Question 1

Anxiety

Accepted Answer

A generalized feeling of apprehension about possible danger. At the subjective level, the individual may feel a negative mood and worry about possible future danger, which he/she is unable to predict or control.
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There is also a physiological component involved in anxiety, including a chronic over-arousal, which readies the person for dealing with the threat or danger if it should occur. The person then attempts to avoid situations where the threat or danger might be encountered.
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There are several types of anxiety disorders, including phobias, panic disorder with or without agoraphobia, generalized anxiety disorder, obsessive- compulsive disorder, and posttraumatic stress disorder.

Question 2

Adjustment Disorders

Accepted Answer

This disorder is characterized by the development of emotional or behavioral disturbances in response to identifiable stressors. The most common stressors are: death in the family, loss of a job, problems at work, divorce, relocation, or health issues. The distress people experience as a result of exposure to these stressors is more excessive than that which would be expected. As a result, there is significant impairment in social or occupational functioning.
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Emotions involved in this disorder range from persistant rage and anger, to depression, anxiety, fear, shame, and guilt. The behavioral disturbances may include: social isolation, physical complaints, academic inhibition, antisocial behavior (i.e. stealing and vandalism), reckless driving, fighting, truancy, and defaulting on legal responsibilities. These emotional and physical symptoms usually occur within 3 months of the onset of the stressor. Once the stressors have subsided, the symptoms are expected to cease within six months.
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Treatment of Adjustment Disorders
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The treatment of adjustment disorders depends on the severity of the reaction to the stressor. If the symptoms are mild, psychotherapy and counseling are appropriate methods of treatment. If the condition is severe enough to affect daily functioning, then medications should be employed as well. The type of medications chosen would depend on the existing symptoms. Anti-depressants – for depressive symptoms, anti-anxiety and tranquilizers - for anxiety, sleeping aids - for insomnia, mood stabilizers - for manic-like behavior, anti-psychotic medications - in cases when agitation, uncontrolled anger, violence or socially inappropriate behavior is present.

Question 3

Attention Deficit Hyperactivity Disorder

Accepted Answer

There are numerous causal factors involved in ADHD. Many people diagnosed with the disorder are believed to have inherited it from one of their parents or grandparents. However, there are also many people with unexplained causes of ADHD.
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To be diagnosed with ADHD, the individual must have 6 or more of the following symptoms:
1. Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
2. Has difficulty sustaining attention in tasks or play activities.
3. Does not seem to listen when spoken to directly.
4. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).
5. Often has difficulty organizing tasks and activities.
6. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework).
7. Often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools).
8. Easily distracted by extraneous stimuli.
9. Is often forgetful in daily activities.
10. Often fidgets with hands or feet, squirms in seat.
11. Often leaves a seat in classroom or in other situations in which remaining seated is expected.
12. Often runs about or climbs excessively in situations in which it is inappropriate ( in adolescents or adults, may be limited to subjective feelings of restlessness).
13. Often has difficulty playing or engaging in leisure activities quietly.
14. Is often “on the go” or acts as if “driven by a motor”.
15. Often talks excessively.
16. Blurts out answers before questions have been completed.
17. Has difficulty awaiting turn.
18. Often interrupts or intrudes on others (e.g., butts onto conversations or games).
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Symptoms of ADHD usually first appear during childhood, and some symptoms may persist into adolescence or adulthood.
ADHD is frequently seen among people diagnosed with other psychiatric conditions, such as, Bipolar Affective Disorder, Major Depressive Disorder, Obsessive Compulsive Disorder, Learning Disorders, and some others.
Therapy of ADHD is aimed at improving academic and vocational functioning. There are non-medication and medication-based therapies.
Non-medication based therapy consists of two parts:
1. Lifestyle and diet modifications
2. Biofeedback and other psychological interventions
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Lifestyle changes include regular physical exercise, strict adherence to wake and sleep schedule. Certain dietary modifications should also take place, including abstinence from sugar and any psychoactive substance, such as caffeine and alcohol.
Biofeedback therapy teaches the individual to “listen” his/her own body. Through these techniques, the patient learns to relax and control restlessness and impulsivity. The use of other psychological interventions would depend on the presented symptoms and the age of the individual. Group, vocational, play, and cognitive-behavioral therapies can be utilized.
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Medication-based therapy is aimed at controlling behavior by activating specific brain regions which are normally responsible for impulse control, focusing, and attention. These regions are located in the frontal lobes of the human brain and are believed to be under-active in individuals with ADHD.
Two groups of medications are used: stimulants and non-stimulants. Stimulants are based on different salts of Amphetamine. Ritalin, Concerta, Adderall, Focalin, Metadate, Daytrana are among the most popular brand names on the market at the moment. They are available in different forms, such as oral medications and skin patches.
Non-stimulants include Strattera, Wellbutrin, Provigil, and Effexor. Strattera, which is the most popular medication out of all those previously listed, is effective for both adults and children. The rest of the non-stimulants on the list are prescribed mostly to adults. There are a few other non-stimulant medications that are being used experimentally at the time.

Question 4

Asperger's Disorder

Accepted Answer

Asperger’s disorder is a form of developmental disorder, where a person shows severe, sustain impairment in social interaction and restricted, repetitive patterns of behavior, interests, and activity. Unlike autistic disorder, in Asperger’s disorder there are no significant delays in language, cognitive development, or age appropriate self-help skills.

Question 5

Autism

Accepted Answer

Disorder beginning in infancy and characterized by withdrawal and self-absorption, failure to develop attachment to a parental figure, ineffective communication and mutism, preoccupation with inanimate objects, and obsessive demand for sameness in the environment. Autistic disorder occurs at the rate of about 5 cases per 10,000 children.

Question 6

Bipolar-Affective Disorder

Accepted Answer

This disorder is usually characterized by instability of mood, energy and/or sleep. People suffering from Bipolar Disorder may experience significant changes in mood and behavior over periods of time. The disorder may first occur as a depressed, hypo-manic, manic or mixed episode.
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A depressed episode can be characterized by five or more of the following symptoms during the same 2-week period:
1. Depressed mood most of the day, nearly every day
2. Markedly diminished interest or pleasure in all, or almost all, activities
3. Significant decrease or increase in appetite and weight loss or gain (more than 5% a month)
4. Loss of sleep, or too much sleep
5. Agitation and restlessness, or markedly slowed mental and motor activity
6. Fatigue or loss of energy almost every day
7. Feeling of worthlessness or excessive/ inappropriate guilt almost every day
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideations with or without plans
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Manic and Hypo-manic episodes differ in duration and severity. They are characterized by a distinct period of abnormal and persistently elevated, expansive, or irritable mood.

During that period some of the following symptoms can be present:
1. Inflated self-esteem or grandiosity
2. Decreased need for sleep (feel rested after only 3 hours of sleep)
3. More talkative than usual or pressure to keep talking
4. Racking thoughts
5. Distractibility (attention too easily drawn to unimportant or irrelevant external stimuli)
6. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
7. Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)
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Mixed episode can include the symptoms characteristic for both depressed and manic episodes at the same time.
The exact cause why some people develop Bipolar-Affective Disorder is not yet known. The studies have repeatedly demonstrated a significant genetic predisposition.
The contemporary model of therapy is a combination of lifestyle modifications, psychotherapy and psychotropic medications. The medications usually consist of mood stabilizers, and the most commonly used drugs are Lithium, Lamictal, Depakote, Zyprexa, Abilify, Geodon, Seroquel, and Tegretol.

Question 7

Depression (including Major Depressive Disorder and Postpartum Depression)

Accepted Answer

Even though the exact causes of depression are still not fully understood, a number of factors have been found to be responsible in precipitating depression:

Psychological stressor, such as personal loss, may frequently become a tiger. Many people suffering from depression during their adult lives have been neglected or abused as children. Postpartum depression may be related to the change in sex hormones following pregnancy. Many people with depression are found to have abnormalities in their levels of cortisol, thyroid and growth hormones. The brain aging process is another significant factor behind depression. The statistic shows that depression becomes more prevalent with age. In many cases a strong genetic predisposition can be traced.
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In order to diagnose depression, five of the following symptoms must all be present during the same 2-week period:
1. Depressed mood most of the day, nearly every day
2. Markedly diminished interest or pleasure in all, or almost in all, activities
3. Significant decrease or increase of appetite and weight loss or gain (more than 5% a month)
4. Loss of sleep, or too much sleep
5. Agitation and restlessness, or markedly slowed mental and motor activity
6. Fatigue or loss of energy almost every day
7. Feeling of worthlessness or excessive/inappropriate guilt almost every day
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day
9. Recurrent thoughts of death (not just fear of dying), and recurrent suicidal ideations with or without plans
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Treatment of Depression is a combination of lifestyle modifications, psychotherapy, and psychotropic medications.
The patient’s life style should become a healthy one, including a normal balance between work and rest, physical exercise, and proper nutrition.
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When dealing with psychotherapy, three major approaches are used: Psychodynamic, Cognitive, and Interpersonal. The Psychodynamic approach promotes personality change through understanding of past conflicts. Cognitive psychology promotes symptomatic relief through alteration of self-destructive, “negative” thoughts and behavior. Lastly, the Interpersonal method promotes resolution of current interpersonal problems.
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The most effective and frequently used anti-depressant medications today are: Prozac, Zoloft, Paxil, Celexa, Lexapro, Effexor, Luvox, Serzone (in its generic form), Cymbalta, Pristiq, Fetzima, Brintellix, Remeron, Viibryd, and Wellbutrin. These medications differ from each other by their effects on various receptors in the brain and body. The decision of which medication to prescribe often depends on the person’s tolerability, since the same medication can cause one patient to feel sick and no side effects in another patient. This is true since the human reaction to antidepressants, which is similar to the reactions to other medications, is highly individual. In addition to tolerability, the choice of which medication to use also depends on the type of depression the patient is suffering from. At times, it is a challenge to predict, without actually testing it out, which type of antidepressant will be the most effective and best tolerated by the patient.  In order to minimize probability of side effects, and improve effectiveness, we usually employ Medication Tolerance Genetic Test, and Brain Neurotransmitters’ Balance Analysis before starting or changing the medications. If insufficient amount of thyroid hormone or estradiol - progesterone imbalance is found in laboratory testing, it needs to be corrected, before psychotropic medications are introduced.

Question 8

Generalized Anxiety Disorder

Accepted Answer

Even though anxiety is a normal emotion we are all faced with every once in a while, its presence becomes problematic when it is experienced too often.
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This disorder is characterized by excessive anxiety and worry (apprehensive expectation), which occurrs more days than not about a number of events or activities (such as work or school performance). Anxiety affects both adults and children.

Anxiety and worry may be associated with:
1. Restlessness or feeling keyed up or on the edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, restless unsatisfying sleep).
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To be diagnosed with Generalized Anxiety Disorder, the condition should last for at least 6 months.
The most effective treatment of anxiety disorder is a combination of psychotherapy and medications.
Cognitive-behavior therapy is the most effective psychotherapeutic approach. Supportive psychotherapy offers patients reassurance and comfort. Insight oriented psychotherapy focuses on uncovering unconscious conflicts. Many people feel an improvement after taking part in psychotherapy, but others also require anxiolytic medications. Those that are most frequently prescribed are: Buspirone, Benzodiazepines, Effexor, Cymbalta, Inderal, and Selective Serotonin Reuptake Inhibitors (SSRIs) such as Zoloft, Paxil, Celexa, Lexapro.
Benzodiazepines, such as Ativan, Xanax, Clonazepam, Valium, etc., should be used with caution, since users easily develop a tolerance and dependency.

Question 9

Obsessive Compulsive Disorder (OCD)

Accepted Answer

This disorder is characterized by either obsessions or compulsions.

Obsessions are defined by :
1. Recurrent and persistent thoughts, impulses, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress
2. The thoughts, impulses, images are not simply excessive worries about real-life problems
3. The person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action
4. The person recognizes that the persistent thoughts, impulses, or images are a product of his or her mind
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Compulsions are defined by:
1. Repetitive behavior (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly
2. The behavior or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize/ prevent or are clearly excessive
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It is unknown why some people develop Obsessive Compulsive Disorders. The genetic factor may play a significant role. More than half of the patients with OCD have a sudden onset of symptoms, which are usually precipitated by a stressful event, such as pregnancy, a sexual problem, or the death of a relative. Because many persons manage to keep their symptoms secret, there is often a delay of 5 to 10 years before patients come to psychiatric attention.
In treatment, the best success is observed when Psychotherapy is used in combination with Pharmacotherapy. The most effective psychotherapeutic modality is Behavioral Therapy. Commonly used medications are: Prozac, Luvox, Paxil, Celexa, Lexapro, and Clomipramine. Higher than regular dosages are usually necessary to achieve therapeutic effect.

Question 10

Sexual Dysfunctions

Accepted Answer

1. Male erectile dysfunction
2. Difficulties to achieve orgasm (male and female)
3. Premature ejaculation
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The treatment of Sexual Dysfunction would entirely depend on the cause, which can be psychological, physiological, or a mix of both. Some laboratory tests may be needed to establish the exact cause of the dysfunction. If the dysfunction is of a psychological nature, a psychotherapeutic approach may be the most effective. The most successful psychotherapeutic modalities are education and behavior therapy. If the disorder is of a physiological or mixed nature, there may be a need for medication. In order to be successful, the conventional approach often needs to be supplemented with Acupuncture and Herbal therapy.

Question 11

Social Anxiety/Social Phobia

Accepted Answer

Excessive anxiety in social situations, often because of a fear of negative evaluation by others.
The phobic feels anxiety when exposed to the feared situation, and understands that this fear is irrational, but yet can’t seem to control it. This social anxiety leads the individual to avoid various social functions, occupations, and relationships with others.

Question 12

Panic Disorder

Accepted Answer

This disorder is characterized by recurrent unexpected panic attacks.

The following may also be present:
1. persistent concern about having additional attacks
2. worry about the implications of the attack or its consequences (e.g., losing control, having a heart attacks, “going crazy”)
3. a significant change in behavior related to the attack
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In some individuals the attacks may be precipitated by being in places or situations from which escape might be difficult (or embarrassing) or in which help may not be available in the event of having an unexpected panic attack. This condition is referred to as agoraphobia.
Treatment is usually very effective. It consists of medications, Cognitive Therapy, and such Behavior therapies as Applied Relaxation, Respiratory Training, and In Vivo Exposure. The most commonly used medications are: SSRIs (Paxil, Prozac, Zoloft, Luvox, Celexa, Lexapro some others), Benzodiazepines (Ativan, Xanax, Valium, Klonopin), Tricyclic antidepressants (Clomipramine, Desipramine, Imipramine), BuSpar, Effexor, Serzone, and Valproic acid. Atenolol and Propranolol can be used to control body autonomic reactions, for example, tachycardia.

Question 13

Phobia

Accepted Answer

A phobia is a persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation (e.g., flying, heights, storms, water, animals, costumed characters, receiving an injection, seeing blood). People suffering phobias usually try to avoid the anxiety provoking situations or objects.
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In the case of Social Phobias (also known as Social Anxiety), there is a fear of social situations, fear of acting inappropriately, fear of being humiliated or embarrassed, and the fear of being exposed to unfamiliar people or possible scrutiny by others.
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The most proven therapeutic modality is Behavioral therapy. The other therapeutic modalities are hypnotherapy and supportive therapy. Medications are used infrequently and predominantly for Social Phobia. Effective drugs are: SSRIs (Zoloft, Paxil, Lexapro, and so on), Effexor, BuSpar, Benzodiazepines (Ativan, Xanax, Clonazepam, Valium and so on). Atenolol and Propranolol are given to suppress body autonomic response such as sweaty palms and tachycardia.

Question 14

Post Traumatic Stress Disorder (PTSD)

Accepted Answer

The person has been exposed to a traumatic event in which both of the following were present:
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1. the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death, serious injury, or a threat to the physical integrity of the self/others
2. the person’s response involved intense fear, helplessness, or horror
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The traumatic event is persistently experienced in one (or more) of the following ways:
1. recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions.
2. recurrent distressing dreams of the event
3. acting or feeling as if the traumatic event were recurring (including a sense of reliving the experience, illusions, hallucinations, and flashback episodes, including those that occur on awakening or when intoxicated with drugs or alcohol)
4. intense psychological distress and reactivity when exposed to internal or external cues that symbolize or resemble an aspect of the traumatic event.
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Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:
1. efforts to avoid thoughts, feelings, or conversations associated with the trauma
2. efforts to avoid activities, places or people that arouse recollections of the trauma
3. inability to recall an important aspect of the trauma
4. markedly diminished interest or participation in significant activities
5. feeling of detachment or estrangement from others
6. restricted range of affect (e.g., unable to have loving feelings)
7. sense of foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)
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Persistent symptoms of increased arousal (not present before trauma), as indicated by two (or more) of the following:
1. difficulty falling asleep or staying asleep
2. irritability or outbursts of anger
3. difficulty concentrating
4. hyper-vigilance
5. exaggerated startle response
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The treatment of PTSD requires a complex approach. Psychotherapy needs to be individualized according to the patient’s history and symptoms. Other various methods may also typically be used, including hypnosis, behavioral, and cognitive therapy. One of the newest psychotherapeutic techniques is EMDR (Eye Movement Desensitization and Reprocessing), in which the patient focuses on the lateral movements of the clinician’s finger while maintaining a mental image of the traumatic event. This technique can be highly effective. Furthermore, in some cases, group therapy and family counseling should be implemented.
The medications used for Pharmacotherapy must be individualized according the symptoms. Anti-depressants, mostly frequently the SSRIs, are used when depression and anxiety are dominant.

Question 15

Schizophrenia and Schizoaffective Disorder

Accepted Answer

Schizophrenia and Schizoaffective Disorder are serious mental health conditions that affect a person's thoughts, emotions, perceptions, and behavior. They are complex disorders with significant impacts on an individual's daily life, relationships, and overall functioning.
1. Schizophrenia: Schizophrenia is a chronic and severe mental illness characterized by a range of symptoms that often emerge in late adolescence or early adulthood.The exact cause of schizophrenia is not fully understood, but it likely results from a combination of genetic, environmental, and neurobiological factors.
Symptoms of schizophrenia can be classified into three main categories:
 • Positive symptoms: These include hallucinations (seeing, hearing, or feeling things that are not real), delusions (strongly held false beliefs), and disorganized thinking or speech.
 • Negative symptoms: These involve a lack of motivation, emotional expression, and social withdrawal.
 • Cognitive symptoms: These can include difficulties with attention, memory, and problem-solving.
People with schizophrenia may also experience disruptions in their ability to function effectively in various aspects of life, such as work, school, or relationships.
1. Schizoaffective Disorder: Schizoaffective Disorder is a mental illness that combines symptoms of both schizophrenia and mood disorders (like depression or bipolar disorder). It is less common than schizophrenia or mood disorders alone and can be more challenging to diagnose.
Symptoms of Schizoaffective Disorder can vary widely, but they typically involve a combination of mood-related symptoms (e.g., depression or mania) along with psychosis (hallucinations, delusions, or disorganized thinking). These mood symptoms can occur alongside, separately from, or even in the absence of psychotic symptoms.
Like schizophrenia, the exact cause of Schizoaffective Disorder is not well-understood, but it is believed to involve a complex interplay of genetic, environmental, and neurobiological factors.
Both conditions require careful diagnosis by a qualified mental health professional, and treatment often involves a combination of antipsychotic medications, psychotherapy, social support, and lifestyle adjustments to manage symptoms and improve overall quality of life.
It's essential to remember that each individual's experience with these disorders is unique, and treatment plans should be tailored to their specific needs and circumstances. Early intervention and ongoing support can make a significant difference in the long-term management of these conditions.

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