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As an 11 year old purchase 400 mg noroxin, you can definitely benefit from CBT! We B 100: I feel so frustrated because I have to color code everything and alphabetize everything order 400 mg noroxin otc. Just to do my homework I have to use 4 different colors of ink (pink buy discount noroxin 400mg on-line, purple, blue, green). I feel like such a weirdo and hate this feeling of craziness. Is there anything that I can do at home to stop this without uprooting my whole life? Gallo: First and foremost, a person with OCD is not crazy or weird. The very fact that you recognize the irrationality of your actions shows how lucid and sane you actually are. I would suggest seeking a skilled CBT therapist in your area. There are two very fine organizations which can help you locate someone. Anxiety Disorders Association of America and the Obsessive Compulsive Foundation. MeKaren: I used to be a checker, but over the years my compulsions have changed. Gallo: While it is hard for me to give specific individual therapeutic advice, you can try resisting the impulse to do so, tolerate the anxiety until it hits a peak, starts to plateau and then eventually declines. Also, there is an excellent guide by Dr Edna Foa on CBT for OCD that you can read to get you started if you cannot find a good therapist. Gallo: Cognitive therapy combined with good spiritual counseling from a clergy member who you respect can help with these types of obsessions and compulsions. Gallo: From the info provided, it is hard to make an definitive diagnosis. It could be OCD or another type of anxiety disorder called Generalized Anxiety Disorder. Unless you really believe that other people are trying to hurt you, you most likely are not suffering from paranoia. Brenda1: What about the type of OCD where you constantly fidget or count things. My doctor says this is a way of distraction, but I do it without thinking. However, it could also simply be a plain old habit behavior, which many of us possess. Gallo, I have done a little reading on CBT (Jeff Schwartz). I can understand how actively refraining from certain compulsions can eventually lead to creating less of an importance in carrying them out. I can sort of relate to that, as throughout the years, I have established at least some kind of control over excessive washing (hands & arms). Since acts like washing and checking are tangible, they are somewhat easier in some cases. However, when it comes to controlling those darn thoughts! Gallo: One technique for banishing thoughts is to use something we call "mental-exposure therapy". I suggest you do this with the help of a skilled therapist, because it involves exposing yourself mentally to the anxiety-provoking thoughts in a systematic and gradual way. It is important that you have professional therapeutic help and support while doing this. Mental exposure does eventually lead to desensitization to the anxiety. Also, a good cognitive therapist can help you learn to do what we call cognitive restructuring, whereby you identify, analyze, challenge, and restructure your obsessive, irrational thoughts. What is being done to promote understanding of this, as a treatable disorder? Gallo: The two organizations I mentioned, as well as the National Institute of Mental Health are actively and aggressively involved in promoting rational understanding of this rather common disorder. You might consider becoming an active member of one of these organizations. Are there any specific accommodations that can be made - or is OCD fundamentally different in that any such accommodations would be enabling instead of helpful? Accommodations, in essence, feed into, and reinforce the ritualistic behavior. Compulsions must be aggressively challenged, if they are to be beaten. Ultimately, the person who produces the cure is the patient him or herself. Gallo: Classical OCD consists of two primary symptoms. Intrusive, Disturbing, Anxiety-Provoking, Obsessive thoughts, coupled with compulsive rituals which are physical or mental actions intended to neutralize the anxiety caused by obsessions. Gallo for being our guest and staying to answer many of the audience questions. I also want to thank everyone in the audience for coming and participating. Please feel free to continue chatting in our OCD chatroom or any other chatroom here. Gallo: Thank you, and good night for having me here tonight. Lee Baer talks about OCD symptoms and treating Obsessive Compulsive Disorder with OCD medications and cognitive behavioral therapy. Included in the discussion: coping with obsessions and compulsions, what to do about obsessive and intrusive thoughts (bad thoughts), defining and treating scrupulosity and OCPD (Obsessive-Compulsive Personality Disorder) and more. Our topic tonight is "OCD: Getting Control of Your Obsessions and Compulsions. Baer is an internationally known expert in the treatment of obsessive-compulsive disorder. He is an associate professor of psychology at Harvard Medical School and the director of research at the OCD unit at Massachusetts General Hospital as well as the OCD Institute at McLean Hospital. Baer has written two excellent books on OCD:Before we get started, I also want to mention that we have an OCD screening test on our site. Is it possible to actually get control over your obsessions and compulsions? Most of our patients do see much improvement in obsessions and compulsions, using either behavior therapy, medications or a combination. David: Does it take both cognitive behavioral therapy and OCD medications to make a significant recovery or will one of those suffice? Baer: For people who are very severely affected, both are usually needed. However, for milder or moderate cases, sufferers often do very well with cognitive behavioral therapy alone, if they are willing to work hard. David: Maybe you could explain how cognitive behavioral therapy works and give us an example or two of using it with an OCD patient? Baer: The simplest example is someone with contamination fears who washes their hands too much. The behavior therapy, in this case called exposure and response prevention, involves having him/her touch things he/she thinks are contaminated and would usually avoid, (this is the "exposure" part) and then resist urges to wash for as long as they can (this is the "response prevention" part). Over a few practice sessions, their fear and avoidance goes down. We modify this basic approach for other types of rituals (another name for compulsions) and obsessions. David: It sounds very rational and easy -- the therapist teaches the patient his or her thoughts are irrational and the patient comes to understand that. Baer: I usually say that behavior therapy is simple, but not easy. Some people are not bothered enough by their symptoms to be willing to endure any anxiety during treatment.

The hallucinatory effects are short and last only an hour or less noroxin 400mg on-line; however buy cheap noroxin 400mg, it can affect the senses order noroxin 400mg mastercard, judgment and coordination for 18 to 24 hours. Users can seriously hurt themselves, because Ketamine numbs the body and they will not feel the pain of an injury. Ketamine lowers heart rate, which can lead to oxygen deprivation in the muscles and brain, resulting in heart failure or brain damage. It is very dangerous when mixed with alcohol and other drugs. It is not not considered an addictive drug like cocaine, heroin or alcohol because it does not produce the same compulsive drug-seeking behavior. However, like addictive drugs, it produces greater tolerance in some users who take the drug repeatedly. These users must take higher doses to achieve the same results as they have had in the past. This could be an extremely dangerous practice because of the unpredictability of the drug effect on an individual. You may experience fear, anger, guilt, surprise, sadness, or relief. There is no right or wrong response to your HIV diagnosis. Remember you are not alone; many people have been where you are now. Having HIV can be difficult and will be stressful at times. Thankfully, recent medical advancements have made living with HIV more manageable. There are many issues to consider that can help make your journey easier. When coping with any medical condition, it is important to have someone to turn to for support. Unfortunately, the stigma that is often associated with HIV may make it more difficult for you to share your HIV diagnosis with loved ones. This is a personal decision with no right or wrong answer. Many people struggle with whether or not to share their HIV status with family or friends. Certainly you do not need to share your private information with everyone. However, it is important that you should not try to go it alone. Talking with loved ones about your HIV status may be stressful. People often cite fear of rejection, lack of understanding, or burdening family and friends as primary reasons not to disclose their diagnosis. If you choose to tell a trusted family member or friend, find a private time that is devoted to your discussion. Decide how much information you feel comfortable sharing regarding your illness and treatment. For instance, your loved one may have questions about the status of your treatment or how you contracted the virus. Remember, your loved one may need time to process this information. The initial talk will likely be the first of many discussions with your loved one as you both begin to learn more about living with HIV. It is important to consider that by not sharing your status you may be depriving yourself of much needed support. A very difficult question regarding disclosure is talking with a partner or spouse with whom you have had unprotected sexual contact. If they are advised of their possible exposure to the HIV virus, they can then be tested themselves. If they are not tested and have HIV, they may be at risk for progression of their disease to AIDS and death. Therefore, you should notify them as soon as you can. If, like some people, you feel unable to disclose your HIV status to a sexual partner, there are some alternatives. Your doctor or, if you have one, your social worker or therapist, can help you with notification and can be present when you inform your spouse, partner, or prior sexual partners about their potential exposure to HIV. Also, in some states, there are Partner Notification Programs that can assist you with this very important process. Partner notification programs will contact a partner to advise that they may have been exposed to the HIV virus. Your identity and your HIV status will not be shared with this individual. You may want to contact your state health department to ask if they provide assistance with partner notification. Whether or not you choose to disclose your status to a friend or family member, you may want to consider joining a support group or talking with a counselor individually. You must decide what form of support will be most helpful. Joining a support group allows for information about coping with HIV to be freely shared in a safe environment. Most community-based AIDS service organizations run a variety of HIV-related support groups. These may include groups for women, gay men, parents, and people struggling with substance abuse and HIV. If you have a choice of groups or community organizations, you may want to shop around to find the agency that best fits your needs. Some people may feel more comfortable addressing their concerns in a private setting. A therapist or counselor who is experienced in working with people with HIV can be instrumental in helping you sort out your feelings about your diagnosis as well as work with you during your decision about disclosure. It is important for you to find someone who is experienced and comfortable dealing with the issues facing people living with HIV. It is also important that you feel comfortable with this person so that you are able to open up to them and share your true concerns and feelings. Keeping secrets from your therapist will prevent you from accomplishing much with your time together. If you are unfamiliar with the support services available in your area, you can contact the National AIDS hotline at 1-800-342-AIDS for local referrals and information. In addition, your local or state health department can be a valuable resource for connecting you with HIV/AIDS support services. There are also many online sites that provide peer support and information. Some examples are:Remember that you are the most important member of the treatment team. Be sure you find someone with whom you can work, ask questions, and address your concerns. When you begin to receive medical care for HIV, it is important to do your homework. Depending on your insurance plan, availability of physicians will vary. Learn about providers in your community that currently work with HIV patients. Most major hospitals will have physicians who specialize in treating HIV disease. You should look for a doctor who has experience with HIV, as treatments and medications are changing rapidly. Feedback from other patients can also help you choose a provider.

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Respiratory System: Frequent: dyspnea order noroxin 400 mg otc; Infrequent: pneumonia order 400mg noroxin, epistaxis buy generic noroxin 400mg online; Rare: hemoptysis, laryngismus. Skin and Appendages: Infrequent: maculopapular rash, urticaria, alopecia, eczema, exfoliative dermatitis, contact dermatitis, vesiculobullous rash. Special Senses: Frequent: fungal dermatitis; Infrequent: conjunctivitis, dry eyes, tinnitus, blepharitis, cataract, photophobia; Rare: eye hemorrhage, visual field defect, keratitis, keratoconjunctivitis. Urogenital System: Infrequent: impotence, abnormal ejaculation, amenorrhea, hematuria, menorrhagia, female lactation, polyuria, urinary retention, metrorrhagia, male sexual dysfunction, anorgasmia, glycosuria; Rare: gynecomastia, vaginal hemorrhage, nocturia, oliguria, female sexual dysfunction, uterine hemorrhage. Adverse Findings Observed in Trials of Intramuscular ZiprasidoneAdverse Events Occurring at an Incidence of 1% or More Among Ziprasidone-Treated Patients in Short-Term Trials of Intramuscular Ziprasidone Table 5 enumerates the incidence, rounded to the nearest percent, of treatment-emergent adverse events that occurred during acute therapy with intramuscular ziprasidone in 1% or more of patients. In these studies, the most commonly observed adverse events associated with the use of intramuscular ziprasidone (incidence of 5% or greater) and observed at a rate on intramuscular ziprasidone (in the higher dose groups) at least twice that of the lowest intramuscular ziprasidone group were headache (13%), nausea (12%), and somnolence (20%). Treatment-Emergent Adverse Event Incidence In Short-Term Fixed-Dose Intramuscular TrialsPercentage of Patients Reporting EventExtrapyramidal SyndromeOther Events Observed During Post-marketing Use Adverse event reports not listed above that have been received since market introduction include rare occurrences of the following (no causal relationship with ziprasidone has been established): Cardiac Disorders: Tachycardia, Torsade de Pointes (in the presence of multiple confounding factors - see WARNINGS ); Reproductive System and Breast Disorders: galactorrhea; Nervous System Disorders: Neuroleptic malignant syndrome; Psychiatric Disorders: Insomnia; Skin and subcutaneous Tissue Disorders: Allergic reaction, rash; Vascular Disorders: Postural hypotension. Controlled Substance Class - Ziprasidone is not a controlled substance. Physical and Psychological Dependence - Ziprasidone has not been systematically studied, in animals or humans, for its potential for abuse, tolerance, or physical dependence. While the clinical trials did not reveal any tendency for drug-seeking behavior, these observations were not systematic and it is not possible to predict on the basis of this limited experience the extent to which ziprasidone will be misused, diverted, and/or abused once marketed. Consequently, patients should be evaluated carefully for a history of drug abuse, and such patients should be observed closely for signs of ziprasidone misuse or abuse (e. Human Experience - In premarketing trials involving more than 5400 patients and/or normal subjects, accidental or intentional overdosage of oral ziprasidone was documented in 10 patients. In the patient taking the largest confirmed amount, 3240 mg, the only symptoms reported were minimal sedation, slurring of speech, and transitory hypertension (200/95). In post-marketing use, adverse events reported in association with ziprasidone overdose generally included extrapyramidal symptoms, somnolence, tremor, and anxiety. The largest confirmed postmarketing single ingestion was 12,800 mg; extrapyramidal symptoms and a QTc interval of 446 msec were reported with no cardiac sequelae. Management of Overdosage - In case of acute overdosage, establish and maintain an airway and ensure adequate oxygenation and ventilation. Intravenous access should be established and gastric lavage (after intubation, if patient is unconscious) and administration of activated charcoal together with a laxative should be considered. The possibility of obtundation, seizure, or dystonic reaction of the head and neck following overdose may create a risk of aspiration with induced emesis. Cardiovascular monitoring should commence immediately and should include continuous electrocardiographic monitoring to detect possible arrhythmias. If antiarrhythmic therapy is administered, disopyramide, procainamide, and quinidine carry a theoretical hazard of additive QTprolonging effects that might be additive to those of ziprasidone. Hypotension and circulatory collapse should be treated with appropriate measures such as intravenous fluids. If sympathomimetic agents are used for vascular support, epinephrine and dopamine should not be used, since beta stimulation combined with ~a1 antagonism associated with ziprasidone may worsen hypotension. Similarly, it is reasonable to expect that the alpha-adrenergic-blocking properties of bretylium might be additive to those of ziprasidone, resulting in problematic hypotension. In cases of severe extrapyramidal symptoms, anticholinergic medication should be administered. There is no specific antidote to ziprasidone, and it is not dialyzable. The possibility of multiple drug involvement should be considered. Close medical supervision and monitoring should continue until the patient recovers. GEODON^ Capsules should be administered at an initial daily dose of 20 mg BID with food. In some patients, daily dosage may subsequently be adjusted on the basis of individual clinical status up to 80 mg BID. Dosage adjustments, if indicated, should generally occur at intervals of not less than 2 days, as steady-state is achieved within 1 to 3 days. In order to ensure use of the lowest effective dose, ordinarily patients should be observed for improvement for several weeks before upward dosage adjustment. Efficacy in schizophrenia was demonstrated in a dose range of 20 to 100 mg BID in short-term, placebo-controlled clinical trials. There were trends toward dose response within the range of 20 to 80 mg BID, but results were not consistent. An increase to a dose greater than 80 mg BID is not generally recommended. The safety of doses above 100 mg BID has not been systematically evaluated in clinical trials. Maintenance Treatment While there is no body of evidence available to answer the question of how long a patient treated with ziprasidone should remain on it, systematic evaluation of ziprasidone has shown that its efficacy in schizophrenia is maintained for periods of up to 52 weeks at a dose of 20 to 80 mg BID (see CLINICAL PHARMACOLOGY ). No additional benefit was demonstrated for doses above 20 mg BID. Patients should be periodically reassessed to determine the need for maintenance treatment. Oral ziprasidone should be administered at an initial daily dose of 40 mg BID with food. The dose should then be increased to 60 mg or 80 mg BID on the second day of treatment and subsequently adjusted on the basis of toleration and efficacy within the range 40-80 mg BID. In the flexible-dose clinical trials, the mean daily dose administered was approximately 120 mg (see CLINICAL PHARMACOLOGY ). There is no body of evidence available from controlled trials to guide a clinician in the longer-term management of a patient who improves during treatment of mania with ziprasidone. While it is generally agreed that pharmacological treatment beyond an acute response in mania is desirable, both for maintenance of the initial response and for prevention of new manic episodes, there are no systematically obtained data to support the use of ziprasidone in such longer-term treatment (i. Intramuscular Administration for Acute Agitation in Schizophrenia The recommended dose is 10 to 20 mg administered as required up to a maximum dose of 40 mg per day. Doses of 10 mg may be administered every two hours; doses of 20 mg may be administered every four hours up to a maximum of 40 mg/day. Intramuscular administration of ziprasidone for more than three consecutive days has not been studied. If long-term therapy is indicated, oral ziprasidone hydrochloride capsules should replace the intramuscular administration as soon as possible. Since there is no experience regarding the safety of administering ziprasidone intramuscular to schizophrenic patients already taking oral ziprasidone, the practice of co-administration is not recommended. Oral: Dosage adjustments are generally not required on the basis of age, gender, race, or renal or hepatic impairment. Intramuscular: Ziprasidone intramuscular has not been systematically evaluated in elderly patients or in patients with hepatic or renal impairment. As the cyclodextrin excipient is cleared by renal filtration, ziprasidone intramuscular should be administered with caution to patients with impaired renal function. Dosing adjustments are not required on the basis of gender or race. GEODONsB?-s-^ for Injection (ziprasidone mesylate) should only be administered by intramuscular injection. Single-dose vials require reconstitution prior to administration; any unused portion should be discarded. Each mL of reconstituted solution contains 20 mg ziprasidone. Since no preservative or bacteriostatic agent is present in this product, aseptic technique must be used in preparation of the final solution. This medicinal product must not be mixed with other medicinal products or solvents other than Sterile Water for Injection. Capsules are differentiated by capsule color/size and are imprinted in black ink with "Pfizer" and a unique number. GEODON Capsules are supplied for oral administration in 20 mg (blue/white), 40 mg (blue/blue), 60 mg (white/white), and 80 mg (blue/white) capsules. They are supplied in the following strengths and package configurations:Storage and Handling - GEODON^ Capsules should be stored at controlled room temperature, 15`-`C (59`-86`F). Storage and Handling - GEODON^ for Injection should be stored at controlled room temperature, 15`-30`C (59`-86`F) in dry form. Following reconstitution, GEODON for Injection can be stored, when protected from light, for up to 24 hours at 15`-30`C (59`-86`F) or up to 7 days refrigerated, 2`-8`C (36`-46`F).

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Granoff: "Vast numbers of people" may get temporary relief from anxiety using only CBT discount 400mg noroxin with mastercard. About 60% of people studied get temporary relief from placebo order noroxin 400 mg with visa. In my experience cheap 400mg noroxin otc, having treated thousands of people, often the relief from only CBT is partial and temporary. Medical research shows that panic disorder is usually lifelong. Some people can have one or an episode of panic attacks never having any others. Some people have their first episode with minimal or no relief for decades. For most people, it is a recurring illness which waxes and wanes throughout life. The longer the study, the larger the number of people who experience a relapse. CBT only is promoted mostly by psychologists, social workers or counselors. These mental health professionals cannot prescribe medications, whereas psychiatrists can prescribe medications and do CBT. You have to be able to read the medical literature with a critical eye and recognize the biases of the researchers. A combination of CBT and medications is the most effective treatment. I tend to stress medications as my bias because too many people are misinformed about their safety and effectiveness. They become fearful that the medical/pharmaceutical industry is taking them on a royal ride for economics. I certainly use CBT in my treatment along with medications. My book and video explain why panic attacks occur (stress), causing the genetic predisposition to kick in, causing the brain chemistry to flip out of balance and how the medications and stress reduction of any kind (including CBT) rebalance the chemistry. Although no gene has yet to be identified to cause panic attacks, the genetic link is clear. In medicine, especially in psychiatry, there is more than one way to skin a cat. Hanging upside down by your toes might work to cure panic attacks in one person. Realize if you still experience the pain of panic while using CBT, like Kim Bassinger did while getting her academy award in the HBO panic show, there are medications that can offer relief. We also discussed the different levels of fear that agoraphobics experience, from a moderate pattern of avoidance, like avoiding air travel, to a housebound agoraphobic with a severe case of anxiety and an extreme need to be in control. Audience members shared their agoraphobic experiences and had questions about anxiety disorder relapses, anxiety and depression, how to overcome anxiety, facing phobic situations, and anxiety associated with a medical condition. Some also expressed concern that they had tried various treatment methods to no avail and were worried that they might never recover from agoraphobia. He is a psychologist, in practice for 19 years, who specializes in the treatment of anxiety disorders and trains other therapists on how to treat anxiety disorders. Foxman is also the author of " Dancing with Fear ," a popular book which offers help for anxiety. Just so everyone knows, Agoraphobia means a fear of open spaces. Many agoraphobics are afraid to even step out of their homes. They call the doctor and the doctor says "you need to come to my office. Foxman: First, I would like to clarify my definition of agoraphobia. The condition to me means a pattern of avoidant behavior designed to protect oneself from experiencing anxiety. There are many situations people avoid, including, of course, going out into the public. In those cases, getting to a health care professional can be a problem but there are some alternatives. I use a home-based self help program called "CHAANGE" for those who are truly housebound, with telephone consultations. If we have time, I would be happy to say more about the CHAANGE program. David: You mentioned those agoraphobics who are housebound. Are their different levels of fear when it comes to agoraphobia? David: So what would be some other "less severe" instances of agoraphobia? Foxman: Many "agoraphobics" function in what appears to be a normal way, such as ability to work outside the home, hold responsible positions at work, etc. However, internally, they are anxious and uncomfortable. Typically, there is a still a pattern of avoidance of some kind, such as meetings, travel, etc. There is also a need to be in control, and anxiety is highest when control is not feasible. Foxman: In my view, agoraphobia is a learned condition that develops over time, usually resulting from having an anxiety experience in a particular situation. Thereafter, that and similar situations are associated with anxiety and avoided. There are three ingredients in most cases of agoraphobia. First is "biological sensitivity": a tendency to react strongly to stimuli outside as well as body sensations. Second is a particular personality type that I discuss in my book. It is usually stress overload that determines when a person becomes symptomatic. David: You mentioned "personality type" as being one of the precursors. The "anxiety personality," as I call it, consists of personality traits, such as perfectionism, difficulty relaxing, desire to please others and obtain approval, frequent worry, and high need to be in control. These traits are both assets and liabilities, depending on whether you are in control of those traits or whether they are controlling you. The anxiety personality sets a person up for increased stress and anxiety symptoms. Foxman: Although it seems that the first anxiety attack occurs "out of the blue," it is usually preceded by a period of high stress when other coping mechanisms are strained. Take a look at the 6-12 month period preceding the first attack and see if your stress level and other changes occurred. David: So, are you saying that first anxiety attack is a way to "blow off" the high level anxiety? Foxman: It would be better to think of the first attack as a warning signal that your stress level is high and earlier signals have been ignored or not attended to. Prior signals include muscle tension, GI symptoms, headaches, etc. David: Here are a few places that are troubling to some of our audience members with agoraphobia:Rosemarie: I have problems with airplanes and also crowded areas, such as Malls. AnxiousOne: Yes, I avoid air travel and crowded places. Foxman: In my opinion, all these places have something in common.

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