Patients' Perceptions: Effects of Religiosity

Effects of Religiosity on Patients' Perceptions of Do-Not-Resuscitate Status

Maria A. Sullivan, M.D., PH.D., Philip R. Muskin, M.D., Shara J. Feldman, B.A., and Elizabeth Haase, M.D.

From New York State Psychiatric Institute, New York City; and the Consultation-Liaison Service, Department of Psychiatry, Columbia Presbyterian Campus of the New York-Presbyterian Hospital.

Forty-eight oncology inpatients participated in a survey designed to characterize their understanding of and beliefs about do-not-resuscitate (DNR) decisions and to identify dimensions of religiosity associated with moral beliefs about DNR decisions.

Seventy-five percent of the patients believed they understood the meaning of "DNR," but only 32% were able to provide an accurate definition.

Seventeen percent believed that DNR decisions are morally wrong, and 23% believed that they are equivalent to suicide.

Those who lacked an accurate understanding of DNR status were significantly more likely to perceive them as morally wrong.

Gender, but not religious denomination, was significantly related to patients' attitudes about the morality of DNR decisions.

The belief that DNR decisions are morally wrong was predicted by certain religious practices, including near-daily meditation, near-daily thinking about God, and the current practice of meditation, and by endorsement of the statement, "My faith sometimes restricts my action."

Psychosomatics 45:119-128, April 2004
© 2004 The Academy of Psychosomatic Medicine

Panic attacks: Treatment

What is the treatment for panic attacks?

Thanks to research, there are a variety of treatments available, including several effective medications, and specific forms of psychotherapy. In terms of medications, specific members of the selective serotonin reuptake inhibitor (SSRI) and the benzodiazepine families of medications are approved by the Food and Drug Administration to treat panic disorder. Examples of such medications include sertraline (Zoloft) and paroxetine (Paxil) from the SSRI group and clonazepam (Klonopin) from the benzodiazepine group. Medications from the beta blocker family (for example, propranolol) are sometimes used to treat the physical symptoms associated with a panic attack. Before SSRIs became available, medications from the group known as the tricyclic antidepressants (TCAs) were often used to address panic disorder. However, SSRIs have been proven to be safer and better tolerated therefore, TCAs are used much less often. When used in the appropriate person with close monitoring, these medications can be quite effective as part of treatment for panic disorder. However, as anything that is ingested carries risk of side effects, it is important to work closely with the prescribing doctor to decide whether medication treatment is an appropriate intervention and if so, which medication should be administered. The person being treated should be closely monitored for the possibility of side effects that can vary from minor to severe and in some cases even be life-threatening.

The psychotherapy component of treatment for panic disorders is equally as important as medication treatment. In fact, research shows that the combination of medication and psychotherapy treatment for panic disorder is more effective than either intervention alone. To address anxiety, cognitive behavioral therapy is widely accepted as an effective form of psychotherapy. That form of therapy seeks to help those with panic disorder identify and decrease the irrational thoughts and behaviors that reinforce panic symptoms. Behavioral techniques that are often used to decrease anxiety include relaxation techniques and gradually increasing exposure to situations that may have previously increased anxiety in the individual.

Often, a combination of psychotherapy and medications produces good results. Improvement is usually noticed in a fairly short period of time, about two to three months. Thus, appropriate treatment for panic disorder can prevent panic attacks or at least substantially reduce their severity and frequency, bringing significant relief to 70 to 90% of people with panic disorder.

There are also things that people with panic disorder can do to help make treatment more effective. Since substances like caffeine, alcogol, and illicit drugs can worsen panic attacks, those things should be avoided. It may be worth engaging in aerobic exercise and stress-management techniques like deep breathing and yoga, as those activities have been found to help decrease the frequency and severity of panic attacks.

In addition, people with panic disorder may need treatment for other emotional problems. Depression has often been associated with panic disorder, as have alcohol and drug abuse. Recent research also suggests that suicide attempts are more frequent in people with panic disorder. Fortunately, these problems associated with panic disorder can be overcome effectively, just like panic disorder itself.
Tragically, many people with panic attacks do not seek or receive treatment.

What happens if panic attacks are not treated?
Panic attacks tend to continue for months or years. While it typically begins in young adulthood, in some people the symptoms may arise earlier or later in life. If left untreated, it may worsen to the point where the person's life is seriously affected by panic attacks and by attempts to avoid or conceal them. In fact, many people have had problems with friends and family or lost jobs while struggling to cope with panic attacks. There may be periods of spontaneous improvement in the attacks, but it does not usually go away unless the person receives treatments designed specifically to help people with panic attacks.

National Institute of Mental Health of the U.S. Department of Health and Human Services

Panic attack symptoms

What are the most common panic attack symptoms?

First of all, the word 'symptoms' is used by doctors to describe the effects of illness... ANXIETY IS NOT AN ILLNESS... it's a behavioural condition. However, anxiety does produce some pretty scary SENSATIONS.
I tell you this because I need you to understand that all the feelings, thoughts and sensations you experience are products of the anxious nerve signals your brain produces, not the signs of illness! Symptoms of panic attacks are unpleasant to say the least BUT they are completely normal and harmless (if inappropriate).
For ease, I will, however, carry on using the word symptom, to describe these sensations.
Not everyone experiences the same panic attack symptoms; we are all different biologically and therefore react differently to each other as a response to the same or similar stimuli.
The following list identifies the most common symptoms of panic attacks. Experiencing four or less of these panic attack symptoms identifies what is called a limited symptom attack.

Common symptoms of panic attacks
· Rapid heart beat, pounding heart or palpitations
· Sweating
· Shaking visibly or inside
· Choking sensations or lump in throat
· Smothering or shortness of breath sensations
· Chest pain or discomfort
· Nausea, bloating, indigestion or abdominal discomfort
· Dizziness or unsteadiness
· Feeling light-headed
· Derealisation (feeling unreal or dreamy)
· Depersonalisation (feeling outside yourself or like you don't exist)
· Fear of losing control or going crazy
· Paresthesias (numbness or tingling sensations) in face, extremities or body
· Chills or hot flushes
· Skin losing colour
· Blushing or skin blotches
· Urgently needing to urinate or defecate

Experiencing different or more panic attack symptoms than are listed above does not mean that your condition is worse or different, or that you are suffering from another un-diagnosed condition. Diagnosis of anxiety disorders is very accurate so chances are you ARE suffering from an anxiety disorder. Some people have anxiety disorder but never suffer from panic attack symptoms.
To find out more about how the Linden method can help you overcome your panic attack symptoms please

How are panic attack symptoms caused?
Panic attack symptoms are caused by a number of biological changes that occur during times of stress and anxiety. The human body is very resilient, even in times of anxiety we are strong, although we may not feel it. It's also very true that some people might be scared that their heart will stop, or give up, through the constant racing, thumping or chest pain, this is simply not true, again these are very common symptoms of panic attacks.
No one has ever come to any harm as a result of anxiety or panic attacks! Consider how hard athletes have to work in order to give their hearts the kind of workout your heart receives through anxiety; athletes hearts do not give up, do they? The heart is a muscle, raising the heart rate exercises it, making it fitter. You wouldn't worry if your heart raced after running for the bus, so why worry about it when it happens during anxiety.
The downside of these panic attack symptoms is that your body will feel tired and shaky after they subside. You may feel as if you have run a marathon yourself. Feeling tired or achy is a necessary side effect, if you are aware that it may happen, when it does, you will know what it is and it won't scare you as much!
Most anxious people complain of aching muscles and general fatigue, these are very common symptoms of panic attacks and anxiety. Muscle tension can cause pain or sensations of tightness anywhere in the body; most common in anxiety are pains in the chest, neck and shoulders. Tension in these places can be distressing; the tension in your chest may cause shortness of breath or rib pain, and it may make your chest or breasts tender or numb. Pains in the muscular tissues of the neck and back can cause the blood vessels and nerves to become restricted; this can cause headaches or migraine but can also cause the head to feel tender or painful.
It is possible for your face or scalp to feel numb or dead, this can affect sensations around your eye, in your cheek, face and jaw and can even affect the sensations in your mouth. This is caused by muscular tension causing restriction around the nerves and blood vessels in my neck. When I first experienced this, I was very scared as are many of my clients. AGAIN, another symptom of panic attacks and anxiety which causes the sufferer unnecessary worry but is completely harmless. Massaging the neck releases much of the tension and thus relieves the sensations; this works for most people.
This tension can cause feelings of numbness in the arms (usually the left), and also the legs. Don't be alarmed if this happens to you.
You must understand that the nervous system is found in every inch of your body. There are nerve endings literally everywhere, around every organ, muscle and over every square millimetre of your skin so the symptoms of panic attacks and anxiety can be experienced anywhere! Tension can be responsible for many of the sensations experienced during anxiety.
Symptoms of panic attacks are EXACTLY what the name suggests, a symptom of the disorder not of another condition. These symptoms should be ignored, they have no importance or relevance to you, or your life.
Do not allow these unpleasant panic attack symptoms and sensations to get the better of you, after all that is all they are. The nerves tell the brain what it should be feeling under certain conditions and the brain responds. If tired and anxious nerve signals become confused, the brain may interpret the feeling of ice against the skin as burning, or the eyes might send a confused signal to the brain that makes you see a smooth surface ripple like water. Perceived sensations never have and never can, hurt any one. All symptoms of panic attacks and anxiety are caused by confused bodily sensations and nerve impulses, you may feel like the end is in sight, but it most certainly is not.

Can panic attack symptoms harm me?
No! Panic attacks symptoms have never harmed anyone. Although they feel horrific and scary, panic attack symptoms are harmless and are simply exaggerated experiences of normal bodily sensations and reactions. Of all the people that I have spoken to about their own panic attack symptoms, none, including myself, ever came to any harm during the, literally thousands, of panic attacks we experienced.

Do I have to put up with panic attack symptoms?
No, you do not. Panic attacks are, like all anxiety disorders, caused by an imbalance in the organ responsible for the anxiety response called the Amygdala. This organ acts like an anxiety switch. Normally, the switch is in the OFF position and only gets activated when it's appropriate to feel anxious. In anxiety disorders this switch gets stuck in the ON position...it's that simple!
So, if an anxiety disorder is to be eliminated completely, it is this imbalanced anxious response which needs to be addressed directly. The Linden Method does exactly that!

What is the solution to panic attack symptoms?
There are no other programs of recovery for anxiety sufferers that resemble this method but past program members consider it to be THE conclusive treatment for anxiety disorders such as: Panic disorder, Phobias, Post Traumatic Stress Disorder, Obsessive Compulsive Disorder and Generalised Anxiety Disorder.
With tens of thousands of Linden Method users, the method is the most effective drug free treatment available. The method is psychologist and medically endorsed and very easy, fast and permanent.
The Linden Method is also equally effective for treating panic attacks in children and senior people too. I have children as young as seven years and a gentleman of 87 using the method currently. Some sufferers think that my method is a means of managing panic attack symptoms, it's not, it's a way of eradicating them from your life completely. Panic attack symptoms whilst pregnant are also very common and the Linden Method will show you that these can be effectively reduced and eliminated too.
Anxiety and panic attacks are simply accentuated versions of natural reactions, remember, they CAN NOT harm you in any way. I will show you how panic anxiety attacks, phobias and all your fearful sensations and emotions can be calmed and erased. Whether you suffer from anxiety panic attacks or phobias, you can and will be symptom free again... that's a promise.

Click here to find out how to get rid of your panic attacks symptoms and anxiety now!

What are panic attacks?

What are panic attacks?

Panic attacks may be symptoms of an anxiety disorder. These attacks are a serious health problem in this country. At least 1.7% of adult Americans, or about 3 million people, will have panic attacks at some time in their lives. The symptom is strikingly different from other types of anxiety in that panic attacks are so very sudden and often unexpected, appear to be unprovoked, and are often disabling.
Panic attacks can occur at any time, even during sleep. An attack generally peaks within 10 minutes, but some symptoms may last much longer.
Once someone has had a panic attack, for example, while driving, shopping in a crowded store, or riding in an elevator, he or she may develop irrational fears, called phobias, about these situations and begin to avoid them. Eventually, the pattern of avoidance and level of anxiety about another attack may reach the point where the individual with panic disorder may be unable to drive or even step out of the house. At this stage, the person is said to have panic disorder with agoraphobia. Thus, panic disorder can have as serious an impact on a person's daily life as other major illnesses, unless the individual receives effective treatment.

Are panic attacks serious?
Yes, panic attacks are real, potentially quite emotionally disabling, but they can be controlled with specific treatments. Because of the disturbing symptoms that accompany panic attacks, they may be mistaken for heart disease or some other life-threatening medical illness. People frequently go to hospital emergency rooms when they are having a panic attack, and extensive medical tests may be performed to rule out these other conditions.
Medical personnel generally attempt to reassure the panic attack patient that he or she is not in great danger. But these efforts at reassurance can sometimes add to the patient's difficulties: If the doctors use expressions such as "nothing serious," "all in your head," or "nothing to worry about," this may give the incorrect impression that there is no real problem and that treatment is not possible or necessary. The point is that while panic attacks can certainly be serious, it is not organ-threatening.

What causes panic attacks?

According to one theory of panic disorder, the body's normal "alarm system," the set of mental and physical mechanisms that allows a person to respond to a threat, tends to be triggered unnecessarily, when there is no danger. Scientists don't know exactly why this happens, or why some people are more susceptible to the problem than others. Panic disorder has been found to run in families, and this may mean that inheritance (genes) plays a strong role in determining who will get it. However, many people who have no family history of the disorder develop it. Often, the first attacks are triggered by physical illnesses, a major life stress, or perhaps medications that increase activity in the part of the brain involved in fear reactions.

National Institute of Mental Health of the U.S. Department of Health and Human Services
http://www.medicinenet.com/panic_disorder/page4.htm

Premenstrual Dysphoric Disorder

Premenstrual Dysphoric Disorder

Twenty to fifty percent of women between the ages of 30 to 40 with regular menstrual cycles experience premenstrual syndrome (PMS) as a regular physiological occurrence every month. In more severe cases, affecting three to five percent of menstruating women, this syndrome is labeled as premenstrual dysphoric disorder (PMDD) . Patients with severe PMDD are at risk for developing postpartum depression. Furthermore, women successfully treated with antidepressants often show breakthrough symptoms of depression in the premenstrual phase of their menstrual cycle. All that is needed is a small increase in the dosage of the antidepressant premenstrually.

PMDD Symptoms
Women with PMDD complain of irritability, anger, tension, marked depressed mood, and mood lability (crying spells for no reason, verbal outbursts, or tantrums ) to such a severity that quality of life is seriously compromised. In addition to these symptoms, some women complain of lethargy, sleep disturbance, limited concentration and a host of physical symptoms such as breast tenderness, headaches, joint and muscle pain, bloating and weight gain.
The primary symptoms that distinguish premenstrual dysphoric disorder from other mood disorders (i.e., major depression) or menstrual conditions is the onset and duration of PMDD symptoms -- with symptoms appearing during the week or so before and disappearing within a few days after the onset of menses -- and the level by which these symptoms disrupt daily living tasks. (This diminished level of functioning is generally in great contrast with the same woman's interactions and abilities at other times during the month.)The symptoms of PMDD may resemble other conditions or medical problems, such as a thyroid condition, depression, or an anxiety disorder. Consult a physician for diagnosis.

What Causes PMDD
Although the exact cause of PMDD is not known, several theories have been proposed. One theory states that women who experience PMDD may have abnormal reactions to normal hormone changes that occur with each menstrual cycle. This may include the fluctuation of estrogen and progesterone levels that normally occur with menstruation causing a serotonin deficiency, in some women (Serotonin is a substance found naturally in the brain and intestines that acts as a vessel-narrowing substance, or vasoconstrictor). Additional research is necessary.

How is Premenstrual Dysphoric Disorder Diagnosed?
Aside from a complete medical history and physical and pelvic examination, diagnostic procedures for PMDD are currently very limited. Your physician may consider recommending a psychiatric evaluation to, more or less, provide a differential diagnosis (to rule out other possible conditions). In addition, he/she may ask that you keep a journal or diary of your symptoms for several months, to better assess the timing, severity, onset, and duration of symptoms. In general, in order for a PMDD diagnosis to be made, the following symptoms must be present:
· over the course of a year, during most menstrual cycles, five or more of the following symptoms must be present:
- depressed mood
- anger or irritability
- difficulty in concentrating
- lack of interest in activities once enjoyed
- moodiness
- increased appetite
- insomnia or hypersomnia
- feeling overwhelmed or out of control
- other physical symptoms
· symptoms that disturb social, occupational, or physical functioning
· symptoms that are not related to, or exaggerated by, another medical condition

What is the Difference Between PMS and PMDD?
The physical symptom list is identical for PMS and PMDD; while the emotional symptoms are similar, they are significantly more serious with PMDD. In PMDD, the criteria focus on the mood rather than the physical symptoms. With PMS, sadness or mild depression is not uncommon. With PMDD, however, significant depression and hopelessness may occur; in extreme cases, women may feel like killing themselves or others. Attributing suicidal or homicidal feelings to “it’s just PMS” is inappropriate; these feelings must be taken as seriously as they are in anyone else and should be promptly brought to the attention of mental health professionals.
Women who have a history of depression are at increased risk for PMDD. Similarly, women who have had PMDD are at increased risk for depression after menopause. In simplest terms, the difference between PMS and PMDD can be likened to the difference between a mild headache and a migraine.

PMDD Treatment
Treatment for PMS depends on the severity of the symptoms. For mild cases, treatment recommendations include diet modifications such as high carbohydrate meals and reducing salt, caffeine and alcohol, as well as a variety of methods for stress reduction and relaxation such as exercise, counselling and stress/behaviour management strategies.
For severe PMDD, treatment is more aggressive, often requiring pharmacological intervention in addition to nonpharmacological treatments. The selective serotonin reuptake inhibitor class of antidepressants are effective in the treatment of PMDD. Fluoxetine (Prozac - Serafem) has been widely studied and found to be effective in reducing symptoms of tension, irritability and dysphoria. These results have been replicated with sertraline (Zoloft) and paroxetine (Paxil). Use of the SSRIs is positive as well in that side effects, such as nausea, diarrhea, headache, and insomnia, to name a few, are minimal and reportedly tolerable by the majority of women.
For some women, even more drastic measures must be taken to ameliorate the symptoms of PMDD. For these women, hormonal therapies are necessary that work by suppressing the menstrual cycle. Effective hormonal therapies include gonadotropin releasing hormone (GnRH) agonists, estradiol and danazol. With respect to the GnRH agonists, women may not be able to continue with this form of therapy in that side effects are similar to symptoms of menopause. This, then, can increase the occurrence or severity of osteoporosis. With estradiol treatment, women must be concurrently treated with progestogen to prevent endometrial hyperplasia. Danazol is effective, however, that has quite a severe adverse effect profile due to its androgenic and anti-estrogen properties. In addition, danazol treatment affects menstrual cycle length. Thus, the side effect profile of hormonal therapies makes them less tolerable in the treatment of PMDD.
For some women, the severity of symptoms increase over time and last until menopause (when menses ceases). For this reason, a woman may require treatment for an extended period of time, and may require several reevaluations to adjust medication dosages throughout the course of treatment.

Overcoming Stigma
In the 1999 consensus paper published in the Journal of Women's Health and Gender-Based Medicine, a 14-member panel of health care experts concluded that PMDD is a distinct clinical entity and that specifically evaluated and approved medications are needed to treat this disorder. They agreed that strong data exist to support the use of SSRIs in treating PMDD.
Women, however, do face barriers to diagnosis and treatment. There is often a stigma attached to any condition that is associated with the menstrual cycle. Many women who do not seek treatment for the mood and physical symptoms of PMDD accept their symptoms as an inevitable consequence of the menstrual cycle which cannot be addressed.
Some women view seeking treatment for PMDD as a sign of weakness. Additionally, physicians aren’t traditionally trained to recognize the signs and symptoms of PMDD—symptoms are often dismissed as just a “part of being a woman.” Therefore, help is often neither sought nor offered.If you find that your doctor is unfamiliar with PMDD, print this information and bring it with you to your visit. An alternative is to get a second opinion from another OB-GYN or psychiatrist.

http://www.healthyplace.com/communities/depression/pmdd.asp
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