processes that can often be traced back to earlier childhood experiences. The behavioral aspect of therapy focuses on the connection between the challenges and obstacles faced as well as the actions and thoughts related to them. Negative and unpleasant thoughts can often lead to emotional distress and various other psychological issues. CBT attempts to help people to gain a better awareness of their negative interpretations and the behavioral patterns which arise from their skewed thinking processes. This therapeutic model frequently helps to develop alternative ways of processing thoughts and assists in developing new, more functional thoughts and behavioral patterns to mitigate psychological trauma and distress.

Three Models of Cognitive Therapy

The book Cognitive Behavioral Therapy by George Muntau has identified three major approaches to cognitive behavioral therapy. They are rational emotive therapy, Beck’s cognitive therapy and stress inoculation therapy.

Rational Emotive Behavior Therapy

Like cognitive behavioral therapy, rational emotive therapy also attempts to remediate maladaptive thoughts and behavioral patterns. It utilizes the process of discussion and persuasion to alter relevant thinking processes.

Beck’s Cognitive Therapy

As previously mentioned, Dr. Beck’s cognitive behavioral model originally developed for treating depression, is now used for a multitude of psychological disorders such as eating disorders, anxiety disorders, insomnia and even has been used in such specialties as sports psychology. The focus is on making the connection between maladaptive thinking patterns, feelings, and the resultant reactions and behaviors. Patients are trained to recognize and utilize automatic thoughts to alter thinking patterns and remediate their emotional distress.

Stress Inoculation Therapy

Stress inoculation therapy utilizes self-guided training to assist the patient in developing and utilizing self-transformational statements and affirmations. It is almost a “pep-talk” approach to altering thoughts and the resulting behaviors.

Cognitive Behavioral Therapy: Conclusion

Cognitive behavioral therapy is currently the model used by the majority of clinicians in providing psychotherapy for a whole variety of mental health disorders including depression, anxiety, insomnia and eating disorders as well as many others. It focuses on a common-sense approach to recognizing and dealing with dysfunctional thoughts which underlie distressful feelings and dysfunctional behavioral patterns. Current studies have found cognitive behavioral therapy to be just as effective as medications alone and to have superiority over medications in reducing the rate of relapse of various psychological disorders. Frequently, cognitive behavioral therapy is used in addition to medications for the optimal remediation of psychological disorders.

By Paul Susic Ph.D. Licensed Psychologist




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Help Wanted: Psychologists in Metropolitan St. Louis Missouri





Part-time and Full-time Psychologists Wanted in the St. Louis Metropolitan Area:

An excellent opportunity and exceptional pay for doctoral level psychologists in St. Louis city, St. Louis county, St. Charles County and the surrounding metropolitan area is now available. Senior Care Psychological Consulting is looking for psychologists to provide services in office, long-term care facilities and homes. Hours are very flexible including part-time and full-time opportunities to provide counseling, assessment and/or psychological testing services to geriatric patients and individuals with long-term chronic medical and mental health concerns. Experienced individuals are preferred but we will train individuals with the right personality and aptitude.

Compensation:

Senior Care Psychological Consulting provides excellent compensation, paid twice monthly without your having to wait on billing cycles or having to assume the risk of nonpayment. The average hourly rates are between $70-$114 per hour. This is a wonderful opportunity for a doctoral level psychologist who is interested in learning or continuing their experience in working with geriatrics and individuals with long-term medical and mental health disability. If you’re interested you may contact Paul Susic Ph.D. Licensed Psychologist at (636) 300-9922 or you may email me at seniorcarepsych@yahoo.com for more information or to express your interest. Senior Care Psychological Consulting is an equal opportunity employer.

Paul Susic Ph.D. Licensed Psychologist
Clinical Director
Senior Care Psychological Consulting





Senior Care Psychological Consulting:

Senior Care Psychological Consulting in St. Charles, Missouri





The Only Strictly Doctoral Psychology Practice in St. Louis, Missouri

Senior Care Psychological Consulting is the premier provider of doctoral level geropsychology services for the metropolitan St. Louis, Missouri area. Senior Care Psychological Consulting is a specialty geriatric psychology practice providing psychological assessment, mental health counseling services, psychological testing, neuropsychological evaluation and disability evaluation to the elderly and chronic mentally ill in an office-based practice in St. Charles, Missouri. We also provide in- home services as well as providing services in nursing homes and other long term care facilities throughout the metropolitan St. Louis, Missouri area.




Paul Susic Ph.D. Licensed Psychologist and Senior Care Psychological Consulting

Senior Care Psychological was founded by Paul Susic Ph.D Licensed Psychologist who has been providing mental health services to the senior community for well over two decades. Paul developed one of the first exclusively geriatric psychiatric Partial Hospital programs in the St. Louis area, which he managed for approximately five years as the Program Manager at the former Incarnate Word Hospital. He also created and developed a whole continuum of outpatient mental health services which he also managed at Incarnate Word Hospital. He later was promoted to Director of the Department of Psychiatry of Incarnate Word Hospital, which he left in December, 1999 to begin a full-time geropsychology practice.

Paul Susic and Senior Care Psychological Counseling have continued their commitment to providing high-quality psychological assessment and mental health counseling services to the senior community. Senior Care specializes in providing psychological counseling and assessment services, psychological testing and neuropsychological evaluation in- home, in nursing homes and long-term care facilities throughout the metropolitan St. Louis area and also in an office based practice in St. Charles, Missouri. All services are provided under the direction of Dr.Susic who is the Clinical Director. Mental health assessments, testing as well as assessments for cognitive (memory) functioning and need for long-term placement are also available at senior care.

Please feel free to call and ask for Paul Susic Ph.D. Licensed Psychologist, and he will be pleased to assist you in any way possible. He may be reached at his office at (636) 300-9922 for local calls, or or he may also be reached by e-mail at seniorcarepsych@yahoo.com

Senior Care Psychological Consulting 500 Huber Park Ct. Suite 205, Weldon Spring, MO 63304

Information and webpage by Paul Susic Ph.D. Licensed Psychologist




Senior Care Psychological Consulting:

Specific Phobia Disorder Treatment Information You Need to Know




Specific Phobia Disorder Treatment and Information: An Overview

Specific phobia disorder can be a very uncomfortable condition at the very least and absolutely disabling at its very worst. However, there are ways to cope with specific phobia disorder to prevent it from undermining an individual’s entire life. It is obviously imperative to have a good understanding of the condition as well as a recognition of when treatment is necessary. Specific phobia disorder involves a fear and avoidance of very specific circumstances or situations. It is very different from panic attacks and agoraphobia in various ways including that there are no spontaneous panic attacks or fear of panic attacks as you would experience in agoraphobia. It is also very different from social phobia in that there is no fear of embarrassment or humiliation in social situations. Direct exposure to the feared object can cause a panic reaction however. Often the fear and avoidance are significant enough to interfere with an individual’s daily functioning including working and social relationships, and frequently cause a tremendous feeling of distress. Frequently, individuals recognize the irrationality of their fear and response, but it continues to cause a considerable level of difficulty in their lives. Although there are many types of specific phobias some of the more common ones follow:

Dental or doctor phobias. Frequently these will begin with a fear of pain related to either dental or medical procedures conducted in the physician or dentist office. Later this may be generalized to anything related to or in memory of doctors or dentists. Unfortunately, this fear may cause some people to not seek medical or dental services when necessary.




Airplane phobia. Usually this phobic disorder is related to a fear of an airplane crashing. Often fears of the cabin depressurizing and not being able to breathe are part of the imagined scenario. A more contemporary version of this phobia is a fear of hijacking or a bombing of the plane Many individuals with this phobia will have an actual panic attack while flying. Some experts have concluded that approximately 10% of the population in the United States will not fly at all while an additional 20% will fly but experience tremendous anxiety.

Illness phobia. This phobic reaction is in relation to a fear of getting a specific medical condition such as cancer or having a heart attack. People with an illness phobia tend to seek constant reassurance from doctors and medical personnel and will avoid any reminder of the dreaded disease if possible. Illness phobia is also very different from hypochondriasis in that with a specific illness phobia people tend to focus on one specific illness as opposed to imagining the development of a variety of diseases or medical conditions.

Elevator phobia. This phobic reaction is usually in relation to fears of elevator cables breaking and the elevator crashing to the floor or being stopped and trapped inside. This fear frequently can cause an individual to have a panic attack although they have not previously had any history of panic disorder.

Animal phobias. The fear associated with this phobia is usually in relation to a variety of animals including rats, spiders, snakes, bats, dogs, and various other animals. This phobic disorder frequently begins in childhood where often the initial fears are considered to be rational or normal. It is only when they continue into adulthood and begin to undermine or interfere with an individual’s daily functioning that they actually develop to the point of becoming a specific phobia disorder.

Acrophobia. This phobia is often referred to as a “fear of heights”. Acrophobia can be related to a multitude of circumstances such as fear of being on the upper floors of a tall building, on top of a mountain, or even bridges. Individuals who experience this type of specific phobia disorder often say that they experience (1) dizziness or vertigo for (2) a feeling of being drawn toward the edge or an urge to jump.

Thunder and/or lightning phobias. This phobic disorder almost always starts in childhood. It is when it actually persists beyond the adolescent years that it is then defined as a specific phobia.
Specific phobias are very common and are believed to affect approximately 10% of the population. Because they do not always result in severe impairment in daily functioning, a significant amount of people who experience these fears and avoidant reactions do not seek treatment. Specific phobias seem to occur equally between men and women. Animal phobias however seem to be more common among women and illness phobia seems to be more common among men.

Development of Specific Phobia Disorder:

Specific phobias in general are usually fears about specific objects and circumstances experienced in childhood that were never really outgrown. However, in some circumstances they can be fears that are developed following the experience of a traumatic event such as an accident, illness or violent experience. Unfortunately, another precipitating factor which may lead to the possible development of a specific phobia may be the modeling of others. For example, repeated exposure to a parent who has a specific phobia can result in children developing it also.

Specific Phobia Disorder Treatment:

Specific phobia disorder treatment can be different from the usual treatment of panic disorders in that specific phobias do not generally involve spontaneous panic attacks. Therefore, they don’t often include treatments such as panic control therapy, interoceptive desensitization and medication.

Cognitive therapy. One of the more common treatments for specific phobia includes cognitive therapy which helps to recognize, challenge and replace some of the specific thoughts that perpetuate the fearful reactions and avoidance behavior. Fearful thoughts such as “What if I panic when I’m trapped on an airplane?” Can be replaced with thoughts such as “Although I’m on the plane for two hours, I will be off soon.”, or “I can get my mind on something else like reading or watching a movie.” These coping statements are usually rehearsed until they are internalized and often are accompanied with deep breathing or relaxation techniques.

Incremental exposure. This type of specific phobia treatment involves exposing the individual to the feared object or experience in incremental steps. An example of this may be when a fear of flying is incrementally approached through the use of imaginary flying experiences such as looking at pictures of people flying or even watching planes take off and land. Also, an individual may take a very short flight at first rather than a longer one. Initially they may even have a support person to accompany this individual, and eventually they may then take the flight on their own.

Relaxation training. Deep breathing and muscle relaxation can be practiced on a regular basis to reduce the general level of experienced anxiety. Relaxation training can be used to help with anticipatory anxiety as well as deep breathing while actually confronting the specific object or circumstance.

Some phobic objects and circumstances are not amenable to real-life desensitization such as earthquakes or other natural disasters. In these circumstances cognitive therapy would be used along with exposure to imaginary experiences of these natural disasters such as looking at pictures or watching movies associated with these feared catastrophes.

Specific phobia disorder conclusion:

It is always important to understand that specific phobia disorder is relatively benign initially, especially if it begins as a childhood fear. Although it has been found at times to last for many years and even decades, it will usually not get worse and sometimes will diminish over time. Fortunately, this disorder is not usually associated with other psychiatric disorders or mental health problems. People with specific phobia disorder often function at a high level in other aspects of their lives.

By Paul Susic Ph.D. Licensed Psychologist




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