By K. Narkam. Fitchburg State College.

Depakote should be dosed up to the level where you either have side-effects or are better order accutane 20 mg online. The blood level numbers for this may range between 100 - 150 on the lab test purchase 20mg accutane overnight delivery. These are higher numbers than are typically seen in the use of Depakote for seizures. Also, periodic liver function tests should be obtained - every three months is a good idea - to make sure that your liver is still happy with the Depakote. In rare cases, it can cause your liver to become upset and you to become sick if it continues. Risperidal is one of those atypical antipsychotics about which we talked earlier which can contribute to weight gain. Kaprikel: I believe that my depression is probably situational, caused by unresolved grief. I find it very painful to discuss this in therapy, so I try to avoid it. How can I deal with this when its too painful to talk about? Cady: Your insightful characterization of the source of your depression is excellent and augurs well for your eventually working through it. One thing that you might do, if you currently find it difficult to talk about, is to read every book you can find on dealing with grief issues. There are grief support groups to which you could belong, or attend, which might also be helpful. Many of these groups do not demand that you speak, so you could sit there, take it all in, and realize that you are not the only one with this type of problem. However, I cannot emphasize enough the need for an EMPATHIC, emotionally attuned therapist to work with. If you can find this sort of person with whom to work, the difficulty in "opening up", I suspect, will fade. Cady: For the PTSD from childhood - excellent, skillful psychotherapy to work through the issues (kind of like the "constructive anger" question we reviewed above. My proposal would be a "full court press," psychopharmacologically speaking. Cady: Raboxitene is a norepinephrine specific reuptake inhibitor which is used in Europe and is currently awaiting FDA approval in this country. Also, there is a great deal of excitement about the Corticotropin releasing hormone (CRH) class of drugs which seem to have potent antidepressant effects. Finally, there is a great deal of interest in "Neuropetide Y" which seems to be a solid antidepressant in its action. These and other developments can be researched by anybody including the lay public, at Pub Med - from the National Library of Medicine. Cady for being our guest tonight and doing a wonderful job. We appreciate you sharing your knowledge, expertise and insights with us. I also want to thank everyone in the audience for coming tonight and participating. We have a large and growing community and you can usually find people interacting almost any hour of the day or night. Cady: Thank you for the opportunity to be here, David. Sasha , our first guest, suffered from treatment resistant depression and had a positive ECT experience. Julaine , our second guest, has a different story to tell. Although her depression has greatly improved, her ECT experience really shocked her. Our topic tonight is "ECT, Electroconvulsive Therapy Experiences. Sasha suffered from treatment resistant depression and had a positive ECT experience and will be coming on first. Our second guest, Julaine, who will be joining us in about forty minutes, coped with excruciating anxiety and depression, underwent ECT, and had a different ECT outcome. Please tell us a little about yourself and your experience with having depression (see: What is Depression? Last year, I got married and it was the happiest time of my life.

The discipline often raises their self esteem which makes them less likely to become a target generic accutane 10 mg amex. The parent should privately contact the teacher or guidance counselor buy generic accutane 10mg online. Follow up regularly to make sure that any plan is followed consistently and to make sure that the system is being followed. Sometimes if the bullying is chronic or severe, the parents and teacher may have to take decisive action. They may ask the bully to apologize, verbally or in writing. They may insist that the bully stay a certain distance from the victim. The teacher may make an effort to seat or group the child with more supportive peers. In general the older the child, the more the parent acts as a coach and the less the parent or teacher intervenes directly. However, when there are physical or sexual actions, direct adult intervention may be justified at any age. Often victims, particularly those who have been victimized many times, are withdrawn and are afraid of social interaction. These children often profit from social interactions with younger children, where they may be less afraid to open up or show some leadership. Practice with kids some strategies of ways they can respond when being bullied. Help them identify times when they are likely to be harassed, and see if there are ways to avoid those situations. Determine the exact nature of the bullying behavior, and help them practice some things to say or do. Here are some specific strategies:Laugh or ignore comments or teasing. Bullies delight in you being scared and getting a big reaction. Say it as angrily as you can and walk away immediately. Stay with a crowd bullies usually pick on kids who are alone. Suggest that children walk to school or sit on the bus with someone who can protect them. If you are alone with a crowd that picks on you, ask him or her why she is mean to you. For both groups, it is helpful to pair them up with children who are neither bullies nor victims, as they can be great teachers of appropriate behavior. Watkins is Board Certified in Child, Adolescent & Adult PsychiatryAccording to Patricia D. Fear of rape or rape phobia often causes women to avoid activities that they enjoy, such as going out in the evening for a play or a coffee or visiting with friends and loved ones. Based on their desire to avoid putting themselves at risk for sexual assault, women develop their own self-imposed restrictions to avoid danger of rape. According to Rozee, studies indicate that this intense fear of rape, common among a significant majority of girls and women, develops in the early years, between about age 2 and 12. She reports that women, participating in the studies claim to remember hearing parental warnings about stranger danger at very young ages. The early parental instructions about stranger avoidance contained no explicit reference to sexual assault. But as the girls grew in age and maturity, parents added increasingly explicit warnings that they probably deemed as age-appropriate for their individual child. Women have a fear of rape most often when at home alone or walking along a street, especially at dusk or after dark. In the book, The Female Fear: The Social Cost of Rape, authors and researchers Margaret T. Gordon and Stephanie Riger say that fully one-third of the women in their study reported worrying about rape once a month or more. Another third of the participants claimed to never worry about rape; yet, they took precautions to guard against sexual assault. Situational circumstances can bring a shelved fear of rape to the forefront of the conscious mind. These rape phobia triggers arise from parental teaching and experiences of implied and explicit sexual harassment and intrusions. Some factors that trigger a conscious fear of rape in women include:Men who honk, whistle, or leer at them as they walk on public streetsPoor lighting in parking areas or along streets and in the workplaceSexual harassment by an acquaintance or co-workerSexually overt commentary by males about their body and appearanceSeveral men with only one or two women in a group of strangers or near strangersWitnessing a man exposing himself or masturbatingMen known to them or strangers that fondle and grope their body partsStigma of rape exacerbates fear of rape because women fear societal scorn and blame if they are is raped.

But in a series of recent studies discount accutane 40mg without a prescription, researchers are noticing that the passionate romance with anti-impotence drugs does not always cut both ways order accutane 10mg online. Annie Potts, a psychologist at the University of Canterbury in New Zealand, began interviewing couples to determine if there are any downsides to treating erectile problems. She has heard from women who say that Viagra (sildenafil citrate) provides a renewed sex life, but at an unexpected cost. Some even feel that the men intheir lives are more attracted to Viagra (sildenafil citrate) than to them. The woman said that erectile dysfunction had certainly caused problems for her marriage before, but after treating it with Viagra (sildenafil citrate), the problems became much worse. The recent findings are but a minor blemish to some of the top selling drugs of all time. Critics concede that Viagra (sildenafil citrate), as well as two related drugs, Levitra (vardenafil HCI) and Cialis (tadalafil), have helped rekindle old romances and are a major reason why once taboo sexual problems are so openly discussed. But the research highlights what some say is a long neglected issue in treating erectile problems: how do women regard their sex lives now that Viagra (sildenafil citrate) is a major part of it? Compared to the large number of studies that have documented the sexual benefits to the Viagra (sildenafil citrate) user, only a handful looked at the attitudes of partners. Overall, research suggests that women generally enjoy the sexual attention. A survey done in Japan showed that two-thirds of women rated their sex as satisfying after their partners took Viagra (sildenafil citrate), compared to 20 percent who said they were disappointed. Markus Muller in Germany, found more tenderness and less quarreling between couples when men were successfully treated for erectile problems. Yet Potts contends that Viagra (sildenafil citrate) has some potentially negative effects as well, even in women who are supportive of their husbands or boyfriends taking anti-impotence drugs. Potts says that men should not assume that their desires are automatically shared by their partners. Potts interviewed 27 women and 33 men in New Zealand as part of her research, which was published in Sociology of Health & Illness and more recently, Social Science & Medicine. She presented her findings at a female sexual dysfunction conference in Montreal, Canada in mid-July. A recurring complaint, Potts found, is that some women said that men felt entitled to have sex after taking Viagra (sildenafil citrate). One man admitted to Potts that Viagra (sildenafil citrate) played a crucial part in going from a monogamous relationship with his wife to 18 different affairs, including some with men, in the space of one year. Viagra (sildenafil citrate) also helped him, as he characterized it, "endure" sex with his wife. Although sex is something that men are thought to want most, more than 75 percent of women in one large survey said this was moderately to extremely important to them as well. So far, however, there is no female equivalent of Viagra (sildenafil citrate). A recent study in the Archives of Internal Medicine found that a testosterone patch could improve sexual interest and activity in women who had low sexual desire after having their ovaries removed. But the dangers of taking steroids has led many to question the safety of the approach, prompting the Food and Drug Administration to turn down a request to make the testosterone treatment available for women. Nothing seems to work, and inevitably the jones to graze always gets the best of me. Every evening, I eat myself into a coma, then crash in front of the TV or down enough Jack Daniels and ginger ale to dull my senses. And I have a hard time stuffing myself into the cheap seats at Knicks games. Even more disturbing: My weight is harshing my sex life. Usually hesitant to approach women, I often rely on friends to make the opening move. But the health implications do terrify me: limited mobility, diabetes, liver damage, gout (from which I already suffer), heart disease, and stroke. Then came the assignment: Spend two weeks at the Duke University Diet & Fitness Center (DFC) in Durham, N. From the outside, this one-story brick building looks like my old grammar school. Its program teaches health and wellness through diet, exercise, and behavior modification--voluntary rehab for the weight-challenged. Looking around orientation, I size up my hefty comrades. They, too, seem to think, "What the hell did I get myself into? But in reality, I get a positive vibe from my fellow food fiends.

Here are some of the most important statistics:One in four women surveyed was victim of rape or attempted rape accutane 20 mg low cost. An additional one in four women surveyed was touched sexually against her will or was victim of sexual coercion order accutane 40 mg fast delivery. One in twelve male students surveyed had committed acts that met the legal definitions of rape or attempted rape. Sixteen percent of the male students who committed rape and ten percent of those who attempted a rape took part in episodes involving more than one attacker. Only 27 percent of those women whose sexual assault met the legal definition of rape thought of themselves as rape victims. Only five percent of the rape victims reported the crime to the police. Only five percent of the rape victims sought help at rape-crisis centers. Whether they had acknowledged their experience as a rape or not, thirty percent of the women identified as rape victims contemplated suicide after the incident. There are a set of beliefs and misunderstandings about acquaintance rape that are held by a large portion of the population. These faulty beliefs serve to shape the way acquaintance rape is dealt with on both personal and societal levels. This set of assumptions often presents serious obstacles for victims as they attempt to cope with their experience and recovery. If a woman agrees to allow a man to pay for dinner, drinks, etc. Sex is not an implied payback for dinner or other expense no matter how much money has been spent. Acquaintance rape is committed by men who are easy to identify as rapists. Women are often raped by "normal" acquaintances who resemble "regular guys. Rape occurs when one is forced to have sex against their will, whether they have decided to fight back or not. Intimate kissing or certain kinds of touching mean that intercourse is inevitable. Men are capable of exercising restraint in acting upon sexual urges. Most women lie about acquaintance rape because they have regrets after consensual sex. Acquaintance rape really happens - to people you know, by people you know. Drinking or dressing in a sexually appealing way are not invitations for sex. Women who subscribe to "traditional" views of men occupying a position of dominance and authority relative to women (who are seen as passive and submissive) may be at increased risk. In a study where the justifiability of rape was rated based on fictional dating scenarios, women with traditional attitudes tended to view the rape as acceptable if the women had initiated the date (Muehlenhard, in Pirog-Good and Stets, 1989). Drinking alcohol or taking drugs appears to be associated with acquaintance rape. Koss (1988) found that at least 55 percent of the victims in her study had been drinking or taking drugs just before the attack. Women who are raped within dating relationships or by an acquaintance are seen as "safe" victims because they are unlikely to report the incident to authorities or even view it as rape. Not only did a mere five percent of the women who had been raped in the Koss study report the incident, but 42 percent of them had sex again with their assailants. The company one keeps may be a factor in predisposing women to an increased risk of sexual assault. An investigation of dating aggression and the features of college peer groups (Gwartney-Gibbs & Stockard, in Pirog-Good and Stets, 1989) supports this idea. The results indicate that those women who characterized the men in their mixed-sex social group as occasionally displaying forceful behavior towards women were significantly more likely themselves to be victims of sexual aggression. Being in familiar surroundings does not provide security. Just as with the victim, it is not possible to clearly identify individual men who will be participants in acquaintance rape. As a body of research begins to accumulate, however, there are certain characteristics which increase the risk factors. Acquaintance rape is not typically committed by psychopaths who are deviant from mainstream society. It is often expressed that direct and indirect messages given to boys and young men by our culture about what it means to male (dominant, aggressive, uncompromising) contribute to creating a mindset which is accepting of sexually aggressive behavior. Such messages are constantly sent via television and film when sex is portrayed as a commodity whose attainment is the ultimate male challenge. Buying into stereotypical attitudes regarding sex roles tends to be associated with justification of intercourse under any circumstances.

Bob M: Here are other similar comments discount accutane 20mg amex, then a question:Tammy: Monika purchase 10 mg accutane otc, do you think that complete recovery is possible? Ack: That is all I have ever heard, that you will always have it. Dbean: Do you struggle with going back and forth between wanting to get better and wanting to keep the eating disorder? Monika Ostroff: To respond to the first question: I do honestly believe that complete recovery is possible. Getting there requires some very hard work, a lot of introspection, asking some really tough questions and then going out and really digging for the answers. It is almost invariably connected to discovering and validating your self-worth. Going back and forth between an eating disorder and getting better happened in the beginning and in the middle of my recovery. I think that ambivalence is a normal part of recovery. After all, look at all the important things eating disorders can do do for you. They protect you, communicate for you, manage your feelings. The thought of living without one is scary at first. But new ships, I have found, can sail a whole lot better than old ones. You learn to make connections, to fill the space your eating disorder filled with people. I think we all deserve the life-affirming connections of healthy relationships. Those relationships can only exist and unfold when we stop befriending anorexia and bulimia and make them move aside. Bob M: Earlier you mentioned that you attended several treatment programs. Monika Ostroff: Four-and-a-half years, perhaps five, since the start of the first program to the recovered point. I know that there was one year in particular when I was only home for a total of 2 weeks. I was searching for the answer and I was pretty determined to keep searching until I found it... Bob M: Just to clarify here, are you saying you went from one eating disorder treatment program to another in search of the right one for you? Or was it that you were able to control your eating disordered behaviors for awhile and then you relapsed? After my first admission, I managed to stay out from July to February, then I went in for a month. Then I was discharged and stayed home until June and then I was inpatient literally all summer. Particularly the year I was just plain old "in the hospital. I took me that long to figure out that what I really needed was gentleness and compassion. It took me a long time to dare to say that I wanted to search for the shreds of worth within me and work towards a healthier life for myself. It took me that long to figure out that to get better I had to like and love myself as much as I liked and loved my friends. To do that I had to learn to listen to and heed the voice in my heart while developing my own authentic voice to express my needs, desires, pain, and dreams. There is a lot of searching within yourself, a lot of questions to be asked and answered. It took me some time to figure out that sometimes not having an answer was an answer in and of itself. I started considering that perhaps I was not all that different, perhaps I did deserve something, perhaps bad things had happened to me by chance and not because I deserved them. That is an important part and you need people who care about you to be there throughout the recovery process. And, as many of our previous guests have said, you may have relapses along the way.

At that point buy accutane 40mg without a prescription, some parents may just say "my child is going through a phase generic accutane 10mg without a prescription. Weltzin: It is true that some children do go through periods of infrequent vomiting to lose weight. However, this often predicts later worsening of symptoms, particularly with a stressful event such as a relationship problem, school stress, moving, etc. Weltzin: Get information from the school or other sources that might be available. Sometimes a school counselor, clergy, or friend will be willing to approach them about the problem. If this does not work then they should be taken to see a specialist. Eating disorder specialists see many patients like this and an important part of eating disorders treatment is working on denial and building a relationship in which the patient feels comfortable with talking about the problem. David: We all hear about the worst cases of anorexia or bulimia. As far as treatment goes, what should a parent do to help their child? How do you determine if your child just needs weekly therapy, outpatient treatment or inpatient eating disorders treatment? Weltzin: This really depends on the severity of the eating disorder symptoms. Often times, this advice will come from a specialist who has done a referral. The majority of patients can improve in an outpatient setting, especially if they are not severely underweight or if they are not severely depressed or unable to control their eating at all. Patients with anorexia, in general, need inpatient and residential treatment as they tend to be unable to correct their eating without specialized help during meals. Patients with bulimia, or those who binge and purge and are at a normal weight, typically fail at outpatient treatment before a more intense treatment like residential is needed. If there are medical problems, which can be life threatening, then inpatient should be done immediately. David: One of the scariest things for parents, I think, is the idea that their child will either die from an eating disorder or suffer with it for the rest of their lives. Weltzin: It is important to emphasize that the mortality rate for anorexia remains about 10%. People do die from these illness and the majority are not in treatment or have left a treatment program. It is also important that the treatment team includes a physician with some experience in eating disorders, especially their medical complications, a dietitian and therapist. As to the prognosis for eating disorders, only about 1/3 of anorexic patients recover in general. With intensive treatment this percentage can be increased to over 60%. Therefore, treatment can have a great impact on outcome. As for bulimia, often times patients do have relapses, but with treatment these tend to be time limited and do not lead to a severe loss of function. Over 50% of patients with bulimia will have a significant improvement and often recover with treatment. David: When you use the word "recover," can you define that? Weltzin: Recovery, at its best, means healthy nutrition. This can be defined as healthy meal patterns, such as three meals a day, and maintaining a normal weight. What is a normal weight can vary depending on who you are talking to, but generally this is a weight in which there are no physical problems, including a loss of menstrual function, decreased energy, or feeling run down. More important to recovery, however, is the psychological aspects including body image, self acceptance, improved mood, healthy relationship, and function in school and work. If patients are at a healthy weight and able to junction in their lives, this is recovery, even if there may be brief episodes of abnormal eating or distorted thoughts. My daughter is 20 years old and went to Toronto General Hospital Eating Disorders program, but we live 3 hours away and no doctor here seems to understand how serious this can get. Weltzin: Unfortunately, services for these problems cannot be provided in smaller communities. First, have a specialist work with a local doctor as a consultant, in which your daughter sees the specialist for updates and progress can sometimes be effective. This can also help the local treaters be able to work with these problems effectively. Alternatively, patients can go to residential programs like the one we have a Rogers and live there and get treatment. This does work, but it also creates some hardship in terms of missing home and also cost.