Mark Corson

By K. Taklar. Marist College. 2018.

In other words purchase celexa 40mg overnight delivery, describe the scene in detail and have your loved one imagine it first buy celexa 20mg line. Don’t carry it out in real life until your partner feels more comfortable with the imagery buy generic celexa 20 mg online. You can consult Chapter 8 for details about using your imagination through exposure as well. You can also give some honest praise for success; just be sure not to sound patron- izing or condescending. Looking at a coach in action Coaching someone you care about can seem overwhelming. The follow- ing example about Doug and Rosie helps you see how one couple worked through a mild case of anxiety with the help of a good game plan. In all that time, they’ve never gone to a movie together because Rosie wrestles with a mild case of ago- raphobia. Although she’s able to go most places and do what she needs Chapter 18: When a Family Member or Friend Suffers from Anxiety 275 to in life, she dreads going anywhere that makes her feel trapped, espe- cially movie theaters. She fantasizes that she’ll need to get out, but she won’t find her way to an exit because of the crowd and the darkness. She imagines that she would trip over people, fall on her face, and desper- ately crawl through the darkened theater. Doug realizes that Rosie makes one excuse after another to avoid going to movies, even though she enjoys watching them on television. Gently, he asks Rosie, “Some things make me a little anxious — heavy traffic or big crowds — what makes you anxious? Several days later, Doug sees a copy of Overcoming Anxiety For Dummies in a bookstore and buys it with Rosie in mind. Doug and Rosie have a productive discussion about her concerns and decide to face them. First, together they devise a staircase of fear, which breaks down the feared situation into small steps. Attending a movie alone and sitting in the middle (95) Attending a movie alone and sitting in the back row by the door (92) Going to the movies with Doug and having him sit in a row behind me (88) Going to the movies with Doug and sitting in the middle (75) Going to the movies and sitting with Doug in the last row by the door (71) Imagining going to the movie and getting stuck in a crowd (70) Going into the theater lobby for a while (69) Buying a ticket by myself (68) Walking up to the ticket window and asking for times of shows (65) Figure 18-1: Walking by the theater while imagining buying a ticket (60) Rosie’s staircase Driving past the theater (48) of fear. Imagining going to the movie (28) 276 Part V: Helping Others with Anxiety Doug plays a role in most of Rosie’s tasks. He reads the script out loud to Rosie while she closes her eyes and tries to picture the experiences. She rates her level of anxiety, and during the first few steps, he stays with her until her anxiety goes down. Not only does he accompany her to the movies, but he also celebrates her successes and encourages her when she starts to falter. It takes attending a number of movies with Doug before she agrees to the final tasks of going by herself. In fact, they begin enjoying their nights at the movies and find that they both love talking about their experiences afterwards over coffee and dessert. Although Rosie balks at going to the theater by herself, her comfort level has increased over the last few months. Rosie and Doug drive to the theater together on her last two items, but he chooses a movie playing on a different screen. Rosie’s fear of the movies had not yet reached the level of severely interfer- ing with her life. Had Rosie not dealt with her fear in this early stage, it would likely have spread from fear of movies to fear of other crowded places. Most people with fears, obsessions, or compulsions need to develop a plan with the help of a therapist. However, the example of Rosie and Doug can serve as an illustration of how a simple plan can be carried out without a therapist. Teaming Up against Anxiety One way you can help your partner overcome anxiety is to collaborate on ways to decrease stress in both your lives. With a little ingenuity, you can explore a variety of solutions that are likely to feel good to you even if you per- sonally don’t suffer from anxiety at all. For example: ✓ Take a stress management class at a local center for adult continuing education. Many of the ideas make life more fun and interesting in addition to reducing stress. It’s a great way to reduce stress, but even if you don’t have much stress, strolling under the sky together is a wonderful time to talk and is great for your health. Chapter 18: When a Family Member or Friend Suffers from Anxiety 277 ✓ Take a yoga, Pilates, or tai chi class together. Again, even if you don’t have anxiety, these classes are terrific for balance, muscle strength, flex- ibility, and overall health. You may choose to attend a church, a synagogue, or a mosque, or scope out a less traditional method of com- muning with a higher power, such as immersing yourselves in nature. Thinking about things bigger than yourselves or the mundane events of the world provides a peaceful perspective. Many people feel that such work enhances the mean- ing and purpose of their lives. And if you don’t have the time for a long vacation, go away for an occasional evening at a local hotel. Getting away from texting, telephones, e-mails, doorbells, and other endless tasks and demands, even for a night, can help rejuvenate both of you. Accepting Anxiety with Love It may seem rather counterintuitive, but accepting your loved one’s battle with anxiety is one of the most useful attitudes that you can take.

The incidence of melanoma is rising more rapidly than that of any often cancer Melasma – any discoloration of the skin Melena – black vomit buy celexa 20mg online, evacuations resembling tar buy celexa 40mg with amex, due to action of the intestinal juices on free blood Meningitis – inflammation of the membranes of the spinal cord or brain buy celexa 10 mg on-line, caused by bacteria, viruses, or other organisms which reach the meninges from other points in the body through blood or lymph, through trauma, or from adjacent bony structures (sinuses, mastoid cells) Menorrhagia – excessive bleeding at the time of a menstrual period, either in number of days or amount of blood or both Menorrhea – normal menstruation or free of profuse menstruation Metabolic – the sum of all physical and chemical changes which take place within an organism, all energy and material transformations which occur within living cells, the food we eat is metabolized into fats, proteins, carbohydrates that our bodies need Metabolic acidosis – a condition resulting from excessive absorption of retention of acid or excessive excretion of bicarbonate. In starvation and in uncontrolled diabetes, glucose is not present or is not available for oxidation for cellular nutrition. The plasma bicarbonate of the body is used up in neutralizing the ketones produced by the breakdown of body fat for energy that occurs in compensation for the lack of glucose. Metabolic acidosis also occurs when oxidation takes place without adequate oxygen, as in heart failure or shock. Severe diarrhea, renal failure, and lactic acidosis may also result in metabolic acidosis. Signs of metabolic acidosis include shock, coma, tachypnea, and almond breath odor. Hyperkalemia often accompanies the condition Metabolites – any product of metabolism Metabolized – to alter the characteristics of a food substance biochemically. To break down a compound to its constituents by biological mechanisms 422 Methamphetamine – a sympathomimetic drug used as a stimulant or weight loss promoter. It is a controlled substance that causes euphoria and has a high potential for abuse Methylcellulose – a tasteless powder that becomes swollen and gummy when wet. It is used as a bulk substance in foods and laxatives and as an adhesive or emulsifier Methylphenidate hydrochloride - a drug that is chemically related to amphetamine. It is used in treating narcolepsy and attention deficit disorder Microorganisms – a living organism too small to be perceived with the naked eye, especially a virus, bacterium, fungus, protozoan, or intracellular, parasite, and some helminths Micturition – the voiding of urine Miosis – abnormal contraction of the pupil, period of distinguishing symptoms in a disease, method of cell division which allows each daughter nucleus to receive half the number of chromosomes present in the somatic cell Mitochondrial – cell organelles or rod or oval shape. Nonselective versions of these medications produced hypertensive crisis and other severe side effects when they were taken with tyramine-containing foods (some cheeses) and several other drugs. Newer members of this class of drugs do not have these effects, but should be used with caution, especially in persons who take selective reuptake inhibitors Mononucleosis – presence of an abnormally high number of mononuclear leukocytes in the blood. An acute infectious disease caused by the Epstein Barr virus, a member of the herpes virus group. The virus is transmitted through the saliva with an incubation period of 30 to 45 days. Symptoms include a gradual onset of 7 to 14 days of flu like symptoms including a severe sore throat, fatigue, headache, chest pain, and myalgia. Findings include enlarged lymph nodes, exudative tonsillitis, and an enlarged spleen. It is caused by antibodies to the acetylcholine receptor in the neuromuscular junction and a decrease in receptor sites for acetylcholine. Because the smallest concentration of acetylcholine receptors in the body is in the cranial nerves, weakness and fatigue of the eye muscles, muscles of mastication, and pharyngeal muscles are the most prominently affected in most patients. The disease is rare, affecting about 60 persons out of one million Mydriasis – abnormal dilatation of the pupil like fright, sudden emotion, anemia, anesthesia, drugs, coma, hysteria, botulism irritation of cervical sympathetic nerve Myelosuppressive – inhibition of bone marrow function Myelotoxicity – destroying bone marrow; pertaining to or arising from diseased bone marrow Myocardial – pertaining to the heart muscle Myocarditis – inflammation of heart muscle, usually as a consequence of infections Myoclonus – twitching or clonic spasm of a muscle or group of muscles, condition marked by persistent and continuous muscular spasms Myopia – defect in vision so that objects can only be seen distinctly when very close to the eyes, nearsightedness Myxedema – infiltration of the skin by mucopolysaccharides, giving it a waxy or coarsened appearance. The clinical 424 and metabolic manifestations of hypothyroidism in adults, adolescents and children are complaints of sluggishness, cold intolerance, apathy, fatigue and constipation. Findings may include infiltration of the subcutaneous layers of the skin by mucopolysaccharides, which coarsen the features and create nonpitting edema. If the syndrome is left untreated, hypothermia, coma, and death may result N Narcolepsy – a disorder marked by recurrent, uncontrollable attacks of daytime sleepiness, often associated with temporary muscular paralysis (cataplexy) that may occur after powerful emotional experiences. Typically, narcoleptic patients arouse from sleep relatively easily Narcotic – producing stupor or sleep, a drug which in moderate doses depress the central nervous system thus relieving pain and producing sleep, but which in excessive doses produces unconsciousness, stupor, coma, and possibly death Nasopharyngitis – inflammation of the nasopharynx (throat/part of the pharynx situated above the soft palate) Necrolysis – necrosis and dissolution of tissue – death of cells, tissues or organs Necrosis – deaths of areas of tissue surrounded by healthy parts, a gradual degeneration caused by blood supply to the area, physical agents such as trauma, radiant energy or products (toxins) of bacteria Neonates – a newborn infant up to 1 month of age Nephrolithiasis – a disorder characterized by the presence of calculi (stones) in the kidney Nephrotoxic – a specific toxin (poison), which destroys renal (kidney) cells Nerve terminal – a small nerve originating in the cerebral hemisphere in the region st of the olfactory trigone, the 1 cranial nerve. The terminal nerve courses anteriorly (in front of) along the olfactory tract and passes through the ethmoid bone. Most filaments of the nerve form a single strand, which passes to the membrane near the anterior superior border of the nasal septum and communicates in the nasal cavity with the ophthalmic division of the trigeminal nerve. The central communications of the terminal nerve end in the septal nuclei, the olfactory lobe, and the posterior commissural and supraoptic regions of the brain Neuralgia – severe pain along the course of a nerve due to pressure on nerve trunks, faulty nerve nutrition, toxins, neuritis, usually no changes can be detected 425 Neuroleptic – a condition of the nervous system, exhaustion of a nerve or nerves from prolonged stimulation, stretching of a nerve to relieve tension, loosening of adhesions surrounding a nerve, disintegration of nerve tissue Neuromuscular – concerning the nerves and muscles Neuroma – former term for any type of tumor composed of nerve cells. Classification is now made with respect to the specific portion of the nerve involved Neuron – a nerve cell, the structural and functional unit of the nervous system, consisting of a cell body and its processes, an axon and one or more dendrites, neurons function in the initiation and conduction of impulses Neurosis – also called psychoneurosis, a disorder of the thought processes not due to demonstrable disease of the structure of the central nervous system, probably due to unresolved internal conflicts which make for an uneasy adjustment in life, contact with reality is maintained which is not the case in psychosis, the neuroses are classified as fatigue, simple nervousness (anxiety), phobic, obsessive compulsive, hysteria, hypochondrial, reactive depression, the disease rarely occurs in one of these pure forms, thus most neurotic persons would be classes as having mixed psychoneuroses Neurosyphillis – an infection of the central nervous system by syphilis organisms, which may invade the meninges and cerebrovascular system. If the brain tissue is affected by the disease, general paresis may result; if the spinal cord is infected, tabes dorsalis (an abnormal condition characterized by the slow degeneration of all or part of the body and the progressive loss of peripherial reflexes) may result Neutropenia – the presence of an abnormally small number of neutrophils (a white blood cell) in the blood. Severely low levels predispose patients to infection Neurotoxicity – having the capability to be poisonous or harmful to the nerve cells Neutropenia – abnormally small number neutrophil (white blood cell) cells in the blood Neutrotransmitter – a substance (norepinephrine, acetylcholine, dopamine) that is released when the axon terminals of a presynaptic neuron is excited and acts by inhibiting or exciting a target cell. Many patients experience side effects of these medications, including upper gastrointestinal inflammation or bleeding. These side effects occur most often in elderly people, tobacco users, and people who drink alcohol. Other potential complications include acute and chronic renal failure, liver function abnormalities, and aseptic meningitis Norepinephrine – a hormone produced by the adrenal gland similar in chemical and pharmalogical, properties to epinephrine but is chiefly a vasoconstrictor and has little effect on cardiac output Nucleic acid – any one of a group of high-molecular weight chemicals that carry the genetic information crucial to the replication of cells and the manufacturing of cellular proteins. They have a complex structure formed of sugars, phorphoric acid, and nitrogen bases. The hallmarks of the disease are thickening, scaling, and discoloration of the nailbed. The treatment may cause liver dysfunction and the drugs are extremely expensive Ophthalmic – pertaining to the eye Ophthalmology – the science dealing with the eye and its diseases Opiates – a drug derived from opium, a drug inducing sleep, to deaden, to put to sleep, very habit forming Organic brain syndrome – a disease usually of the elderly associated with a gradual deterioration of the cognitive portion of the brain memory, comprehension, ideation, and orientation become defective Oropharyngeal – the central portion of the pharynx lying between the soft palate and the upper palate and the upper portion of the epiglottis Orthostatic – standing or an erect position Osmotic – the movement of a pure solvent, as water, through a semipermiable membrame from a solution that has a lower solute concentration to one that has a higher solute concentration. The rate of osmosis depends on the concentration of solute, the temperature of the solution, the electrical charge of the solute, and the difference between the osmotic pressures exerted by the solutions. Movement across the membrane continues until the concentrations of the solutions equalize Osteomalacia – a vitamin D deficiency in adults that results in a shortage or loss of calcium salts, causing bones to become increasingly soft, flexible, brittle, and deformed.

My first treatment was a complete failure generic 40 mg celexa amex, and it was only after I had seen a prescription of our old Quaker physician purchase 20 mg celexa amex, Dr buy celexa 40mg without a prescription. Characteristic symptoms - deep redness of mucous tissues, and dark coatings upon tongue; and to-day, with the same symptoms, I should use the same treatment. Now Quinine has no influence, only to produce cerebral symptoms and increase the severity of the disease. His skin is sallow; yellowish discoloration about the mouth; complains of dull pain in right side under false ribs extending to shoulder, and occasional umbilical pains; enlargement of spleen, bowels irregular, stools clay colored; has frequent attacks of nausea; urine highly colored with bile; pulse in intermission 90, temperature 100°; has little appetite, and is very much debilitated. The disease gives way slowly - patient had two chills after the medicine was commenced. The remedy was continued without change for two weeks, and the cure was permanent. There is nothing remarkable about the case, except the loss of energy and desire to do anything, and the fact that ordinary means do not reach it. Pulse soft and open, 70 per minute; temperature 99°; skin relaxed and moist; tongue broad and sodden; bowels irregular, stools semi-fluid with scybala: urine in large quantity, colorless. I think I have pointed out the Strychnine case, so that any of our readers may know it - but I would be very glad to have it confirmed by other observers. Shultz, of Logansport, employs Strychnine, quite frequently, by hypodermic injection, and expresses himself pleased with its action. They had contracted the disease on the Lower Mississippi, Yazoo and Red River, and it was remarkably stubborn, some cases being continued from June to Mid-Winter, with temporary arrests from Quinine. Three-fourths of them presented the following symptoms - tongue broad, heavily coated at base in the morning, bad taste in the mouth, weight and fullness in epigastrium, fetid breath, and unpleasant eructation after eating. I treated every case with thorough emesis, (Compound Powder of Lobelia), repeated in some cases, and the use of a solution of Acetate of Potash, ʒiij. The treatment was a decided success, but I obtained a reputation for giving nasty medicine that I never will get rid of. Scudder turned him inside out - but, says he, “I have been in the South every Summer since, and I have not had a shake. Recollect that constipation is not the symptom; on the contrary the bowels will frequently move every day, yet the patient says the unpleasant feelings are never removed by it. Characteristic symptoms - tongue full and coated from base to tip with a yellowish, pasty fur; bowels tumid. Prescribe - Podophyllin thoroughly triturated, adding a small portion of Capsicum or Ginger, to free purgation. Late in the Fall I was applied to by a Southerner, who told me he had had ague for over a year; he had tried everything, and could get no relief. He had taken Quinine, Fowler’s Solution, Salicine, and indeed all the common drugs. Prescribed - Filled an ounce bottle one-fourth full of Homœopathic pellets, and dropped on them Fowler’s Solution, gtts. The gentleman came to my office in about ten days, and after telling me that he thought he was well, and was going home, said, “Now, Doctor, I wont ask you what your bill is. In 1864 I had to treat three students who, coming from Missouri and Illinois, brought ague with them. During October and the first two weeks of November, they kept the disease partly in check by the use of Quinine and Podophyllin pills. But finally these failed, and the disease commenced to present typhoid symptoms, one of them being confined to his bed. There was no seeming loss of flesh, but the tissues seemed sodden, and expressionless. The tongue and other mucous tissues were tumid and bluish; a brownish fur gathered on the tongue, and sordes about the teeth; the bowels were loose, stools papescent; the chills not very severe, but the fever intense; pulse in intermissions, soft and fluent, during fever small and thready. They had taken the usual remedies, Quinine in full doses, as well as Strychnine; what should I give them? But they will cure some cases, and those are usually inveterate ones that Quinine won’t reach. Clark had suffered with ague for some five years - broken at times - but never free from its effects. Can not take a grain of Quinine without cerebral symptoms; can not take the ordinary medicines in use, because they nauseate and are rejected by the stomach. Evidently a very bad case, and the young Doctor is at his wits’ end to know what to do. Had just been studying the action of remedies, and was at that time especially interested in cutaneous absorption, and concluded I would ask the skin to do the work of the stomach. I have used Quinine inunction in scores of cases since - not always with such positive results, but nearly always with benefit. In children it is a favorite remedy, especially in cases of slow infantile remittent. Kemp, tells me he has employed it in a large number of cases this year and last, and with the most flattering results. Used Ether Spray to chill a surface three inches in diameter over the epigastrium, and applied a Solution of Quinine. I have used Quinine in this way in a few cases, and in part of them with excellent results. Either applied with a sponge, and evaporated by fanning, answers quite the same purpose as the spray apparatus.

During her interview generic celexa 40 mg otc, Leeann doesn’t mention her intense fear of flying celexa 10 mg low price, somehow hoping that it will just go away buy discount celexa 10 mg online. Now, in three weeks she faces her first flight, and her distress prompts her to seek help. Chapter 8: Facing Fear One Step at a Time 127 Lucky for her, Leeann picks up a copy of Overcoming Anxiety For Dummies. She reads about exposure and concludes that it’s the best approach for her problem. To see how Leeann completes the first task — understanding her fear and all its components — see Table 8-1. I’ve avoided vacations and trips with friends and family in order to avoid flying. Then, I’d have to do if I actually faced my fear to pack my luggage, drive to the airport, go head-on? What other situations are If I don’t get over this, I’ll never get my promo- affected by my fear? Not only that, I’ll continue to feel embarrassed around friends and family when- ever the topic comes up. Do I use crutches to get One time I got on an airplane and got sick to my through my fear? What bad outcomes do I an- I fear that I’d go crazy, throw up on the passen- ticipate if I were to encounter gers next to me, or start screaming, and they’d my fear? Of course, the plane could crash, and then I’d die or suffer horrible burns and pain, unable to get out of the plane. You can see that Leeann’s fear of flying consists of several activities, from making a reservation to getting off the plane. Constructing a staircase of fear The preceding section helps you comprehend the nature of your fears. After you come to that understanding, you’re ready to take your fear apart and build a staircase. Make a list of each and every single thing you’d have to do if you were to ultimately, totally face your fear. Zero represents the total absence of fear, and 100 indicates a fear that’s unimaginably intense and totally debilitating. Arrange the items into a staircase beginning with the lowest-rated item at the bottom and ending with the most difficult item on the top stair. Landing (92) Taking off (92) Boarding the plane (88) Waiting to board (75) Going through security (71) Checking in (68) Figure 8-1: Driving to the airport (65) How Leeann ranks her Packing (48) fears about Making a reservation (28) flying. Visiting the airport without flying (20) Leeann’s staircase contains only ten steps. For example, Leeann could add an in-between step or two, such as planning her trip or parking in the airport garage. For a phobia like Leeann’s, the steps represent tasks that all directly lead to her ultimate fear. The best staircase of fear chooses one of those fears and includes everything associated with that fear. Choose between the two kinds of exposure — the kind that occurs in your imagination and the exposure that occurs in real life. Chapter 8: Facing Fear One Step at a Time 129 Imagining the worst Many times, the best way to begin exposure is through your imagination. That’s because imagining your fears usually produces less anxiety than confronting them directly. In addition, you can use your imagination when it would be impossible to re-create your real fear. For example, if you fear getting a disease, such as Hepatitis C, actually exposing yourself to the virus wouldn’t be a good idea. You may think that viewing your fears through your mind’s eye won’t make you anxious. However, most people find that when they picture their fears in rich detail, their bodies react. As they gradually master their fears in their minds, the fears are generally reduced accordingly when they confront the real McCoy. Before you start, try getting more comfortable by using one of the brief relaxation strategies we describe earlier in this chapter. Imagine as many details about your fear step as you can — the sights, sounds, smells, and anything else that brings your imaginary experi- ence to life. If you have difficulty picturing the experience, see Chapter 12 for ideas on how to sharpen your mind’s eye. After you have a good picture in your mind of what being exposed to your fear would be like, rate your anxiety on a scale of 0 to 100. It will come down that much as long as you stay with the imaginary exposure long enough. For example, if you experience anxiety at a level of 60, keep thinking about the exposure until it drops to around 30. If the imaginary experience went easily, you may want to try the next step up in your staircase of fear, and perhaps another one after that. Always start with the last step that you completed successfully (in other words, one where your anxiety level dropped by half or more). The strategy works in much the same way as imaginary exposure; you break your fears down into small steps and arrange them into a staircase of fear from the least problem- atic to the most intensely feared. It’s just that these steps all happen through action, not in your imagination as in the previous section. Start with a brief relaxation procedure, such as the ones we describe in the earlier section, “Getting ready by relaxing.