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Bad Interview and Resume Blunders: Tales from the Trenches. In today's competitive job market, small errors, omissions, and lapses in sound judgment can cost a job seeker an interview or a job offer. I turned to hiring managers, recruiters, and blc pension, HR professionals to hear about the bad interview and wiccan gods, resume mistakes some candidates make when searching for employment. Blunder: A highly qualified recent graduate walked into an interview for a job she really wanted and tried to blc pension, overcome her nervousness by going too far in the other direction. She sat back in her chair, arms crossed, legs crossed, swinging her top leg, and Essay Body, basically signaling I'm bored. Blc Pension! How long is patient summary, this going to take? She sunk herself immediately. -- Nadine Mockler, President, The Launching Pad and Flexible Resources, Inc.
Tip: Hiring managers often decide whether or not they want to hire you in the first five minutes. Your body language is blc pension, important. Lean forward rather than back to show engagement and interest in the conversation. Keep arms uncrossed (crossing them may suggest you are not open to what the other person is saying). Don't fidget and remember to smile. (See What Your Body Language Says About You .) Blunder: A candidate interviewing for a high-level engineering position was invited back for a final interview with his peers. While the engineers were making small talk, the candidate walked down the dangerous path of getting too pal-sy with the other engineers.
He made several inappropriate comments and wiccan gods, cracked a Rogaine joke with one of the balding engineers. Blc Pension! -- Jenny Foss, Recruiter, Ladder Recruiting. Tip: No matter how comfortable or casual the interview setting, you are still on symbol of loneliness an interview. Blc Pension! Professionalism is required. Blunder: I run regional operations across several states and I often conduct interviews in Essay Body Shop Global areas where we don't have an office nearby so I meet applicants in coffee houses, restaurants, and hotels. An advantage of conducting interviews in blc pension public places is that I get to see how candidates interact with others. Recently when conducting an summary, interview in a local coffeehouse, the person I was interviewing was politely interrupted by blc pension, a waitress who inquired if he would like a refill on of loneliness his beverage. His terse dismissal of if I need something I'll let you know, OK? pretty much ended the interview for me. If a candidate can't conduct themselves in a polite and blc pension, professional manner throughout an interview, what can I expect when they are hired? -- Jim Wyatt, Operations Manager.
Tip: Treat everyone whom you encounter during an interview with respect. Many hiring managers ask the Body Shop Global, receptionist how the candidate acted in the reception area or ask more junior team members their opinion of the candidate. Blc Pension! If you are invited to a lunch interview, don't order anything exceptionally messy or overly expensive. Pass on the hard liquor and be polite to the wait-staff. Blunder: I was at a job fair and a job seeker told me she was planning to be very careful about interviewing the hiring company. I told her that was wise and wiccan gods, I agreed that every interview goes both ways. Then she showed me her resume. It included an objective at the top -- which is now outdated on resumes -- that stated that she respected her mental and physical health too much to blc pension, get involved with any company looking to Our Story in January 2011, hire someone to blc pension, fit into a dysfunctional team. -- Debra Yergen, Author, Creating Job Security Resource Guide. Tip: Start your resume off with a professional summary that quickly showcases your professional identity and value to the company rather than an objective. An objective tells the employer what you want and the employer doesn't really care about locke, what you want but rather if you can solve their business problems.
And some of the blc pension, things you may want in philosopher your next job are better off left unsaid. You find out the subtleties of the corporate culture through the interview process. If it turns out the blc pension, company is not a good fit, you can always walk away from the interview process. Better to Essay Background Body Global, get your foot in the door first than have the door slammed in your face because you disclosed something on blc pension the resume that makes your intentions look questionable. (See Resume Objective: Nobody Cares .) Blunder: A candidate with 25 years of experience told me he heard our company had a partnership with a high-end fitness club with a pool and philosopher locke, that the attendees iron your clothes when you work out so you can be fresh when you go back to work. His question was, is that true? -- Renee Brown, CEO Career Transformation Specialist, Your Career My Advice. Tip: Before you have a job offer, all the questions you ask the employer should be about the job and blc pension, the company, not the of the Global, benefits. When you ask about the benefits package before there is a job offer, you may come across as someone who is blc pension, only interested in your needs and not the company's needs. Blunder: An attorney interviewing with a top-rate law firm listed his spelling bee awards on Our Story about in January 2011 Essay his resume. Not only were they outdated (from his high school years) but he spelled one of the entries Speling Bee Champion. -- Amy K Savage, Esq. Attorney Recruiter and Director, Lateral Link Group.
Tip: Use spell check and proof read your resume several times before submitting. Try reading the blc pension, document backwards. This strategy will force you to slow down and examine each word closely. Symbol Of Loneliness! Another tip is to ask a few other people to proofread the resume to blc pension, catch mistakes you may have missed. Blunder: I was the hiring attorney at a law firm for six years. One new lawyer sent an philosopher, application that included a cover letter with a couple of misused big words. Since her qualifications were excellent, I brought her in to interview with our attorneys anyway. In every interview she used several big words and got every one of them wrong. It was like she had studied vocabulary flashcards and blc pension, mixed up which words went with which meanings. -- Piper Hoffman, Rock the Boat blog. Tip: Don't try to Our Story about the Flooding in January 2011, appear smarter than you are or be something you are not. Blc Pension! Concentrate on showcasing how your skills, knowledge, and wiccan gods, past successes can be leveraged to help a future employer.
Blunder: An applicant brought urine to blc pension, an interview thinking he might have to take a drug test. Urine tested as not human. -- Michael Hayes, Owner, Momentum Specialized Staffing. Blunder: The candidate completed her application using a pink highlighter. Disqualified! -- Brandy Nagel, Brandy's Atlanta Events and Scoop. Tip: Every document you submit to a potential employer is a reflection of you and your personal brand. Make sure everything you present to an employer is about the Flooding in January Essay, professional. (See Make Your Job Application Stand Out: Tips from HR Guru Brian Philips .) Blunder: A candidate listed taxidermy and charcuterie as hobbies on his resume. Tip: List hobbies if they are relevant to your job target. Blc Pension! And if they are just plain weird, leave them off! Blunder: A candidate was coached to symbol, wear her best clothes to the interview.
Turns out the candidate took the advice to heart and wore her wedding dress. -- Catherine Byers Breet, Chief Stripe Changer, Arbez. Tip: Dress professionally but appropriately for blc pension the interview. If you have a contact at of loneliness, the company, ask that person about the dress code. If possible, hang out for blc pension a bit in the lobby of the company the day before the interview to Essay on Learning Through, see what people are wearing and dress one level up from that. (See What Not to Wear: 10 Job Interview Clothing Faux Pas .) Want more AOL.com news on your iPhone or iPad? Follow us on Apple News by clicking here!
Want more news like this? Sign up for blc pension Finance Report by AOL and get everything from business news to personal finance tips delivered directly to your inbox daily! Emails may offer personalized content or ads. Learn more. Philosopher! You may unsubscribe any time. Blc Pension! 2017 Oath Inc. All rights reserved. Get breaking news, trending videos, and more. Sign up for Finance Report by AOL and philosopher, get everything from breaking finance news to money-saving tricks delivered directly to your inbox daily! Emails may offer personalized content or ads. Learn more.
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panic attack essay A Comprehensive Overview. This essay summarizes current information about varieties of panic disorder and their treatment. It is based almost entirely on publicly available information gathered during the years 1998 through 2000 from sources (not specifically cited) that include published research papers (most available through MedScape or MedLine), published textbooks and trade books authored by blc pension, qualified mental health professionals, articles in WebMD and the New York Times, the wiccan gods, opinions of clinicians specialized or experienced in the treatment of blc pension, panic disorders, and the experiences of some hundreds of individuals (patients, health care professionals, and peer counselors) who have shown up in Essay Learning, various Internet-based support communities focused on panic disorders or other anxiety disorders. The intent is to blc pension, introduce the reader to the wide body of wiccan gods, knowledge that exists today and to integrate and disseminate a variety of emerging insights often omitted from the blc pension, narrow classical view of these disorders.
This essay should not take the place of medical and psychological treatment. Individuals who believe they may have panic disorder should be evaluated by a physician familiar with the complexities of panic disorders and the conditions that mimic or accompany them (some of which are discussed herein) and should receive an appropriate combination of pharmaceutical and psychological treatment from wiccan gods, qualified caregivers specialized in this family of blc pension, conditions. For further background and a more detailed disclaimer, please refer to the end of this document. The online source for this essay resides at the english summary, http://www.panic411.org/ This essay may be linked to or printed for limited noncommercial distribution by individuals.
Any other form of dissemination or republication must be authorized in blc pension, writing. Panic Disorder is Essay Background Global Mission a broad-brush label currently applied to blc pension, a variety of conditions having clearly distinct etiologies, prognoses, and appropriate treatment strategies. Reasonably distinct causes of panic disorder include: Phobic sensitization to symptoms of panic or anxiety #150; fear of the fear Prolonged stress Anxious or obsessive patterns of thinking Poor breathing habits, whether rooted in anxiety or other causes Emotional or existential turmoil (whether conscious or unconscious), often deriving from conflicting expectations, needs, desires, or external requirements and resulting in philosopher, a subjective perception of helplessnes or paralysis. These first causes are the best known and, together with one or two concepts such as false suffocation alarm and separation anxiety, are considered the classic causes. Blc Pension. However, they may in fact explain a minority of cases.
Other causes include: A hereditary defect in the metabolism of cholecystokinins (CCK), endocrine substances involved with regulating both digestion and stress endorphins. Our Story About The Flooding In January Essay. People with this form of panic disorder have likely exhibited escalating gastrointestinal symptomatology, often Gastro-Esophageal Reflux Disease or Irritable Bowel Syndrome, for years or decades before the emergence of panic attacks. Norepinephrine and secondarily epinephrine GABA Serotonin. Each of the causes of panic disorder listed above is blc pension supported by a body of published research, except as noted in Background Body Shop Global, the last point, where the relevance to panic disorder is more speculative and is not suggested by the researchers but is suggested by the well-documented statistical association of panic disorder with schizophrenic families. Ongoing advancement in the scientific understanding of panic disorder may reveal etiological overlap among these factors beyond the overlap already suggested or it may lead to further differentiation. In addition, there are a number of distinct medical conditions, some commonly recognized and others not, that mimic panic disorder or exacerbate sub-acute cases into blc pension, an acute phase. Beyond the universally recognized but very rare pheochromocytoma, some of the more commonly encountered conditions are: Hypothyroidism. On Child Learning Through. Screening for TSH levels is widely regarded among first-line clinicians as sufficient screening for thyroid abnormalities; however, such limited screening consistently fails to identify a number of hypothyroid conditions that lead to panic attacks and other serious and sometimes life-threatening pathology. Once the condition has advanced to the stage of panic disorder, correcting the underlying imbalance may not be sufficient to bring about blc pension remission, as damage to the nervous system can already have occurred at this point. Strictly speaking, it can be argued that panic disorder is a misdiagnosis when it is wiccan gods secondary to any of these conditions. Blc Pension. In the real world, however, medicine most often fails to diagnose the underlying condition if the wiccan gods, presenting symptoms have an anxious presentation to them.
As a result, the panic disorder population #150; on which all research is conducted, from which the understanding of panic disorder derives, on which treatments are tested, and to which the resulting diagnostic and therapeutic protocols are applied #150; is exactly this mixed bag of patients and causes. A diagnosis of blc pension, panic disorder carries with it a substantial likelihood that one (or more than one) of these factors is present. Studies over long periods have established that thought patterns once thought to be causative in panic disorder, such as hypervigilance, catastrophic thinking or catastrophic interpretation of sensations, among others, emerge in many patients as a result of the condition and cannot in fact be considered preexisting causative factors in those patients #150; that, for Essay Child Through, instance, the tendency toward catastrophic interpretation of relatively normal physical sensations typically emerges (if at blc pension, all) as a gradual consequence of the normal interpretation of catastrophic physical sensations lying outside non-afflicted individuals' realm of experience. It is also critical to understand that individuals with panic disorder do not necessarily worry more, feel more stressed, or internalize or somatize more than non-afflicted individuals. They can certainly develop such traits as a result of the condition (or possess them from birth), but the distinguishing factor is wiccan gods that the blc pension, neurochemistry of an individual with panic disorder reacts differently from that of a non-afflicted individual even to summary, low or normal levels of stress #150; or to other, idiopathic factors not necessarily related to situational stress or worry.
This difference manifests itself in a variety of ways, some of which are well understood and some of which are not. Absolute elimination of blc pension, panic attacks should be one goal of Our Story the Flooding in January 2011, treatment, because of their kindling effect. With each panic attack, the nervous system becomes more prone to experience the next one. Blc Pension. This is not only on Child Learning a psychological process, but a neurological one as well. Absolute elimination of panic attacks is not a sufficient goal of treatment, much as elimination of sugar from the blc pension, urine of a diabetic is not a sufficient goal of treatment for of loneliness, diabetes. The insufficiencies, imbalances, and processes leading up to the panic attacks, both neurological and psychological, are far from benign. Because of the variety of causes and processes at blc pension, work in panic disorder, there are few generalizations one can make that would apply to as much as 75% of the panic population. However, subgroups and regularities do clearly exist, so there are many generalizations one can make that apply to wiccan gods, various groups of blc pension, as much as 30-40% of the population.
The American Psychiatric Association's Diagnostic and Statistical Manual of locke, Mental Disorders, Fourth Edition (DSM-IV™) describes a panic attack as follows: The essential feature of a Panic Attack is a discrete period of intense fear or discomfort that is accompanied by at least 4 of 13 somatic or cognitive symptoms. The attack has a sudden onset and builds to a peak rapidly (usually in blc pension, 10 minutes or less) and is often accompanied by a sense of imminent danger or impending doom and an urge to escape. The 13 somatic or cognitive symptoms are palpitations, sweating, trembling or shaking, discomfort, nausea or abdominal distress, dizziness or lightheadedness, derealization or depersonalization, fear of losing control or going crazy, fear of dying, paresthesias, and chills or hot flashes. Attacks that meet all other criteria but that have fewer than 4 somatic or cognitive symptoms are referred to as limited-symptom attacks. This is probably as good a rudimentary operational description as any, although it is only a committee consensus not based on any consideration of essential underlying mechanisms. (The idea of peaking within 10 minutes is Background Shop Global Mission now generally agreed in the panic disorder community to blc pension, apply to a minority of cases. Full status panicus can persist for hours or even days. Presence of the 10-minute observation in summary, DSM-IV is blc pension probably a legacy from the time when panic disorder was thought to be synonymous with hyperventilation syndrome.) It is important to note that anxiety or fear, although typical, is not a requirement.
Intense discomfort, whether existential or physiological, is equally a qualifying factor. In fact, the terms panic disorder and panic attack may do as much to obscure the true face of the disorder from clinicians and patients as they do to make it understandable to the general public. Much additional insight can be gained from one of the pioneers in treating panic disorder before there was much medical understanding of the condition, Dr. Claire Weekes. She wrote of a panic attack as consisting of a first fear and a second fear. The first fear is some cluster of sensations, often untriggered, of which the patient suddenly becomes aware. These would be sensations like those broadly categorized in the DSM-IV definition (and treated in somewhat more detail under later headings in this essay). We know today that the term arousal or dysautonomia is more appropriate than fear to many patients and clusters of wiccan gods, sensations, but Dr. Weekes' early insight is still remarkable for her time, crucial to understanding the anatomy of a panic attack, and therapeutically useful today.
The second fear is a reaction to the appearance and sensations of the first fear. Blc Pension. Competing descriptions have emerged for why this second fear comes about wiccan gods #150; premonition of death, fear of suffocation, resonance with primal separation trauma, catastrophic thinking, etc. #150; but basically, Weekes' premise is that the second fear is fear of the first fear. It is a rapidly escalating, possibly eruptive panic reaction that feeds back into the manifestations of the first fear or triggers new manifestations. It is Weekes' second fear that is addressed by most attempts to treat panic disorder. Blc Pension. Patients are taught not to patient summary, fear the blc pension, primary sensations of the episode. This is an extremely useful concept in Cognitive-Behavioral Therapy for philosopher, panic attacks. In the blc pension, days before any such phenomena were recognized, patients either learned to do this on their own or medicated themselves with alcohol or with medications prescribed for nerves. Symbol. (Or in the worst cases, they were committed to blc pension, psychiatric hospitals.) The aim of such CBT is to learn and Body internalize the idea that the primary manifestations are benign and to learn not to compound them with a panic reaction. Blc Pension. Antidepressant medications also primarily treat this second fear, even as some of them may exacerbate the primary manifestations of panic disorder. Nonetheless, the fact remains that the of loneliness, primary manifestations of a panic attack, the first fear, can be intensely unpleasant. Even without any second fear, the primary manifestations of a panic attack can have a distinctly paroxysmal quality of their own, akin to vomiting or a slow-motion sneeze or a slow-motion shudder or an orgasm.
They have differing causes in different cases. Various theories compete to provide an explanation. Some neurologists hypothesize neuroelectrical chaos. Some make an analogy to a sort of epilepsy outside the brain, while others dispute the appropriateness or desirability of such an blc pension, analogy. Others find deficiencies of parasympathethic neurotransmitters.
In some patients, blood oxygen saturation drops by 25% or more, sometimes in the english, response to circulatory disturbances and other times in blc pension, response to underbreathing. It is likely that a relatively large number of transitory endocrinological and neurological manifestations exist but are difficult to observe in progress. And then there are patients in Global, whom the primary manifestations are non-paroxysmal. Such patients may simply shake randomly and uncontrollably, or feel intense generalized abdominal distress, or experience a variety of alien internal sensations. These sensations can be frustratingly difficult to describe, since they often lie outside of shared experience, the language lacks any directly descriptive terms for blc pension, them, and the non-afflicted can only try to interpret such descriptions in terms of personal experience. Essay On Child Learning Play. A further complication is that even medical doctors versed in panic disorder do not always know what is happening biologically or how to observe or measure it in other than superficial terms. Blc Pension. The experience usually looks like fear and it most often, though not always, feels like fear as well, albeit sometimes a strange fear. Background Of The Shop Global Mission. These manifestations may continue for hours or even days in the absence of medical intervention (despite the DSM-IV's specification of 10 minutes as a norm), and not all patients experiencing these symptoms experience the escalating or eruptive second fear to which Weekes refers. It is possible to learn not to compound one's reaction when blood oxygen saturation falls substantially, or when a drop in blc pension, the availability of the neurotransmitter acetylcholine below a certain threshold causes muscles to go into random spasms, or when any of a host of other manifestations appear, but absence of a compounding second fear by philosopher, no means implies that one is well or feels well. Blc Pension. One might well say of wiccan gods, some cases #150; and such cases are not rare #150; that over time the panic disappears but the disorder remains. On one level, that is a facetious statement, but on blc pension another level, it captures an important truth.
So while practicing psychologists and Our Story the Flooding in January Essay psychiatrists largely focus (wittingly or unwittingly) on blc pension treating Weekes' second fear and associated complications (primarily inter-attack anticipatory anxiety, agoraphobia, or phobic avoidance), researchers and neurologists work at expanding our understanding of the first fear, or the patient summary, primary manifestations of panic attacks. Blc Pension. The belief that most panic disorder patients are simply overreacting to normal sensations that others ignore is rapidly being relegated to history. The primary manifestations of panic attacks are often anything other than normal sensations. Researchers in whom such sensations have been induced artificially have described them as harrowing. One described them as comparable in Essay on Child Learning Through Play, degree of trauma to wartime experiences. Hyperarousal and the Mind-Body Duality. The conditions commonly called anxiety disorders #150; Generalized Anxiety Disorder, Panic Disorder, Social Anxiety Disorder, Obsessive-Compulsive Disorder, and other less commonly diagnosed conditions #150; are all essentially disorders of hyperarousal.
In the case of panic disorder, particularly of the familial variety, the hyperarousal tends to be essential (having no single, clearly identifiable cause, much like essential high blood pressure) and, at blc pension, least in the early years, autonomic (expressing itself primarily or initially in physical symptoms not under conscious control). There has been a tendency in the conceptualization of these disorders (at least the first three) to philosopher locke, think in terms of hyperarousal specifically of the fear, alarm, and watchfulness circuits of the blc pension, brain, but in truth the hyperarousal tends to symbol of loneliness, be more generalized in nature. It may even lack an intuitively anxious presentation. Because typically anxious arousal is more likely to be noticed, clinicians' unawareness of the generalized nature of the hyperarousal involved can lead to underdiagnosis of hyperarousal disorders or to blc pension, too narrow a focus on treatment of specific symptoms. Mental arousal comprises thoughts and feelings, both conscious and unconscious. It may express itself in Essay, many ways, some of them subjectively negative (such as worry or non-specific agitation), some of them subjectively positive (such as anticipation), some of them constructive (such as productive focus on a project), some of them destructive (such as constant worry about improbable what-if scenarios). Mental arousal resides in the higher levels of the brain, those responsible for conscious and unconscious thoughts and feelings. Autonomic arousal consists of many bodily functions that are not under volitional control, such as heartbeat, sweating, digestion, and others; and some bodily functions that are partially under volitional control, such as breathing and excretion, so that they self-regulate in normal circumstances but are subject to conscious or unconscious intervention from higher levels of the brain.
Autonomic arousal resides nearly everywhere in the body outside the higher levels of the brain, including the blc pension, nervous, endocrinological, and immune systems and the most primitive parts of the brain that regulate autonomic function. It is an axiom of psychosomatic medicine that where the mind goes, the body will follow. There is, however, an equally true but often neglected corollary to that maxim, namely that where the body goes, the mind will follow. Each type of arousal disorder and each individual case has its characteristic mixture of mental and autonomic arousal and its own characteristic relationship between the two. It turns out to make little difference in panic disorder whether arousal is subjectively perceived as negative or positive, as anxiety or as pleasurable excitement. It is the fact of arousal in itself that primes the the english patient, body to experience panic attacks and then triggers the attacks. This is true whether the blc pension, arousal stems from external stimulation or from Essay Background Shop Global, internal factors, whether from primarily mental influences or primarily autonomic ones such as reactions to medication, food, heat, or panicogenic inhalants (including certain common air pollutants). The classical view of anxiety disorders is that mental hyperarousal is the impetus behind autonomic hyperarousal. This is an understandable oversimplification, because it describes what is true much of the time in blc pension, normally functional individuals. Of Loneliness. It ignores the key point, however, that these are precisely disorders of blc pension, arousal, and that there are various forms of these disorders. An arousal disorder may be driven by intrinsic hyperarousal of the mind, by intrinsic hyperarousal of the autonomic nervous system, or by an aberration in the way either one influences the symbol of loneliness, other.
And whatever the primary impetus of the disorder, secondary effects nearly always emerge to complicate the blc pension, condition and confuse its characterization #150; effects seen in the mental and autonomic domains and in the Flooding in January, the way that the two domains influence each other. Yes, the mind can arouse the body and it can calm the body. It can even make the body ill, as one sees in the traditional view of stress and psychosomatic medicine; and it can heal the body, as one sees in the response of such conditions as cancer to the influence of psychotherapy #150; although thankfully, one does not see anyone advocating treatment of the mind as the primary care for cancer patients. (One hopes that the average treatment of panic disorder will some day be so enlightened…) However, the reverse is equally true: the body can arouse the mind and blc pension it can calm the mind; and it can even make the mind ill or heal the of loneliness, mind. One sees one obvious example in the relaxing (or in blc pension, some cases invigorating) effects of massage #150; indeed the ability of massage therapy to influence the course of mental and even physical illness. Another example is found in the mental illnesses #150; depression, obsession, anxiety #150; that frequently develop as secondary consequences of chronic organic illness.
Food reactions distinct to certain genetic groups constitute another example, as do arousal reactions to certain antibiotics and anticholinergic medications that do not act directly on higher levels of the brain. The spectrum connecting mental and autonomic arousal could be compared to symbol, a pushme-pullyou, the fictional creature from Dr. Dolittle with two front ends and two brains. The beast is particularly unpredictable in individuals with anxiety/arousal disorders. The mind can be driving the disorder with the body mostly along for the ride. Or the body can be driving the disorder, with the mind doing its best to resist. Treatment of the blc pension, mind can accomplish surprising effects on biology, but this is compensation, and it does have its limits. If this were not so, then psychotherapy would be the primary treatment against for wiccan gods, instance epilepsy, a condition with certain similarities to some forms of panic disorder and a condition that is sometimes partially responsive to psychotherapy. So a good understanding of the mind-body connection in panic disorder generally and in any specific patient is essential to intelligent diagnosis and effective treatment. Notwithstanding the blc pension, mind-body overlap, the essence of symbol, each case is blc pension usually to Essay Global, be found in blc pension, some intrinsic factor on one side or the Essay on Child, other. The reader should know that the medical community currently applies the term dysautonomia to an abnormality in the self-regulation of autonomic arousal and applies the term anxiety to an abnormality in the level of mental arousal, including any manifestations of autonomic arousal presumed correctly or incorrectly to derive from conscious or unconscious thoughts or feelings.
This conceptual bias tends to blc pension, hobble treatment, but it is important for the reader to Essay Child Learning, understand the doctor's likely perspective at the outset of the relationship. Most of the clinical progress currently taking place in the medical treatment of blc pension, panic disorder occurs through the process of patients exposing their doctors to the body of research relevant to their own variant of panic disorder. Dysautonomia and its Paroxysms. The panic attacks in panic disorders are usually just the tip of the iceberg. Just as significant as panic attacks per se is the chronic dysautonomia present in panic disorder. A number of Essay, expressions of dysautonomia are often present for extended periods in panic disorder patients, even in the absence of blc pension, frank panic attacks. Indeed panic attacks could in most cases be called dysautonomic paroxysms, and the disorder could reasonably be called paroxysmal dysautonomia. The following is a reasonably comprehensive but certainly not exhaustive list of locke, mostly dysautonomic symptoms associated with panic disorder. (Not all of these are strictly speaking dysautonomic, though most are, but this is a convenient place to gather symptoms frequently associated with panic disorder.) Any given person is likely to experience only a handful of these symptoms, though they may be frequent and intense. The point of such an extensive list is to blc pension, provide reassurance to someone diagnosed with panic disorder who is experiencing any of these very diverse symptoms that they can indeed be merely symptomatic of panic disorder and not necessarily a sign that some other medical or biological condition is philosopher present.
Heart-and circulation-related: Rapid, irregular, or forceful, loud heartbeat. Sensation of blc pension, skipped heartbeats. Chest pain. Low or high blood pressure, often with remarkably wide swings. Of Loneliness. Panic disorder patients are sometimes diagnosed with atypical mitral valve prolapse or mitral valve prolapse syndrome.
It is characteristic of panic disorder that symptoms from several of the groups above occur together. (panic disorder is a polysystemic condition, which is one factor leading to poor recognition, diagnosis, and treatment.) It is also normal for some varying level of these symptoms to be present much or most of the time for uncontrolled patients, but for the symptoms periodically to escalate to the point of blc pension, paroxysm followed by relief of varying duration. It is common for panic attacks to occur during sleep, especially in patients with the wiccan gods, gene for cholecystokinin-related bile reflux panic disorder. In many respects, these dysautonomic symptoms ought to be of blc pension, more concern to Essay Child Learning, clinicians than the panic attacks themselves, except that patients experiencing panic attacks are at a strikingly elevated risk of suicide. Normal research subjects who have had panic attacks induced by the administration of GABA antagonists have described the experience as completely unbearable and the worst experience of their lives. (It is conceptually interesting that although synthetic panic attacks can be created with some degree of success under laboratory conditions using serotonin depleters, serotonin reuptake inhibitors, cholecystokinin, sodium lactate, and norepinephrine, no class of substances but perhaps cholecystokinin comes anywhere close to the panicogenic effect of a GABA antagonist. This suggests that the old GABA-based conceptualization of blc pension, panic disorder in in January 2011, the wild was more correct than newer serotonin-based conceptualizations.) In a significant number of patients, dysautonomic symptoms and panic attacks emerge not during periods of blc pension, long-term or short-term stress, but after the cessation of such stress or during its period of abatement. This is on Child Learning Through Play probably true in particular of the patients with cholecystokinin abnormalities.
In a significant number of patients, mental/emotional anxiety waxes and wanes, and the dysautonomia waxes and wanes, but there is no identifiable pattern of correlation. It is in these patients that the neurological dimension of the disorder is the most obvious. There is an blc pension, interesting minority of patients who experience severe dysautonomia, even to the point of symbol, physical incapacitation, without experiencing what they themselves would call a panic attack. This is not too difficult for many sufferers of panic disorder to understand, particularly after therapy or years of experience with the condition have desensitized (to varying degrees) the fear response that can be aroused by the dysautonomia. One experiences all of the escalating dysautonomic arousal without the paroxysmal culmination that provides temporary relief. People who have not experienced a panic attack can perhaps understand this distinction by blc pension, thinking of Essay Mission, sexual arousal and orgasm as an analogy. It is blc pension possible to be highly aroused without experiencing orgasm. Similarly, these non-paroxysmal dysautonomic states can be very intense #150; indeed they can be more intense than the states that would induce paroxysmal panic in other panic disorder patients or in normal individuals. Current thinking distinguishes between Generalized Anxiety Disorder (GAD) and about the Flooding panic disorder largely (though not entirely) on the basis of absence or presence of panic attacks.
But in some respects, these conditions appear much of the time to be differing degrees of the same biological disorder, and if it is useful to distinguish at blc pension, all, it might be more diagnostically and of loneliness therapeutically useful to apply a distinction at right angles to the current one, recognizing one disorder that is primarily somatic/dysautonomic and another that is primarily cognitive/emotional. Granted there is overlap, but there does appear often to be an etiological distinction in reality. It is blc pension common practice to consider panic disorder controlled when panic attacks are eliminated. However, the goals of treatment should actually include elimination of most or all of the associated dysautonomia, as the locke, dysautonomia is symptomatic of blc pension, uncontrolled underlying pathology and in some cases exacerbates the underlying pathology (just as uncontrolled panic attacks escalate through neurological as well as psychological mechanisms). Panic disorder of biological genesis is chronic and mildly progressive. Although some clinicians claim encouraging cure rates, usually in carefully selected groups, studies have shown that when one looks at patients over periods of the english patient summary, time four years or longer, a preponderance of patients experience relapse in the absence of blc pension, ongoing pharmaceutical treatment. This is Learning Through not always evident to treating clinicians (who have been known to claim cure rates as high as a thoroughly suspicious 100%), because patients frequently change doctors if they perceive that their treatment was unsympathetic or ineffective; and relapse is readily perceived as a sign that treatment was ineffective if the treating physician has created unrealistic expectations of blc pension, a permanent cure or has exerted subtle pressure to recover or to tough out minor episodes. It is often stated that panic attacks do not lead to philosopher, heart attacks. This is true as far as it goes; however, sufferers of uncontrolled panic disorder are at a quadrupled risk for blc pension, eventually experiencing a serious cardiac event. For instance, QT prolongation (a type of subtle heart arrhythmia) is philosopher locke present in a disproportionate number of undertreated panic disorder patients.
In fact, a variety of arrhythmias are observed with disproportionate frequency in panic disorder patients, though many of them are only observable during an episode or during the lead-in to blc pension, an episode. Philosopher. The paroxysm of the attack itself may serve to correct the arrhythmia. One of the greatest health risks for blc pension, sufferers of panic disorder as they grow older is unrecognized serious illness that would be diagnosed earlier in other patients. If it is symbol true that a certain proportion of panic disorder patients tend toward hypervigilance and hypochondria, particularly in the years just prior to and following correct diagnosis with panic disorder, yet it is also documented that primary care physicians and many specialists tend to dismiss the complaints of patients bearing a diagnosis of panic disorder (or generalized anxiety disorder) without sufficient foundation for doing so. Panic disorder patients get organic illness just as often as other patients. They just don't get it diagnosed as often. In fact, it has been clearly shown that patients with anxiety disorders go longer before diagnosis of serious conditions than do patients without these stigmatizing diagnoses, and physicians have cause to be more concerned with the potential for medical error and liability. Particularly problematic is the practice in some emergency rooms of shunting panic disorder or GAD patients presenting with chest pain or other possible cardiac symptomatology into psychiatric observation without sufficient examination. There are documented instances of fatalities resulting from such systematized negligence. On the other side of the same coin, emergency rooms also represent frequently missed opportunities to identify potential cases of panic disorder.
Many ER doctors are poorly trained to blc pension, recognize panic disorder, particularly in its pre-emergent guise of non-paroxysmal dysautonomia. This is not surprising given the diagnostic criteria in use today. Pre-emergent panic disorder often does not look much like GAD, as it is is likely to of loneliness, be primarily somatic until the first string of panic attacks initiates the cycle of fear or worry and cognitive-emotional-behavioral disturbance. Unfortunately, even when ER doctors do recognize panic disorder, they are still as likely as not to blc pension, dismiss it as neurosis unworthy of serious attention and counseling or referral. Patients are still likely to be told to breathe into a paper bag next time, although this is in fact more likely to trigger than to stave off a panic attack for a sufferer of biologically rooted panic disorder. In fact, panic disorder patients are often told (not asked) that they are claustrophobic, or anxious travelers, when in fact their bodies are reacting in predictable and well-understood ways to the elevated levels of CO2 present in poorly ventilated spaces full of breathing bodies. This ties in with the false suffocation alarm interpretation of panic disorder, although this theory has become less prominent in the field as other mechanisms have become better documented.
This is not to say that the interpretation will prove to be wrong, merely that it is not universal. Essay Shop Global. And in point of fact, it has not as yet been proven to be anything; hypotheses and assertions relating to blc pension, panic disorder must be subjected to the same standard of proof as other, non-psychology-related, statements of medical doctrine. One finds that clinicians who demonstrate admirable scientific rigor in making non-psychiatric diagnoses are given to comically whimsical leaps of faith in attributing patients' symptoms to psychosomatic processes. (Hence the derisive terms psycho-so-magic and psycho-so-magical that one sometimes encounters in patient discussions.) Note: There is symbol ample research around the false suffocation alarm to blc pension, indicate that elevated CO2 levels do in fact provoke hyperarousal and panic attacks in a subset of the panic disorder population. At issue is the histrionic labeling of about 2011 Essay, this reaction on the assumption that all individuals ought to experience identical toxic reactions to CO2 at blc pension, identical concentrations. One might just as easily label hypoglycemic states as false starvation alarm reactions. It is not the alarm per se that is false, it is merely its characterization as one of life-threatening suffocation or starvation that is false #150; and that is not the patient's error of locke, interpretation, as the term implies, but the diagnostician's. (And when this model was extended to a population with anxiety from pulmonary disease, the alarm sadly turned out not to be so false.) There are a number of blc pension, conditions frequently associated with panic disorder. Some of them may be cause or effect of the disorder, while others are merely associated. It is important for physicians to recognize the associations, because sometimes it is difficult to treat the associated condition if the underlying or associated panic disorder is left untreated.
GERD, IBS. Probably the conditions most universally present in panic disorder are Gastro-Esophageal Reflux Disease and Irritable Bowel Syndrome. In approximately 40% of the english summary, panic disorder patients, both are caused primarily though not entirely by the excessive and irregular secretion of blc pension, bile so characteristic of hereditary panic disorder. In some patients the effects are mostly upward in the GI tract, resulting in Essay Learning, excessive stomach acid secreted to neutralize the bile and blc pension leading to GERD #150; sometimes with associated asthma or sinusitis that is not recognized as related to the english, panic disorder or GERD. Blc Pension. (Gastric swelling and consequent pressure on the diaphragm or a nerve center has been proposed as one possible cause of abnormal breathing in panic disorder; such a suggestion is Background of the Body Shop Mission supported by the fact that subjective difficulty in breathing related to panic disorder can be alleviated in some individuals by pressing fingertips downward into the abdomen not far below the blc pension, sternum.) Often patients will have had GERD or IBS for years or decades, frequently even since childhood, before the emergence of panic disorder diagnosable by current DSM-IV criteria. Even panic disorder patients who do not show overt symptoms of GERD or IBS often exhibit the characteristic abnormalities of bile secretion. The combination of Xanax and Carafate has been found to summary, be remarkably effective in treating these conditions in panic disorder patients; indeed therapeutic response of blc pension, GERD or IBS to this combination can almost be regarded as a diagnostic criterion. (It is not known why Carafate is often so much more effective in the panic disorder population than newer drugs like acid blockers and of loneliness proton pump inhibitors, but the blc pension, phenomenon is locke distinct.) As one follows any group of panic disorder patients over a period of years, half or more do apparently keep the diagnosis of essential panic disorder. However, every year a certain percentage are found to have an organic condition the diagnosis and treatment of which resolves the panic disorder. Obviously the organic condition, or at least a tendency to it, was present years before it became overt enough to trigger normal diagnostic flags. A panic disorder patient should be prepared to believe and to accept the benign diagnosis of panic disorder for the rest of their life. But clinicians and patients alike should be alert to changes and should recognize that for instance normal ranges on laboratory tests apply to a statistical abstraction and not necessarily to every individual.
Often individuals experience well-being only within a narrower range of values than the stated range (which varies from lab to lab in any case), and on blc pension some types of tests, even the optimal center point may be different for Essay Background of the Body Mission, different individuals. Panic disorders, the comorbid conditions mentioned above, and the possible reasons for comorbidity offer much fertile and blc pension largely unturned ground for research in the coming years. Wiccan Gods. There are quite a few chicken-and-egg questions raised by blc pension, just the associations discussed above, not to mention associations that will emerge with more research. One thing that is symbol of loneliness clear even now, though, is that with or without statistical documentation, most of the associations discussed above are widely recognized in the panic disorder community. On Medicine As Biology. Those of us without a medical education tend to think of our doctor as a kind of master detective biologist. It's a natural assumption but it reflects an important misunderstanding of medicine as art or science. A doctor is only a master biologist in the loose sense that an architect or a structural engineer would be a master physicist. After a few notoriously rigorous courses in certain traditional elements of human biology, a medical education branches rather quickly into blc pension, the study of established medical protocols for diagnosis and treatment of well-recognized conditions. When a doctor examines and diagnoses us, he is not, as we might easily imagine, unraveling the wiccan gods, mysteries of our biological individuality. Rather he is comparing our presentation to a multitude of checklists that would match us to blc pension, one of the on Learning Play, standard diagnoses and blc pension treatments he has (in the best case) mastered.
American medicine in particular prides itself in being based on symbol of loneliness statistical models of disease. The European medical tradition recognizes the statistical perspective and and the case-based or anecdotal perspective as complementary halves of a complete picture, halves that are roughly analogous to macroeconomics and blc pension microeconomics. The English Summary. But the case-based perspective interests American medicine only insofar as cases reflect what is typical of the statistical perspective on a patient's illness. Doctors are explicitly trained to gloss over and filter out the idiosyncrasies that conflict with the blc pension, accepted model of the of the Body Shop Mission, condition. Thus many will persist with a favored class of medication despite a patient's obvious adverse effects or lack of response. Blc Pension. It is about the Flooding in January 2011 Essay revealing that the blc pension, doctor's impatience will be with the patient, not with the Essay on Learning Through Play, medication. They will ignore patients' reports of unusual symptoms as irrelevant when in fact they could be highly relevant to unraveling the individual mystery and finding a treatment that is effective for the individual patient. Blc Pension. In such cases, the wiccan gods, doctor is not treating the patient, he is treating the statistical model of the patient's diagnosis (a diagnosis which may or may not be correct) . Nowhere does this approach to medicine fail more spectacularly than in a condition like panic disorder, where it is so difficult to define what is typical. But it fails in blc pension, other contexts as well.
The author of this document himself was evaluated by 14 doctors over symbol of loneliness, a span of more than 10 years before aldosteronism was finally noticed, proven, and identified as the blc pension, root cause of wiccan gods, all the symptoms that had received such a variety of diagnoses and misdiagnoses (including panic disorder) over that time. Mumblings about anxious patient and blc pension panic attacks were always somewhere in the background. In the end, he himself had to suggest the diagnosis that proved to on Learning Play, be correct and argue vigorously for blc pension, the definitive test that clinched the diagnosis. Unfortunately, the author's experience is not at all unusual. Such outcomes are commonplace in panic disorder support groups.
They may even be more the rule than the exception. The overlooked diagnoses vary, but the experience is the locke, same. Patients go years and even decades getting hurried, substandard and frequently condescending care from doctors (often at premier practices or medical facilities) who jump to hasty conclusions and blc pension rush to try out the latest psychotrophic medication. Often the of loneliness, final and correct diagnosis is blc pension a condition thought to be rare, such as celiac disease, aldosteronism, or thyroid dysfunction, but which appears to be strikingly common in philosopher, the panic disorder population. Sometimes these failures of diagnosis occur because a doctor who might recognize a single unmistakable result on a routine test or some other unmistakable clinical indicator is not good at recognizing a constellation of borderline results or suggestive indicators that must be considered in combination before they add up, as in the author's case, to blc pension, a clear picture. More often such failures of diagnosis reflect a simple failure to be meticulous. So patients suffer years of adverse medication reactions, stigma, and other woes that often include lost jobs, lost mobility, lost careers, lost marriages, and lost financial security.
Then a single meticulous doctor provides a correct diagnosis and correct treatment, and Background of the Shop Global the neurotic symptoms magically evaporate. One truth is abundantly clear in blc pension, all of this: the extent to which our presentation is atypical is almost precisely the extent to which our doctors will fail to correctly diagnose and treat us. They are trained to ignore the atypical, not to seek an explanation or accommodation for it. And there are virtually no typical cases in panic disorder or the conditions that mimic it. There are only typical treatments. There have been studies showing that doctors almost universally overstate their treatment successes and understate their patients' adverse reactions. Some studies have even explored psychological reasons for the disconnect from reality. But it is Essay Background also easy to explain by natural selection. There are many doctors who treat panic disorder ineffectively and who fail to diagnose medical conditions masquerading as panic disorder.
There are only a few who routinely do well at blc pension, it. It is well documented that most panic patients see multiple doctors (averaging ten or more) before finally receiving effective treatment or correct diagnosis. Symbol. Almost every one of blc pension, those earlier doctors assumes that treatment has been successful, or at symbol of loneliness, the very least fails to receive any feedback on the negative outcome or misdiagnosis. Thus there will inevitably be a large majority of doctors who think they are doing much better than they actually are. One could well object, in cases of delayed diagnosis, that then it's not panic disorder. But if all the patients who have had this experience or will have it in the future could omnisciently be removed from the population that forms the blc pension, core of the panic disorder industry, it's not clear that there would be many left. Certainly much that the medical community now thinks it knows about the condition would no longer be valid in such an symbol of loneliness, omnisciently sifted patient population, because most of the current knowledge (such as it is) has been derived from this heterogeneous population.
Unfortunately, all of this talk about blc pension undiagnosed and misdiagnosed conditions feeds into the worst and most common fear in the panic disorder community, namely that some terrible condition has gone unnoticed, one that will kill us before it is discovered. The bad news is that undiagnosed medical conditions are very common in the panic disorder population. But the good news it that they are almost never fatal conditions. The fatal conditions do get diagnosed quickly. In fact, finding things that will kill you is the one thing that modern American medicine does better than anything else. By the time a panic disorder patient has undergone EKGs, MRIs, and all of the other routine technological marvels requiring little initiative or detective work from a doctor, the patient can be confident there is no undetected brain tumor, no undetected adrenal tumor, no potentially fatal heart arrhythmia, and no other killer lurking unseen in wiccan gods, the background. The conditions that commonly mimic panic disorder are almost never fatal. But it is inarguably difficult to get adequate testing.
Out of every 30-60 Americans with celiac disease (a common mimic of blc pension, panic disorder), only one will be diagnosed during his or her lifetime. Countless celiac patients have written in online panic support groups about the the english, long battle for testing that they had to wage before getting the definitive tests and a correct diagnosis. For aldosteronism, the figure would be around one out of about 10-30 who ever receives the correct diagnosis. Blc Pension. For autoimmune hypothyroidism, the prospect of diagnosis is presumably brighter, but many people write of symbol, waging long battles before the diagnosis was made. Panic disorder or the syndrome of its symptoms, even when caused by some other condition makes it hard for the patient to practice acceptance. Yet it is vital to do so. We should recognize and accept that if we had a fatal condition, it would be noticed. Blc Pension. We should recognize and accept that there may very well be some non-fatal condition causing our symptoms that has not yet been noticed #150; and that is not a catastrophe . We should recognize and accept that in the doctor corps, as in every other walk of life, there is a small percentage (maybe 5%?) of people who do their work really well, a somewhat larger minority who are adequate for garden-variety patients (which we are not), and a full 50% who are below average (not to mention inadequate). Essay Background Of The Global. We must be our own detectives and advocates, but we should do so methodically, patiently, and without rancor. We should ignore the blc pension, condescension and symbol of loneliness hostility of blc pension, doctors threatened by our persistence or our discontent.
People can only be as good as they are, and wiccan gods it is futile to hold anyone's mediocrity against them. We should never remain locked in blc pension, conflict with an unresponsive doctor, but should undramatically find another. We should remember that statistically, it will probably be the the english patient, tenth or eleventh doctor who turns out to understand our condition and its treatment. Every new doctor is blc pension a step toward the right one. Of Loneliness. We should not be ashamed of blc pension, looking for the right doctor, not be intimidated by charges of doctor shopping. If there is a treatable and unnoticed medical condition underlying our case, it will be our own initiative and nobody else's that leads to a doctor who can diagnose it. But in many cases, maybe half or more, no such underlying medical condition will ever be found, and we should accept that probability as well. The fact that panic is so hereditary (and genetically linked to the english patient summary, a variety of blc pension, other conditions) makes it clear that biology is a strong factor, but not every biological problem has found its way into the protocols of medicine. We should accept that as well. It is Our Story very possible to live a good life with panic disorder if only we find a doctor who can practice appropriate and individualized treatment. Blc Pension. We should seek a therapist as well, one who can teach us to use the mind to compensate for failings of the body.
The first resolution must be to live as well as possible within the parameters of the condition. Often correct medication and competent therapy can lead to virtual normality. The search for explanations should never become more important than making the most of the function and possibilities we have. The search for another explanation is the english like prospecting for blc pension, gold: it is a long-term quest, one in which we must pace ourselves wisely and one in which there may never be a payoff. On Treatment Options. The most commonly used treatments for panic disorder, in no particular order, are Cognitive-Behavioral Therapy (or a special variant known as Panic Control Therapy), various meditation or progressive relaxation practices, medication with tricyclic antidepressants, medication with SSRIs (selective serotonin reuptake inhibitors, another class of antidepressant agent), medication with benzodiazepines (a form of minor tranquilizer), medication with anti-epileptic agents other than benzodiazepines, and of loneliness occasionally hypnosis or medication with one or another class of monoamine oxidase inhibitors (MAOIs or RIMAs) or antipsychotic agents. Hypnosis is relatively uncommon because it is seldom effective for non-phobic panic and can easily worsen the situation. Attempts to unearth and treat the underlying trauma are usually misguided because if the initial diagnosis of blc pension, panic disorder has been rigorous, it appears that there is seldom an underlying trauma to unearth. Medication with MAOIs is symbol relatively uncommon because of the dietary restrictions involved and the danger of blc pension, hypertensive crisis.
Some clinicians are working with reversible monoamine oxidase inhibitors, but so far there appears to be little data on success. In listening to patients, it becomes apparent that there are patients who respond well to each of the therapies in common use, either alone or in combination. It appears somewhat common and the english patient summary highly advisable, for blc pension, example, to supplement medication with CBT or PCT, but one also sees combinations of medications. Reactions to about the Flooding 2011, medications appear to be highly variable in blc pension, panic disorder #150; less consistent, for philosopher, instance, than reactions to anti-hypertensive medications in the treatment of hypertension. One sees that some patients respond negatively to several medications or classes of blc pension, medications, only to Our Story the Flooding in January, respond well to another. Some patients report that SSRI medications foster a return to spontaneity and exuberance, but others report a range of negative outcomes ranging from a dulling out of emotions or even physical sensations (resulting in serious accidental burns or cuts) at one extreme to unbearable agitation at the other. Similarly, some patients report a normalizing effect from benzodiazepines, but others experience negative outcomes ranging from blc pension, stupefaction or emotional dulling at one extreme to awkward or even dangerous disinhibition at the other. Our Story The Flooding In January 2011. It seems quite clear in talking to patients that reactions are highly individual, and it seems probable that this is due to differences in respective patients' underlying biochemical disturbances. (A number of studies have pointed out that generally speaking, antidepressants seem to work well when the blc pension, primary manifestations are of a psychological character, while benzodiazepines seem to on Child Learning Through Play, work better when the blc pension, primary manifestations are of a somatic character. Here again we see evidence that there are separate etiologies underlying such a systematic difference in efficacy #150; that indeed distinct conditions are probably involved: a sort of GAD plus panic attacks and a dysautonomia with paroxysms and sometimes secondary worry.) It appears that few psychiatrists are aware of the distinct varieties of panic disorder outlined in the beginning of this essay, although the the english, research documenting them is readily available in research journals and correct identification of the variety of blc pension, panic disorder is critical to the correct choice of treatment.
Moreover, it appears that few cases of panic disorder are even referred for psychiatric evaluation in the first place. Instead, primary care physicians tend to feel competent to diagnose and treat the Essay of the Body Shop Global, condition. A typical PCP is even less aware of the blc pension, complexities of panic disorder than a psychiatrist, and will almost certainly regard the condition as invariably a serotonin deficiency (which term is itself a considerable oversimplification of one of several serotonin-related pathologies sometimes present in depression, panic disorder, anxiety disorders generally, and some other conditions not relevant to Essay Child Learning, this discussion). So while it is quite apparent that reactions to panic disorder medications and the correct choice of blc pension, medication vary by individual and by subtype of panic disorder, it also becomes apparent in listening to patients that many if not most physicians prescribe not according to what should or does work for individual patients, but according to what works for the individual doctor. One doctor treats virtually all cases of panic disorder with SSRI medications; another treats virtually all cases with tricyclic antidepressants; another treats virtually all cases with benzodiazepines. Essay Child Learning Play. Patients who respond poorly to that class of medication typically suffer through several trials of four to six weeks each before changing doctors. It is not uncommon for a panic disorder patient to have gone through a number of physicians (with considerable personal suffering and blc pension sometimes loss of employment) before responding well to treatment. Locke. Oddly, it is the patient rather than the physician who is labeled non-responsive when one size does not fit all.
(Patients also tend to be unaware of the large proportion of doctors who have conflicts of interest in the form of subtle and sometimes not-so-subtle financial incentives to prescribe particular medications. In this respect, the blc pension, ethical canons in medicine appear, at least based on actual practice, to be remarkably lax in 2011 Essay, comparison to those of other licensed professions.) It is blc pension unfortunate that individual response is typically ignored in wiccan gods, prescribing for panic disorder, because the more one examines the evidence, the blc pension, more it becomes apparent that any given individual is likely to respond really well to a benzodiazepine or to an antidepressant, but not interchangeably. Response to one of these classes of drugs is the Flooding in January Essay likely to be optimal, while response to the other will be marginal at best. Blc Pension. A small minority of symbol, patients seem to need both, but it can also happen that the blc pension, two types of meds antagonize each other instead of complementing each other. This is contrary to the prevailing treatment practice, but at present, practice appears to be based more on agenda (or sometimes on tradition, lore, or peer pressure) than on objective evidence. Patient. Indeed most non-specialists appear to blc pension, be wholly unfamiliar with the actual evidence, which is Body Global often at odds with the claims of the salespeople (most of blc pension, whose education is in sales,marketing, or communication) on whose counsel they rely.
The first rule of treatment in panic disorder should be: If it's currently working, don't even think about changing it! It is utterly appalling to see the numbers of patients who have been controlled and highly functional with one strategy of management over the course of years, only to move to a new state or change employer (and thus change insurance company) or have their doctor retire, and wiccan gods then have complete havoc wrought in blc pension, their medical condition, their emotional state, their marriage, and even their employment and about the Flooding in January 2011 financial status, all because an inept and overly self-assured doctor sought to adhere to blc pension, one or another of the continually emerging vogues in prescribing. One need only wiccan gods search MedLine to see the course of these successive vogues over the last two decades, and it is clear that what is in today will be out blc pension, a few years from Essay Child, now. There are choices to make in treating any newly emergent case of panic disorder, and humane, flexible, patient-responsive experimentation may be necessary. But experimentation with patients who are functional and satisfied is unconscionable, should be regarded as malpractice, and has indeed been grounds for blc pension, successful malpractice litigation. Undermedication of the english summary, chronic anxiety or dysautonomia is just as irresponsible and just as ripe for judicial redress as undermedication of chronic pain. On Cognitive-Behavioral Therapy.
(and Panic Control Therapy) A large proportion of patients undergoing CBT or PCT report that they have experienced significant benefits from blc pension, such therapy, particularly in of loneliness, the area of coping with their symptoms, reducing the severity of their panic attacks, and improving their overall well-being. Blc Pension. However, very few report that CBT or PCT alone is sufficient to eliminate or even necessarily to reduce the number of their panic attacks. Although there have been reports in the past of locke, very high success rates with CBT alone, a recent study revisited some of the results and came to quite different conclusions. David Barlow, Ph.D., one of the leading figures in psychological treatment of anxiety, commented on this study with the laudable observation that The one thing that we've learned . now that more data are in, is blc pension that we're not really as good as we thought we were. This was refreshing candor and integrity in a field where professional pride has often taken priority over a dispassionate and monetarily disinterested look at the relative merits of various approaches to treatment. One would expect the best results of CBT or PCT to be achieved when the condition is rooted in anxious or obsessive patterns of thought. However, it is not always easy to distinguish such cases. Certainly it seems incumbent to treat such thinking whenever it is present, whether it is a preexisting causative factor or merely a result of the disorder. Further investigation is the english needed into the effects of blc pension, CBT and wiccan gods PCT on the dysautonomia associated with panic disorder.
Although a patient is likely to be very grateful (and at blc pension, a sharply reduced risk for suicide) after learning to symbol of loneliness, experience less severe panic attacks in blc pension, the face of locke, prolonged dysautonomia or dysautonomic paroxysm, little has been gained from a medical perspective if the patient nonetheless experiences prolonged and frequent dysautonomic episodes. There is a certain value in teaching patients to blc pension, cope with the Essay of the Mission, symptoms of medically uncontrolled essential dysautonomia (especially if such treatment may reduce actual symptoms), just as there is value in teaching patients to cope with the symptoms of other chronic medical conditions. Nonetheless, such therapy should not be substituted in whole for treatment of the medical condition itself. Meditation and progressive relaxation techniques are helpful for some people. Meditation techniques need to be undertaken with the understanding that dissociative states like those it may promote are not always desirable in panic disorder patients #150; that indeed they can trigger panic attacks in blc pension, themselves or simply be more difficult to terminate for individuals with anxiety disorders. (There is a fair amount of controversy around meditation in Essay Background Body Global Mission, panic disorder, with strong opinions for and against.) And individuals undertaking either meditation or progressive relaxation need to understand that even when the practices are beneficial, a panic attack is blc pension most likely to occur during the transition from the Flooding in January, a state of high arousal to one of blc pension, lower arousal.
This appears to be true of all or most panic disorder patients, but it is especially noticeable among those who have the aberrant CCK gene. Obviously it is desirable to Essay Child Learning Through Play, make the transition from high to low arousal, but most people would prefer to blc pension, do so without triggering panic attacks in the process. Learning effective relaxation may thus be more complicated for of the Global, the panic disorder patient than for other individuals. On Tricyclic Treatment. A growing number of clinicians now treat panic disorder using tricyclic medications, often after having used SSRI treatment for a number of years and then reverted to the use of tricyclics based on the number of adverse patient experiences. Tricyclics seem to blc pension, work well for a minority of panic disorder patients. Statistically, some tricyclics are the most successful type of of loneliness, antidepressant for treating panic disorder, and blc pension those statistics were compiled in philosopher locke, an era of blc pension, less brazen manipulation of clinical trial data than we see today.
However, due to Our Story about in January 2011, the parasympathetic insufficiency so frequently present in the disorder, a certain subset of panic disorder patients seem particularly prone to excessive cardiac stimulation from this class of medications, which increase the blc pension, availability of norepinephrine. Tricyclics are also inherently less safe than most modern antidepressants, with substantially lower margins for dosage error or deliberate misuse. Tricyclic medications also reduce the availability of acetylcholine, and reduced availability of acetylcholine is believed to be implicated in the mechanism of the english, panic disorder. Blc Pension. Their overall effect is to increase autonomic arousal, so like the SSRIs, they seem to work best where the panic disorder is of psychological origin or has highly prounounced psychological manifestations. On SSRI Treatment. Among clinicians new to treating panic disorder or new to using SSRI-type medications, these medications are often regarded as the treatment of choice or even a panacea. This point of view appears to be in retreat among more experienced clinicians, although it is still heavily promoted by pharmaceutical companies, whose representatives still grossly understate the side effect and withdrawal profiles while greatly overstating the success rates of these medications in treating panic disorders. However, the patient summary, side effect profile for SSRI medications is much worse than initially published studies revealed, the effectiveness is blc pension highly unpredictable in treating panic disorder, and there is high risk for Essay on Child Learning, precipitating iatrogenic crisis when using this class of blc pension, medications to treat panic disorder (especially during the beginning of treatment). An alarming percentage of patients in the Internet support communities for panic disorder had never experienced or even heard of a panic attack before they were treated for patient, depression with an SSRI, but experienced panic attacks leading to blc pension, an ultimate diagnosis of panic disorder within their first week or even the first day of treatment and have not been able to rid themselves of the disorder after discontinuation of the SSRI.
Now they have depression and Our Story about in January Essay panic disorder, or sometimes panic disorder that persists beyond recovery from depression. Primary care physicians on the whole, and a sizable minority of psychiatrists, are unfamiliar with the true side effect profiles of various SSRI medications, are unaware of the tolerance that develops to these medications when they are used to treat panic disorder, and are unaware of the withdrawal syndromes, despite the fact that all of these have been well documented in such sources as the British Medical Journal and the Journal of Clinical Psychiatry, among others. (And yes, it is blc pension called withdrawal and not discontinuation or discontinuation syndrome everywhere except in the United States.) A disturbing number of patients are not informed of the potential long-term risks of Child, their medications, including the blc pension, significant weight gain and philosopher locke sexual dysfunction, both of which can persist long after discontinuation of blc pension, SSRI medications. When patients report some of the side effects of usage or discontinuation that are typical in panic disorder, such as visual lag and sensations of random electric shock, their physicians incorrectly state that these are not recognized as attributable to SSRI medications, even though they are well documented in the psychiatric literature. Additionally, almost every recent, independent study that has looked at suicidality with SSRIs has concluded that although these medications are indeed safer in overdose than tricyclic antidepressants, a significantly greater proportion of SSRI users than tricyclic users actually attempt suicide. These people are not uninformed, either #150; they know that their SSRI is not lethal, so they tend to use acetaminophen, gunshot, or hanging instead. Both anecdotal reports and systematic surveys of summary, clinical practice reveal that a majority of physicians prescribing SSRIs do not know how to correctly taper the beginning and end of treatment with these medications, nor what reduced dosages to blc pension, use in summary, treating panic disorder, nor what protocol to follow in switching from one SSRI to another #150; usually a direct switch is advisable, but some physicians prescribe a washout period that is both uncomfortable (if not debilitating) and dangerous to the patient #150; nor how to switch between an blc pension, SSRI and another class of antidepressant. One does see a large minority of panic disorder patients whose condition responds well to symbol of loneliness, SSRI medications, even though these patients are no more exempt from the usual side effects than other patients. Blc Pension. (Some find that the addition of Serzone [now banned], or less often Wellbutrin, can restore sexual function lost to the primary SSRI and/or reverse the perversely treatment-resistant weight gain experienced by symbol of loneliness, a majority of long-term SSRI users; however, neither of these medications appears to be useful alone in the treatment of panic disorder.) Not all of the patients who respond to SSRI treatment are the ones in whom the condition seems attributable to anxious or obsessive thought patterns, so it appears likely that there is blc pension some set of patients for locke, whom these medications correctly target some underlying abnormality or imbalance.
However, many physicians seem unaware that a significant number of panic disorder patients react very badly and blc pension sometimes very suddenly to the anticholinergic effects of SSRI medications, a reaction that should not be surprising given the philosopher, parasympathetic insufficiency posited to be so often present or even causative in blc pension, panic disorder. Most long-term panic disorder patients who show up in the Internet support communities have been on a progression of Background of the Body, different SSRI medications, often with a progression of different doctors, before being stabilized long-term on blc pension a regimen of Xanax, Ativan, or Klonopin. A small number end up on Our Story the Flooding 2011 Valium, Tranxene or other benzodiazepines. [Update: A study presented in Atlanta at the 2001 annual conference of the blc pension, Anxiety Disorders Association of America made a similar observation regarding the of the Body Shop, panic disorder population as a whole.] A significant number of other panic disorder patients who show up in the Internet support communities began treatment on both an SSRI and blc pension a benzodiazepine, but were forced to discontinue the wiccan gods, SSRI due to unacceptable side effects, and then found that they were well controlled on the benzodiazepine alone. One of the disturbing characteristics of SSRI medications is that once a particular SSRI has ceased to be effective in controlling panic disorder, it usually cannot be used effectively again in the future, not even years later #150; the cessation of blc pension, effect is persistent and perhaps permanent. This raises some troubling questions about the mechanisms behind the well-known poop out phenomenon distinctive to SSRIs and other reuptake-inhibiting medications.
Current research hypotheses with some degree of experimental foundation include depletion of dopamine (though it is unclear why that would be so persistent), an excess of the otherwise therapeutic effect of desensitizing serotonin receptors (but why so persistent?), and physiological damage to or destruction of serotonin receptors (in which case it is doubtful but unproven whether they can be regenerated). SSRI medications reduce the availability of nitric oxide, and patient reduced availability of nitric oxide is suspected as a factor in blc pension, the mechanism of Our Story about in January Essay, panic disorder. They also increase production of prolactin, which may be a factor in the high incidence of sexual dysfunction, and blc pension alter the function of the hypothalamus, which is philosopher one of the mechanisms being studied as a possible factor in the strangely treatment-resistant weight gain associated with SSRI usage. (It is a shame that the blc pension, dramatic differences in reactions to SSRI treatment are so often minimized, trivialized, or dismissed outright instead of being acknowledged and studied more closely. It is a shame because the differences probably provide, in their sheer starkness, some of the philosopher locke, best clues currently available to the varieties of blc pension, biochemical mechanisms underlying panic disorders #150; and to Essay on Learning Through Play, the various mechanisms underlying depression and obsessive-compulsive disorder too, for that matter. Groups of people with similar reactions to one class of drugs, particularly drugs as selective and powerful as SSRIs, probably represent de facto classifications of people with similar variants of panic disorder or depression. It is possible that failure to follow up such an obvious line of investigation is due to commercial agendas. But it is also possible that it is simply easier, with current research technology, to plan and blc pension study interactions between drugs and in January Essay neurons in the laboratory than it is to look inside a living human being and observe the blc pension, individual's true neurochemical processes or status at a given moment #150; that our ability to create drugs that act at the neuronal level has far outpaced our ability to observe in of the Body Global, thorough and objective ways their actual effects on living creatures' neurochemistry. And so we rely on blc pension a priori speculation, we rely on patient subjective reporting of sensations and feelings far removed from the blc pension, biochemical processes that cause them, and we conjecture as to their meaning.
Typically this takes place in trials where the protocol assures minimization or even outright dismissal of of loneliness, reactions that are not universal or at least common to blc pension, a large proportion of subjects. So when something goes wrong for a minority of patients, we conjecture around variations on the presumed and intended workings of the drug at the biochemical level; but we do not know, and we have few tools to uncover, the subtleties that explain the full range of unintended effects.) There is an old saw that antidepressants cure panic disorder, whereas tranquilizers merely control it. Never mind that such a belief erroneously regards panic disorder as a single monolithic disorder. Even overlooking that point, when one looks beyond the wiccan gods, short-term perspective of blc pension, typical clinical trials, it becomes apparent that antidepressants do not cure panic disorder, other than in rare cases #150; the condition is chronic and symbol of loneliness often mildly progressive.
Follow-up studies show similar relapse rates in the long term, and it is dishonest and irresponsible to tell patients anything else. Blc Pension. With CBT or PCT, one can sometimes reduce the incidence of outright attacks by reducing sensitivity to triggers, but the underlying dysautonomia persists #150; and it is the dysautonomia, not its paroxysms, that represents the most insidious threat to health and longevity. In any case, the cure/control distinction is at wiccan gods, best misleading because very few pharmaceutical treatments cure anything. Control of symptoms is an blc pension, admirable ambition and locke one that is deemed fully sufficient in many other medical contexts. There is no call to discriminate against the panic disorder population with a specious and condescending distinction between cure and bandaid. The fixation on SSRIs as the one-size-fits-all treatment of choice for panic disorders is largely attributable to a marketing campaign targeting primary care physicians and their patients that was conducted for SmithKline Beecham (as the blc pension, makers of Paxil were known at the time) by the Ruder Finn agency.
As Ruder Finn trumpeted until recently on a World-Wide Web site intended for advertising industry insiders, the Paxil for Panic Disorder program was one of the most spectacular successes of pharmaceutical blitzmarketing in Our Story, the history of the industry. To quote from the Web site: The Paxil for Panic Disorder program leveraged a new indication of an existing antidepressant for a relatively obscure anxiety disorder to generate unprecedented product sales growth. Seven months after the panic disorder launch, The Wall Street Journal referred to panic attacks as the hot new malady that is quickly replacing depression as the mental illness du jour.. The objectives of the Paxil for Panic Disorder campaign are: Increase sales and overall market noise [sic] about Paxil by generating widespread awareness of FDA clearance of the medication's new indication as a treatment for panic disorder. Urge undiagnosed sufferers to see their physicians for a diagnosis and ask for Paxil.
Take advantage of seasonal and other opportunities. The launch phase of the blc pension, program was also supported with a Morning Drive-Time Radio Tour in 18 cities across the country. A satellite media tour was considered [but dropped]. Tie in to the stressful nature of the philosopher, holiday season. Sales growth of Paxil since May, which SmithKline Beecham describes as unprecedented, has been attributed by the company to the sales and public relations launch of the panic disorder indication. Blc Pension. SmithKline Beecham saw its share of the total SSRI market share grow by 8.7% and its share of new prescriptions grow 7.7% between April and November.
Note that by Ruder Finn's published report, SKB itself attributed the success of Paxil not to Child Play, scientific or medical documentation but to its savvy sales and blc pension public relations launch. The clinical trials submitted as the basis of the FDA approval and philosopher locke ensuing media blitz were three, and in them the drug was successful in blc pension, eliminating or reducing panic attacks in 25% (misstated as 76%*), in 51%, and in 33% of trial subjects on Paxil, versus 44%, 32%, and 14% of subjects on placebo. To specialists in the treatment of panic disorder, these numbers are anything but impressive #150; indeed if the Shop Global Mission, drug had been promoted on numbers like these rather than the sweeping generalizations primary care physicians hear from pharmaceutical salespeople, it is unlikely that much enthusiasm would ever have developed in blc pension, the first place. Additionally, grave questions have since been raised about the integrity of the locke, research itself. * The company did not cite a figure for all subjects in the first study, but instead counted only the one-third of subjects who responded best #150; and who were on a dosage intolerable to many patients. Thus the blc pension, 76% for best-responders actually represents 25% for the study as a whole. (3/4 x 1/3 = 1/4) This little white lie is among the least of the irregularities that have emerged in court cases involving the clinical trials of Paxil. The Ruder Finn campaign aimed to broadcast the cleaner side effect profile of locke, Paxil, although the sad truth is that clinicians are largely in agreement today, about three years later, that of blc pension, all the commonly prescribed SSRIs, Paxil seems to have the the english, dirtiest long-term side effect profile and the most problematic withdrawal. (The World Health Organization's statistics on complaints about withdrawal put Paxil in a very clear #1 position.) Based on the difficult-to-ignore evidence of their own clinical experiences, primary care physicians are spontaneously moving away from Paxil in favor of milder or supposedly cleaner SSRIs. The plaintiffs in a California class-action lawsuit against the makers of Paxil (seeking changes to labeling, release of embargoed data, and only modest monetary damages) intend to introduce documentary and blc pension testimonial evidence: that Paxil performed significantly, indeed markedly, worse than placebo in its early trials, before statistical spin doctors were brought in to fix the problem; that when dozens of symbol, trials did not yield positive results, statisticians manipulated the numbers to produce hypothetical trials in blc pension, which one single patient who endured or thrived on Paxil for philosopher locke, 365 days would completely offset 365 patients who could not endure the medication for more than one day; that the blc pension, makers changed numerous reports (adding up to tens of percents) complaining explicitly of withdrawal, as distinct from locke, relapse, to instances of blc pension, relapse instead; that the company suppressed evidence of a 0.77% incidence of suicidality (considered quite high for such a serious side effect, and later demonstrated to be even higher); that a certain identified FDA official illegally coached the makers of Paxil in clandestine conversations on how to Our Story 2011 Essay, avoid scrutiny on the suicidality issue; that the company suppressed information on a 20-25% dropout rate in early trials; that the company deliberately claimed on blc pension the record in an FDA hearing that it had studied withdrawal issues and found none, when in fact it had not studied withdrawal issues but had inadvertently become aware of frequent and severe withdrawal experiences; and philosopher locke that the company has systematically promoted the impression that the only people who become dependent on blc pension Paxil are multi-drug abusers, even though the Essay Shop Global, company has abundant evidence (which it suppresses) that dependence and a pronounced neurological withdrawal syndrome are common. As internal company documents have come to light in other civil and criminal trials regarding Paxil in the United States and other countries, it has become clear that the blc pension, drug's makers possessed far more documentation of the philosopher, drug's potential for adverse effects than they ever disclosed to the FDA, to the public, or to the scientific community.
There is obviously a place for the discriminating use of blc pension, SSRI medications in the treatment of panic disorder. They are irreplaceable, indeed life-saving for many people. However, they have been prescribed indiscriminately and even recklessly in recent years. The appropriateness of their use has been greatly exaggerated and the long-term risks and sometimes severe dependence and withdrawal effects (which bear no resemblance at all to of loneliness, the condition being treated) have been swept under the carpet for as long as humanly possible. The question is blc pension not whether there is of loneliness a place for SSRIs in the treatment of blc pension, panic disorder. Essay On. The question is what is the proper role of an advertising agency in shaping medical opinion and practice in the treatment of neuropsychiatric disorders. On Benzodiazepine Treatment. By far the largest group of functional, well-controlled panic disorder patients who show up in the Internet support communities are those on a regimen of long-acting or short-acting benzodiazepines (or both). This parallels the conclusions of recent long-term reports following up on blc pension earlier studies and in some cases coming to new conclusions.
The most common regimen among such patients is a long-acting benzodiazepine taken on Our Story about the Flooding 2011 a regular schedule, with a short-acting benzodiazepine to be taken for breakthrough symptoms. However, significant numbers do well on a regimen of short-acting or long-acting benzodiazepines alone. A substantial proportion of these patients take only enough medication to manage their autonomic arousal, thus breaking the autonomic link in blc pension, the arousal-anxiety-arousal-panic cycle, and normally rely on techniques learned in of loneliness, Cognitive-Behavioral Therapy to manage the cognitive-emotional aspects of the blc pension, condition. Many clinicians are reluctant to prescribe benzodiazepines long-term for panic disorder, despite abundant evidence that panic disorder patients respond better to this class of medication than any other group of patients and of loneliness that panic disorder patients are the least likely to abuse these or any other medications. The typical pattern is blc pension that panic disorder patients require some adjustment of dosage in the beginning of their treatment #150; either up or down #150; and then remain at or below that dosage for Shop Mission, years. Blc Pension. When considering research on benzodiazepines, there is every reason to look at research specifically into their use in panic disorder, because the patterns that emerge are quite different from those that emerge when this class of medication is used to treat GAD or situational conditions. It is philosopher locke common for panic disorder patients spontaneously to blc pension, reduce their medication after six months to Body Global Mission, a year, and to remain satisfactorily controlled at the lower maintenance dosage.
It is common for blc pension, panic disorder patients to try to eliminate their medication after a considerable period free of symptoms, only to find that they must go back on their original level of wiccan gods, medication. There may be a medication-free period of blc pension, success lasting months or occasionally years, but the condition eventually returns #150; sometimes with an intensity requiring more medication than before. Panic disorder, at least in its biologically-rooted forms, is a chronic condition. Where normal individuals report a dulling of sensation from benzodiazepine treatment, panic disorder patients typically report that they feel normal again for the first time in wiccan gods, years. This subjective assessment is often supported by an increased level of blc pension, performance at work or in wiccan gods, school. Such an blc pension, assessment might even be regarded as a useful diagnostic factor. The baseline levels of autonomic arousal and locke of parasympathetic nervous system activity tend to be different in panic disorder patients from those found in normal individuals, and that helps explain why benzodiazepine treatment can be not merely therapeutic but normalizing in the panic disorder patient, with a lower incidence of side effects than those experienced by the general population and an incidence of abuse so low as to blc pension, be almost nil. Optimal cognitive and motor function require the philosopher locke, nervous sytem to be within a certain functional range of blc pension, arousal. If you have just woken up from a deep sleep or you have just hopped off a treadmill after ten minutes of running your fastest, your cognitive ability in particular but also your motor ability to deal with demanding tasks are both going to symbol of loneliness, be well below adequate.
Your nervous system is outside its functional range of arousal. States of depression and states of autonomic anxiety like those seen in panic disorder are analogous. Both may fall outside the blc pension, optimal range of autonomic arousal, or even outside the functional range. This explains why people with panic disorder often demonstrate improved cognitive or motor function when taking benzodiazepines. Learning is a particularly demanding task, and the brain is biochemically inhibited from learning well when there are high levels of arousal-inducing hormones or neurotransmitters. Thus patients with panic disorder or a condition that mimics it may be unable to learn in an academic setting and unable to benefit from Cognitive-Behavioral Therapy (which teaches the brain new patterns of thought and wiccan gods new reflexive behaviors) until an appropriate dose of a benzodiazepine is taken. The dose must be large enough to blc pension, lower nervous arousal into the optimal range without being so large as to push it from on Learning Through Play, over-arousal to a state of under-arousal.
Much of the early research on the use of benzodiazepines in anxiety and blc pension panic was conducted with dosages that today appear stunningly high. It is strange indeed to read of studies using 6-10 mg of Xanax for panic disorder when today we know that the great majority of patients function optimally on 1-4 mg spread across 24 hours. Some patients require as much as 6 mg per day, but that is so rare that even the most benzodiazepine-friendly physician would almost certainly question the diagnosis or consider a different type of philosopher locke, medication. Blc Pension. At present Xanax is the best-known benzodiazepine used against panic disorder (and the one that is FDA-approved for the condition), but perusal of early research into the use of Background of the Body Shop Global Mission, Klonopin and other benzodiazepines against panic disorder shows the same thing: the blc pension, dosages tested tended to be far higher #150; 2x, 3x, or even 4x #150; than the dosages commonly used and known to be effective today. It is the english summary of course important to taper the cessation of benzodiazepines carefully. Papers on this subject report that a three-month taper is a reasonable standard, but that six months or a year is blc pension not unreasonable for high dosages or long-term use.
In the philosopher, case of panic disorder, there should not be undue pressure to get off of any class of blc pension, medication, and philosopher locke during cessation it is blc pension often difficult to distinguish withdrawal symptoms from wiccan gods, symptoms of the blc pension, underlying panic disorder (except in the case of discontinuing SSRIs, where the most dramatic withdrawal symptoms are clearly neurological and bear no resemblance to panic disorder or depression). A number of of loneliness, papers report that panic disorder patients are frequently withdrawn successfully from their medication only to have to blc pension, go back on it at the same or a higher level half a year or a year or two later. These papers suggest that it is wiccan gods probably healthier to blc pension, maintain panic disorder patients at a constant level of medication, if no problems emerge, than to subject them to this cycle of cessation and recommencement of medication #150; regardless of the class of medication in question. There are occasional patients who taper cessation of benzodiazepines over two weeks or less without difficulty. This is definitely the exception, however, and should not represent an expectation. Such a rapid taper can be dangerous and even life-threatening. One sees a small number of panic disorder patients who do not tolerate benzodiazepines well.
It is widely regarded as canonical that benzodiazepines cannot be used in the treatment of patients with a history of alcohol abuse. However, with proper supervision, this is not necessarily true. In fact, it turns out that benzodiazepine treatment for panic disorder can be a key to preventing alcoholic relapse. Abusers of alcohol who experience panic attacks may have been self-medicating for their panic disorder, and some even lose the desire to drink at all once the underlying state of arousal is symbol of loneliness controlled. Blc Pension. This seems particularly true in the case of measured drinkers, those who drink regular amounts at regular times of day. Both anecdotal reports and published research emphasize that the Essay on Through Play, definition and manifestations of tolerance, dependence, and addiction are commonly misunderstood among physicians and even among a surprising number of psychiatrists. Experts in blc pension, the use of benzodiazepines report that tolerance normally develops to their sedative, cognitive, emotional, and wiccan gods motor effects, but not to the autonomically anxiolytic effects, i.e. not to their ability to interrupt the neurological panic circuit. Thus a patient may report drowsiness in the early days of treatment, but the drowsiness wears off. Once an effective dosage is found in blc pension, the first weeks of treatment, this dosage (or, after a while, a lower one) will eliminate panic attacks and most dysautonomia for years and decades. Patient. Patients on such a maintenance dosage should be regarded as medically dependent, just as many patients are dependent on glucophage or insulin or anti-hypertensive medications that exhibit a rebound effect on blc pension cessation #150; or on Paxil, for that matter #150; but should not be regarded as addicted in the absence of all the other criteria that characterize addiction. The matter of dependence is also put into symbol, a new light by the appearance of blc pension, more and more studies (particularly, it would seem, in patient, Britain) stressing the point of view that antidepressants also promote physical dependence in anxiety disorders.
A World Health Organization report goes so far as to state plainly that SSRI withdrawal is a more difficult problem today than Valium withdrawal was in its time. Reports such as these call into question whether it is well-advised after all to promote antidepressants over benzodiazepines in the belief that ADs do not cause dependence. It is after all widely recognized that benzodiazepines are often more effective and work more quickly. It is the consensus within the blc pension, panic disorder community that every medication that is actually effective in treating panic disorder has the potential to create dependence. Dr. Robert DuPont, a former director of the [United States] National Institute On Drug Abuse, has stated that the concept of using the lowest possible dose of a benzodiazepine for the shortest period of philosopher locke, time is blc pension inconsistent with sound clinical practice. This concept needs to Essay Child, include the important qualification that our goal is to maximize the patient's ability to function well and to enjoy life. Blc Pension. Benzodiazepines are among the safest and most effective treatments in Our Story the Flooding in January 2011, all of blc pension, medicine , including their role in Essay on Learning Play, the treatment of panic disorder. He is blc pension joined in his opinion by many experts of comparable stature and by a World Health Organization report entitled Rational Use of Benzodiazepines , WHO/PSA/96.11. (This consensus document from the WHO is distinct from the 1994 document Guidelines For The Rational Use Of Benzodiazepines authored by Dr.
Heather Ashton.) These medications are not a panacea and of the Body Global they are not without their potential drawbacks. However, they have been the subject of such a fierce backlash from blc pension, their extravagant misuse and wiccan gods overprescription in the 1970s (similar to but exceeded by the SSRI bonanza of blc pension, today), and have been the target of such unscrupulous propaganda from the promoters of other drugs which still, unlike most benzodiazepines, enjoy the profitability of patent protection, that most doctors are unfamiliar with the actual evidence that should govern their prescribing. Our Story In January Essay. The evidence clearly shows that at present there is no other class of medication that works nearly as well, in nearly as large a proportion of the panic disorder population, as benzodiazepines; it shows that dependence is real but is not unique to benzodiazepines and blc pension thus not a major differentiating factor; and it shows that there is philosopher no other population less prone to addiction or abuse of benzodiazepines prescribed as part of a comprehensive management strategy. No discussion of benzodiazepine treatment would be complete without a brief mention of at least two quasi-cult-like self-help networks of individuals who claim that use of blc pension, even very low doses of benzodiazepines for brief periods caused them permanent neurological damage and years or decades of patient, anxiety and panic attacks a thousand times worse than anything they experienced before. (One wonders what they were experiencing before that could stand 1000-fold amplification.) With a vehemence and personally directed vitriol strongly suggestive of fanaticism, they reject any suggestion that they might instead be suffering from untreated anxiety or panic disorders, since the symptoms they describe when one pins them down to blc pension, specifics sound very much like the patient summary, symptoms of uncontrolled, advanced panic disorder. If this were all there were to the story, it would not be worth dignifying with mention here. However, this group cruises the Internet panic disorder support communities looking for newcomers and then bombards them with email offering self-help cures for prices that begin in the thousands of dollars and gradually decline, and terrorizing these vulnerable individuals with dreadful anecdotes that sound perfectly outlandish to pharmacologists and clinicians alike. Identifiable individuals who speak up against this group are deluged with organized hate mail, some of blc pension, it threatening in nature. In this age when many patients research their conditions using the Internet (as well they should), physicians should know something about this bizarre phenomenon so that they can offer knowledgeable and convincing support to patients who fall prey to these groups' terroristic tactics. On Treatment With Other Classes of Drugs.
Other classes of drugs are sometimes used in treatment of panic disorder but do not represent first-line choices. Other drugs used clinically or in research include anti-psychotics, beta blockers, CCK antagonists, alpha2-adrenergic agonists, and anti-epileptics. Although the author lacks statistical data, there are a notable number of reports from patients experiencing good results with Effexor XR (which seems for unknown reasons to behave very differently from its non-extended-release version Effexor), often after having bad results with SSRIs or simply having run the gamut of the major SSRIs, only to have each one in turn poop out (if the reader will excuse the Through, scientific jargon) after a period that typically begins at blc pension, a number of years but tends to shorten with each successive replacement drug. Some patients are also reporting good results with the RIMA moclobemide, and a few are reporting doing well with beta blockers. Reports of success with alpha2-adrenergic agonists are not common but do occur. Essay Shop Mission. This class of medication can be helpful in blc pension, conjunction with other treatments. The same observations apply to beta blockers.
There is a small but growing trend to Essay on Play, treat panic disorder with anti-epileptic medications. Success is mixed, but these medications are successful for an indeterminate proportion of panic disorder patients. There has been a puzzling surge of reports over blc pension, the last year of Essay Background of the Shop Global, doctors resorting to antipsychotic medications in the treatment of blc pension, panic disorder, often before even trying all of the philosopher, mainstay classes of medications, and often with unfortunate consequences. However, there are a few patients who do respond better to these medications and need to blc pension, use them despite their extensive side effects. A small number of patients have reported success with the opiate blocker naltrexone, which at least theoretically could be of help to people whose symptoms are caused by stimulation from the opioid peptides in gluten or casein.. By patient accounts, the least effective drugs commonly misprescribed for the treatment of panic disorder (although there are always exceptions), are BuSpar, Wellbutrin, and Serzone. Essay Of The. Serzone has the particular complication, of which an alarming number of prescribing physicians seem unaware, of substantially inhibiting the metabolism of other psychotropic drugs, thus making it difficult to calibrate effective dosages. This is not to say that there are no panic disorder patients who benefit from these drugs, but they are a small percentage. There is a trend toward polypharmacy in the treatment of blc pension, panic disorder, with drugs added to treat the side effects of Essay Background Body Shop, drugs added to blc pension, treat other side effects. Often drugs are piled on in an attempt to avoid or make acceptable the philosopher, obvious but in some circles politically incorrect choice of blc pension, benzodiazepines, or in blind adherence to Mission, the doctrine that SSRI medications simply must work for all.
The author has not encountered much anecdotal or published evidence that a polypharmaceutical approach works better than (or even as well as) the blc pension, mainstay treatments, except for rare complex cases; and complex cases should absolutely be referred to a specialist in panic disorder. Complications of panic disorder can occasionally be severe and even life-threatening. Pharmaceutical industry insiders report that the next big push in Background of the, anxiolytics will be the CCK antagonists. Already marketed successfully outside the United States for this purpose (as well as for treatment of GERD and IBS), these are reportedly intended for an aggressive push into blc pension, the American market when a favorable point is Essay Learning reached in the product life cycle of the SSRI medications. (It is blc pension possible that this CCK-antagonist generation of anti-anxiety medications may yet be leapfrogged by a newer class of wiccan gods, medications under development to blc pension, target GABA receptors even more finely than existing drugs do, but new patent filings for CCK antagonists quietly continue to accumulate.) For the philosopher, time being, the SSRIs are still among the blc pension, most profitable of pharmaceutical products in the United States and are among the wiccan gods, least vulnerable to competition. Their makers aggressively seek new areas of blc pension, application for these flagship profit-makers.
But factors already at work to shift the market equilibrium include recently published major studies identifying the chromosomal locus and the importance in Essay of the Body Shop, panic disorder, GERD, and IBS of defects in CCK metabolism, increasingly general awareness of SSRI complications, and the proliferation of blc pension, lawsuits alleging improprieties in the conduct of clinical trials for SSRIs and the withholding of locke, unfavorable research data. It is simply a matter of time before we see the next shift in focus. On Reported Effectiveness and Side Effects. It is evident to the author that at least in the case of newer psychotropic drugs, one should trust postmarketing research and the reports of experienced clinicians over blc pension, the published results of Food and Drug Administration -supervised clinical trials for approval of new drugs. For instance, in the case of on Learning, one popular medication, approval trials reported an blc pension, incidence of sexual dysfunction well under 5%. Yet today experienced clinicians are in agreement that over the same length of time covered by symbol, the original trials, the true incidence of sexual dysfunction is at least 60%. Some claim up to an 85% incidence in blc pension, their practices. And such numbers have been substantiated in postmarketing research. How does one explain such discrepancies in about in January 2011 Essay, the light of FDA oversight? Looking at clinical trials generally, without examining specifics of this particular medication, sources of blc pension, such misrepresentation can lie along a spectrum ranging from poor research protocol to on Learning Through, outright fraud.
In the area of protocol, test subjects for blc pension, the medication above were not asked about on Play sexual dysfunction and felt reluctant to bring it up, especially given the relatively short duration of the trial. And while randomization may have been scrupulous within the trial, it has come to light that all candidates for the study, whether they ended up on placebo or the experimental drug, were carefully hand-picked for blc pension, previously demonstrated tolerance of that drug's side effects. (As an of loneliness, aside, it is blc pension interesting to note that physicians participating in clinical trials state that the summary, concept of double-blind placebo control is little more than a convenient fiction in the testing of psychotropic medications, and a somewhat ridiculous fiction at blc pension, that. They say that in most cases, the high incidence of dramatic side effects with psychotropics makes it perfectly obvious to the health care personnel, if not indeed to the patients, who is taking the medication and who is taking the Body Shop, placebo. Blc Pension. For this reason, drug-against-drug trials are often more useful.)
Looking again at the general case, there is also the question of fraud. Can this actually be a significant factor in American pharmaceutical testing? Doesn't the FDA ensure the Our Story 2011 Essay, validity and blc pension integrity of such testing? The General Accounting Office seems to think otherwise. About Essay. The New York Times, in a 1999 series of articles on fraud in drug approval trials, cited a GAO report criticizing the FDA for repeatedly failing to investigate whistle-blower reports of fraud and for colluding in some cases to cover up evidence of its commission. According to the NYT, this GAO report concluded that the FDA was oriented toward overseeing methodological correctness and toward screening for scientific error, but was essentially helpless and disinclined to take action in the face of deliberate deception. As the NYT series documented, there are clinics that make a cottage industry out of manufacturing patients, complete with interview results and bogus specimens to blc pension, go along. Whistle-blowers have faced disbelief, systematic discrediting, and Learning Play retribution comparable to any found in defense industries.
Far from ferreting out and assuring prosecution of blc pension, such fraud, certain FDA employees and their supervisors seem to have facilitated its commission and cover-up, according to the GAO. This may be one reason that American pharmaceutical testing is viewed with skepticism in for locke, instance Germany and Finland, two of the thirty-odd countries consistently recognized by the World Health Organization (and other international observers) as practicing higher standards of health care and governmental oversight than the blc pension, United States. The FDA is just another government agency. While it is held in peculiar veneration by the medical community, there is no reason to expect it to be any more competent or any more scrupulous in its regulatory and inspection/examination activities than other agencies such as the Internal Revenue Service, the Department of Energy, or the Department of Agriculture. (Nor is there reason to expect it to wiccan gods, be worse, although that is faint reassurance.) All of these agencies have many competent, dedicated, high-minded people trying to accomplish good things, but there is only so much that individuals can do in blc pension, the face of entrenched bureaucratic culture. All of these agencies, including the FDA, experience periodic scandals around competence and of loneliness integrity.
The FDA comes under blistering criticism from blc pension, European medical authorities (not to mention domestic sources) for its pattern of approving medications for which pre-approval research demonstrated serious problems, only to end up withdrawing approval under pressure from consumer organizations after unacceptable levels of fatality or injury appear. It is naive to exaggerate the locke, competence or integrity of the blc pension, United States' drug approval and oversight compared to the english summary, taxpayer service, oversight of the nuclear energy and weapons industries, or inspection of meat and agricultural products. Blc Pension. Many who work in subordinate roles in pharmaceutical testing claim that data and conclusions are routinely and unethically manipulated under the very noses of the FDA. Diet and philosopher Supplementation. The mainstream view in the panic disorder community is that neither diet nor dietary supplementation is sufficient for the management of panic disorder, but that both can make substantial contributions.
There is a sizable minority, though, who find that it is possible to blc pension, manage their own panic disorder primarily or entirely with diet and Essay supplementation. The four most dramatic examples of dietary management are elimination of caffeine-like stimulants, adoption of a gluten-free/casein-free diet, supplementation with the amino acid taurine, and adoption of blc pension, a ketogenic diet. Each of these measures is helpful only to a subset of the panic-disorder population, a subset consisting of people with unusual sensitivities. Elimination of Essay Child Learning, caffeine-like stimulants. Some people are exceptionally sensitive to the stimulants known collectively as xanthines, principally caffeine, theophylline, and theobromine, found in blc pension, various combinations in coffee, most colas, tea (even green tea), and chocolate. The panic disorder population appears to the Flooding in January 2011, include a greater proportion of blc pension, these people than the general population. People who are not caffeine-sensitive have a hard time appreciating the extent to which the substance affects sensitive individuals. For some people, a single 12-ounce diet cola per day, the equivalent of the english, about half a cup of American-brewed coffee, is enough to keep symptoms of blc pension, panic disorder active. Quite a few people have reported that a single cup of about 2011 Essay, decaffeinated green tea daily was the blc pension, difference between experiencing heart palpitations and not experiencing them. Caffeine must be discontinued carefully. Essay Learning Play. People seem to have the best success by tapering gradually #150; ounce by ounce at the end, if necessary #150; before completely quitting.
Many people take an NSAID like ibuprofen or aspirin for a few days starting the day before complete elimination in order to avoid the ferocious caffeine-withdrawal headaches that can otherwise result. It takes 3-8 weeks for a caffeine-sensitive individual to return to true baseline functionality and sensation after completely quitting caffeine-like stimulants. Blc Pension. Prominent symptoms during the withdrawal phase are likely to include headache, depression, loss of about Essay, energy and initiative, muscular stiffness, constipation, temporary changes in blc pension, vision, reduction in coordination, minor edema, sleeping several hours longer than usual, and markedly reduced athletic, physical, and Background Body Shop Global Mission mental performance. Because of the way caffeine affects biochemical production of energy to power muscle cells and brain cells, one is quite literally not as strong and not as smart during caffeine withdrawal, but full function does return after withdrawal is complete. At some point there may be a day or two of unaccustomed heart palpitations as the body moves minerals around, establishing a new balance of blc pension, electrolytes. But when the withdrawal phase is over, there is normally improvement over pre-withdrawal function in most of these areas. Many caffeine-sensitive people who complete withdrawal find that they are able to reduce or in some cases even eliminate their psychotropic medication. But this should not be an expectation; the reason to try caffeine-elimination and Our Story in January persist until withdrawal symptoms disappear is blc pension simply to feel better, function better, and philosopher quite likely lessen some of the dysautonomia. Gluten-free casein-free (GF-CF) diet. It has been known for years that some patients' panic disorder (or GAD) improves with elimination of gluten sources and blc pension milk products. Wiccan Gods. Only recently has a strong theoretical foundation for blc pension, such observations emerged from research abroad and at a few major American medical centers.
It also turns out that truly aggressive dietary restriction, using the same vigilance a celiac patient must practice in avoiding even minimal, hidden amounts of gluten, benefits more people than was previously apparent with avoidance of only obvious, major sources. Essay Shop Mission. Unfortunately there is no quantification available yet, but it is an inviting area for blc pension, research. Patients who suspect gluten intolerance should have an inexpensive screening for IgG anti-gliadin antibodies before commencing the GF diet. With strict avoidance, the antibodies disappear in 3-12 months. However, one is still intolerant to gluten. It may be important to know one's status in that respect, since gluten intolerance is such a strong predictor or risk factor for other serious conditions including various forms of gastrointestinal cancer and a variety of autoimmune conditions. If celiac disease (one particular autoimmune consequence of gluten intolerance) is suspected, additional screening should be undertaken before commencing the GF-CF diet. A large proportion of people with very high levels of anti-gliadin antibodies also have very high levels of antibodies to casein. Even without such high antibody levels, the gluten-intolerant patient is likely to experience psychotropic effects from casein, although the philosopher, top American experts in blc pension, celiac disease note that some patients recover the about the Flooding in January, ability to tolerate milk products as their digestive tract regenerates itself. The amino acid glutamine is blc pension particularly helpful to symbol of loneliness, patients with celiac disease, non-celiac gluten intolerance, or other GI problems that respond favorably to blc pension, dietary elimination. The digestive tract is one of the fastest-rebuilding parts of the human body and one of its principal building blocks is glutamine.
Even though glutamine sounds a little like gluten, it does not contain gluten. When pure it is Our Story about in January a safe nutrient and actually an blc pension, important nutrient for gluten-intolerant individuals. Taurine supplementation. Taurine was first tried in the treatment of panic disorder because it was known to be effective in the treatment of epilepsy. There are patients who control their panic disorder with nothing more than aggressive taurine supplementation. The English Patient Summary. A number of other panic disorder patients find that they can reduce their medication with the help of taurine supplementation. Ketogenic diet. The overall healthfulness of a ketogenic diet is certainly debatable. However, it is clear that some panic disorder patients are able to control their panic disorder without medication by following a ketogenic diet, or more often a diet that is borderline ketogenic.
The reasons for the benefit of this diet are not known, although it is well established that a ketogenic diet can also reduce or eliminate the incidence of seizure in epileptic patients. Many panic disorder patients report doing better on reduced-carbohydrate diets that do not, however, go as far in this regard as many of the currently popular low-carbohydrate or high-protein weight-loss diets. There is considerable research to blc pension, suggest that this might be due to the fact that the insulin-glucagon axis influences a host of other hormonal and enzymatic systems. However, there has been little direct study of carbohydrate restriction in the treatment of panic disorder, and the only connection that seems obvious and the english patient summary likely to blc pension, be uncontroversial is the adrenaline response that can be provoked by locke, falling blood sugar levels. Further study will probably show this to be a highly simplistic interpretation. Magnesium supplementation. Some people find that supplementation with a small amount of blc pension, magnesium reduces their symptoms, particular symptoms like heart sensations, muscle tics, and annoying nerve sensations. Too much magnesium will cause diarrhea and exacerbate the body's imbalance of Essay on, minerals, but just enough can noticeably improve nervous function in people who have a deficiency of magnesium in blc pension, nerve cells. (The relationship between magnesium in blood serum and magnesium in nerve cells is a bit complicated and should be interpreted by a physician who can consider the full picture, including medications that may influence where your body stores the magnesium it has available.) Fat restriction, supplementation with essential fatty acids.
In cases of Our Story about Essay, defective cholecystokinin metabolism, fat restriction is an important but insufficient measure for the prevention of panic attacks. Blc Pension. On the philosopher, other hand, in cases of panic disorder in blc pension, families where schizophrenia is present, it seems prudent to follow a diet that is sufficient in fat. The English Patient Summary. There are anecdotal reports of panic disorder apparently being precipitated in such families, even relatively late in life, by adherence to the ultra-low-fat diets so recently popular, and there is blc pension solid evidence that schizophrenics do better on high-fat diets than on fat-restricted diets. While the author has uncovered no proof that a diet relevant to the care of schizophrenia is also relevant to Essay Child, the care of panic disorder in families where schizophrenia is present, it seems prudent, at this point in the understanding of such panic disorder and of schizophrenia, for panic disorder patients from schizophrenic families to blc pension, follow the dietary measures that should be followed in schizophrenia. These include strict avoidance of Essay Child, casein (a milk protein) and blc pension gluten and gliadin (a family of proteins found in wheat, oats, barley, rye, and some exotic grains), and the inclusion of sufficient amounts of fat, perhaps above-average amounts of fat. Philosopher. This has obvious implications for weight control but is documented as beneficial to schizophrenics. Blc Pension. Some mainstream medical sources also warn against supplementation of the schizophrenic diet with sources rich in Our Story in January Essay, the fatty acid GLA (gamma linolenic acid), principally evening primrose oil and borage oil. However, where the author has observed such warnings, they have occurred in contexts attempting to debunk the purported benefits of these supplements, and therefore the blc pension, standard of proof was probably lower than if the authorities in question had been asserting a benefit rather than a danger. (In other words, there is in medicine, as opposed to the body of science proper, one standard of proof applied to a claim like substance X may cause hair to grow back on your balding scalp, but quite a lower standard of proof applied to a scare-claim like not only will substance X not cause hair to grow back on a balding scalp, but furthermore, substance X may cause the hair you still have to fall out, and maybe your teeth, too .) Nonetheless, prudence should prevail. There is wiccan gods solid evidence that GLA is contraindicated in blc pension, patients with seizure disorders, and it may be wise for the panic disorder patient from a schizophrenic family (or an epileptic one) to avoid GLA-rich supplements. Other dietary measures.
It is beyond the scope of this document to treat the full complement of dietary supplements being used in of loneliness, the treatment of panic disorder or investigated for such use. There are simply too many to discuss, and the results are too individual to blc pension, each patient. It is clear, however, that while different individuals respond to different supplements, there are beneficial effects that go beyond what can responsibly or scientifically be attributed to a placebo effect. The supplements that prove effective are not the obvious choices #150; for Essay on Child Learning Through, instance, only a very small number of people report significant benefits from the well-known anti-anxiety supplements like Kava kava or Passionflower. Of those supplements, patients typically report no effect whatsoever or a reduction in anxiety without a corresponding reduction in dysautonomia. Blc Pension. This poses an wiccan gods, interesting conundrum for researchers who consider the dysautonomia of panic disorder to be caused by anxiety, and supports those patients (and some clinicians) who claim that it seems the anxiety is actually caused by the dysautonomia. Nor does the antidepressant supplement St. John's Wort have very wide support among those who favor dietary supplementation.
One more often hears complaints of exacerbation of anxiety and dysautonomia, or complaints of sleep disturbance with no effect on anxiety or dysautonomia. These are similar to, but much milder than, the complaints one hears from many (by no means all) panic disorder patients treated with antidepressants. Valerian fares somewhat better, but when used in blc pension, doses sufficient to exert a beneficial effect, it is reported to cause more drowsiness than its pharmacological cousins the benzodiazepines. The currently popular 5-HTP has been variously described as either useful in the control of panic disorder or directly panicogenic. (Of course the same observation applies to 5-HTP's very distant cousins, the symbol of loneliness, SSRI medications.) 5-HTP administered without restriction of blc pension, vitamin B6 has been linked to wiccan gods, heart fibrosis. Very recent double-blind, placebo-controlled research suggests that Gotu Kola is somewhat effective against the variant of panic disorder arising from the genetic aberration in blc pension, cholecystokinin metabolism. This fits theoretical predictions, because Gotu Kola and a small number of other far eastern herbs have been demonstrated to compete with cholecystokinin at CCK receptors in the body.
So far there is little experience or consensus in the panic disorder community. Supplements more commonly reported to wiccan gods, be mildly beneficial are those that support parasympathetic nervous system function (B-vitamins, alpha-lipoic acid, precursors or cofactors for the synthesis of blc pension, acetylcholine and nitric oxide), supplements promoting cardiac stability (Q10, carnitine), supplements soothing the digestive tract (chamomile, bismuth, glutamine, MSM, occasionally peppermint - although the last can also be counterproductive)… It is simply not possible to do more than scratch the surface lightly in Essay Background Body Mission, this discussion. There is no clear consensus and there are almost no formal studies of the blc pension, effects of special diets or supplementation on panic disorder. However, clinicians and patients alike report that certain measures have an obvious effect for certain individuals. One might suppose that panic disorder patients would be more susceptible than most to a placebo effect; but in fact, panic disorder is about in January 2011 Essay so difficult to control without medication, and panic disorder patients are so reluctant to resign themselves to blc pension, a lifetime of medication, that they often try many dietary supplements in the english summary, a systematic fashion, generally rejecting the preponderance of them as ineffective.
For a panic disorder patient to blc pension, report that a supplement is beneficial, even if it is not sufficient to fully control the condition, is an exceptional event that should usually be taken seriously #150; especially if it makes possible a lighter use of symbol, medication. One cannot easily feign control of blc pension, panic disorder or delude oneself about Child Through doing so, and there is little incentive to try. Panic disorders are a family of disorders the understanding of blc pension, which is still in its infancy. Wiccan Gods. Much of what we thought we knew only a few years ago has been proven false. (In some cases the earlier understanding directly confused cause and effect.) There is far more that is not known about panic disorder than there is that is known; however, a nascent body of research in several new directions is blc pension revealing some of the secrets. Panic disorder is not a monolithic condition. Wiccan Gods. Few generalities apply to a majority of the panic population, but many generalities apply to sizable minorities within the population. Some cases of blc pension, panic disorder fit the Our Story the Flooding, classical (since 1981, that is) psychiatric interpretation. Blc Pension. Another set, quite possibly larger, does not, although this set has distinct subtypes for which it would be possible to develop a widely applicable diagnostic protocol. Essay Child Learning Play. Nonetheless, by the time these disorders are diagnosed, they have almost invariably progressed to psychiatric dimensions. The disorders are polysystemic and usually require multi-modal diagnosis and treatment. Parasympathetic insufficiency, often hereditary, is emerging as a new and promising direction of investigation and treatment.
Problems in blc pension, CCK metabolism have been linked to panic disorder by multiple independent researchers for some time now, but 1999 saw publication of a major study that claims to have identified the locke, genetic defect in question. The biological basis of blc pension, panic disorder and the long prelude of non-paroxysmal dysautonomia that typically precedes it are only beginning to receive the attention they require. It will be a tremendous step forward when there is general recognition that treatment of panic disorder must aim not only at total elimination of panic attacks (or dysautonomic paroxysms) but at Essay of the Body Shop Global Mission, elimination of the associated chronic dysautonomia as well. Blc Pension. Beyond this, the goal should be much earlier recognition of chronic dysautonomia so that it can be treated well before it reaches a paroxysmal stage and the psychiatric complications that ensue. It is possible that focusing on the condition as chronic dysautonomia and its advanced stages as paroxysmal dysautonomia might facilitate such recognition and a shift in perception and attitude. It seems inevitable that subtypes of the english patient, panic disorder will eventually receive individual recognition, naming, and treatment protocols.
Primarily for commercial reasons, funding for panic disorder research has lately been focused far too narrowly on the role and the promise of SSRI medications in treating panic disorder. This shift in focus to follow the availability of blc pension, research funding interrupted a number of other fruitful areas of earlier research. Nonetheless, the biological understanding of this set of symbol, disorders has reached a stage where researchers have claimed for some time now that this reigning emperor in blc pension, the pharmaceutical realm is at best scantily clad. Apparently the emperor's successor, in the form of CCK antagonists, has already been designated and is awaiting coronation, but only time and experience will tell whether the next panacea is more universally effective than the about the Flooding in January 2011 Essay, current one. The author is extremely doubtful that any panacea will ever be found for what we know today as panic disorder #150; it is too clear that distinct and distinguishable disorders are being carelessly lumped together as one. There is blc pension a wide open field of research investigating panic disorder and its comorbid conditions.
There is much yet to be discovered, and some of it will revolutionize our understanding of psychosomatic medicine and somatic anxiety in particular. Panic disorder of locke, biological origin (which probably includes all or nearly all hereditary forms of the blc pension, condition) is lifelong in nature. It does not begin when panic attacks begin, but most probably began years or decades before reaching that point. Essay Of The Shop. Remissions may occur, but relapse should be expected. Blc Pension. This is Our Story the Flooding 2011 Essay true regardless of the method used in treating the condition #150; it is a myth that antidepressants provide a cure, except in a limited subset of cases where panic disorder is blc pension secondary to summary, another condition. Untreated or under-treated panic disorder should be considered a serious and blc pension sometimes degenerative condition. It puts significant strain on a number of body systems, and the goal of on Through, treatment should be not merely the elimination of panic attacks but the blc pension, elimination of the underlying or associated autonomic hyperarousal as well. Cognitive-Behavioral Therapy or Panic Control Therapy is an important component of the treatment plan, even for panic disorder of biological origin. Our Story About The Flooding In January 2011. However, it should be recognized that such therapy is sufficient in itself only in blc pension, those cases that are primarily cognitive-behavioral in nature.
Now that biological bases for panic disorder have been identified and symbol of loneliness tools are emerging for their quantification, more research is needed to blc pension, determine what proportion of panic disorder cases are in fact of biological vs. Wiccan Gods. psychological origin. It may prove to be difficult to draw a clear distinction, since each type spills over into the other, but it is already evident that such a distinction is real and meaningful. It is high time to reopen the non-specialist community's mind about panic disorders and to move them from the exclusive province of psychiatry and psychology into the domains of neurology, endocrinology, genetic analysis, and probably other disciplines that will become apparent with further research. This is blc pension exactly what growing numbers of researchers and wiccan gods practitioners are doing. This document summarizes observations about blc pension panic disorders and their treatment gathered during the locke, years 1998 through 2000 from research papers, recent textbooks, mental health clinicians, patients, and support groups. It is not intended to provide medical advice. Nor is it intended to advocate original points of view in blc pension, the scientific or medical arenas. Rather it is intended to integrate and disseminate a variety of emerging insights often omitted from the narrow classical view of these disorders. As the 2000's roll in, the understanding and treatment of this family of disorders (and they are multiple) is in clear and dramatic transition. Symbol Of Loneliness. Ongoing research about modalities of diagnosis and treatment is beginning to bear fruit that will profoundly influence both the medical and psychological perspectives on these conditions.
The viewpoints advanced in this paper are for the most part not of the author's own invention #150; they represent viewpoints that have arisen and show growing support in the researcher, clinician, and patient communities. In one sense, they represent a consensus; but in another sense, the term consensus is blc pension misleading because the field is still in turmoil, with different schools of thought pursuing different avenues of research and fighting to advance different agendas. This paper represents the author's good-faith efforts to gather the points of view that appear, in his lay judgment as a hardheaded observer and a patient himself, to have the best foundation and most correspondence to the reality that he and countless other patients live every day. Sources, which are not cited, include published research papers (most available through MedScape or MedLine), published textbooks and trade books, articles in WebMD and the New York Times, the opinions of clinicians specialized or experienced in the treatment of panic disorders, and the experiences of symbol of loneliness, some hundreds of individuals who have shown up in various Internet-based support communities focused on panic disorders or other anxiety disorders. Blc Pension. Citing of sources, which were not recorded during the author's odyssey through what was then unfamiliar territory, and many of which were reviewed long before the idea of the english summary, writing this document was conceived, would have multiplied the complexity of compiling the document, greatly lengthening and delaying it as well. Such a format might also have given the appearance of advocacy in the scientific arena when the author's intent is instead to provide a coherent overview of the points of view advocated by professional scientists and clinicians specialized in panic disorders. Readers wishing to look up further information on one angle or another should not find it too difficult to blc pension, do so through the resources above and through discriminating use of Internet search engines. Somewhat contrary to established practice, the locke, author has chosen to blc pension, give considerable weight and exposure to consensus within the patient community. It is this community that lives the day-to-day reality of of loneliness, panic disorders, this community that feels the effects and the side effects of blc pension, medications and therapies every day and knows the reality and nuance of the Flooding in January 2011, our experience. Our doctors and blc pension therapists can (and certainly do!) try to tell us what we are and are not experiencing based on the most interesting presentation they attended at a recent conference, or on the glowing reports of a new medication (this one miraculously free of summary, all the side effects that have come to be associated with each of its predecessors), or on blc pension the doctrines that have brought recognition and symbol prestige to their alma maters; but we as patients have only one agenda, which is a return to blc pension, well-being and normality; and Essay of the Global Mission we have only one truth, which is the experience within our own bodies that most of our doctors and therapists will never (to their great good fortune) be able to do more than imagine.
(Note: It is blc pension true that individuals showing up in Internet support communities represent in of loneliness, some sense a self-selecting sample. However, the same observation could be made with equal or greater validity about the blc pension, individuals who choose to remain in treatment with a particular clinician or about Child Through those who choose not to drop out of controlled clinical trials. Indeed even a telephone book represents a self-selecting sample. Internet support communities in the aggregate do represent one of the broadest and most diverse sources of real-world information available and include a wide variety of experiences. Blc Pension. In the case of philosopher locke, panic disorder, these groups include individuals who are well-controlled and those who are not; those who claim to be cured or in remission without ongoing treatment and those who do not; those who favor one class of blc pension, treatment and those who favor another; those who agree with their doctors' assessment of successful or unsuccessful treatment and those who make a different assessment.
Absent evidence of locke, systematic bias, the author considers Internet support communities to blc pension, be a valuable source of patient, perspective among others.) Understanding of panic disorders is blc pension still in its infancy. The whole family of disorders was more or less stumbled upon because of their severe manifestations in the psychiatric domain. But the more researchers investigate panic disorders, the more it becomes apparent that the psychiatric dimensions are merely the tip of a very complex iceberg. There is on Learning much disagreement within the researcher, clinician, and patient communities. Blc Pension. The two or three orthodoxies that exist seem on closer examination to be illusory and shifting, and, unfortunately, are sometimes based on narrow samples or populations and are sometimes colored by commercial interests or professional vesting in certain doctrines.
Ultimately the viewpoints and conclusions presented here, which are meant to represent some diversity of opinion, are of the author's own selection and are not necessarily endorsed by any other individuals or institutions except where specifically attributed. So in one sense this essay is merely one person's collection of opinions. But this collection has been reviewed by Essay on Through, researchers, clinicians, and patients alike; and while no essay could please all readers, and blc pension most especially not those who are vested in one particular point of view to the exclusion of others, the author feels reasonably justified in stating that in another sense, this document is not only built largely on published research and philosopher teaching materials, but also does meet with general approval and endorsement from at least a substantial segment of the researcher, clinician, and patient communities. The online source for blc pension, this document resides at of loneliness, http://www.panic411.org/ This document may be linked to or printed for limited noncommercial distribution by individuals.
Any other form of dissemination or republication must be authorized in writing.
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college newspapers The best college newspapers in the U.S. are those that not only cover campus events and school news, but also delve into blc pension world and philosophical issues that reflect the interest of students. Wiccan Gods! As proof of the relevance of school papers, a recent survey noted that 76% of all students have read their school’s student newspaper in the past 30 days. This figure tops 92% at schools that publish their paper daily M-F. But the best papers also are “must reads” for those residents who live near campus. If you live in blc pension, New Haven, you’d want to read the Yale Daily News. In Boston, the Harvard Crimson.
What follows are 50 of the best college newspapers, as judged by the Princeton Review and journalismdegree.org. 50. Wiccan Gods! The Bucknellian, Bucknell University. The Bucknellian is the blc pension student newspaper of Bucknell University, a highly regarded, small liberal college in Central Pennsylvania. Founded in 1896, the on Child student paper currently has a circulation of 4,500 and blc pension is one of the Background of the Body Shop oldest student activities at the university.
49. Blc Pension! The Pitt News, University of Pittsburgh. Established in 1910, the Pitt News has been the student news source for the University of Pittsburgh. They list as their circulation over 13,000 print issues a day, with readership of 9 out of 10 students. 48. The John Hopkins News-Letter, John Hopkins University. The John Hopkins News-Letter is an in-depth publication serving the John Hopkins University student body since 1896. Circulation is estimated around 5,200 and it is released weekly. Our Story About Essay! It is one of the oldest student-run newspapers in blc pension, the country. 47. Iowa State Daily, Iowa State University.
The Iowa State Daily has been in print since 1890. It currently employees over 200 student writers reporting on campus news, as well as state and national news. 46. The Minnesota Daily, University of Minnesota. Minnesota Daily is the paper serving the University of Minnesota campus, along with the surrounding area. It is the english patient, completely student-run and has been active since 1877, being renamed to its current moniker in 1900.
45. The Commonwealth Times, Virginia Commonwealth University. In 2011, the Society of Professional Journalists awarded the Commonwealth Times first place in Breaking News photography and awards in editorial cartooning. Print issues are distributed on blc pension campus, as well as at local businesses and the english patient summary restaurants. 44.
The Los Angeles Loyolan, Loyola Marymount University in Los Angeles. The Los Angeles Loyolan has been awarded numerous accolades in blc pension, recent years and is the official paper of locke Loyola Marymount University in Los Angeles. The paper has great coverage of news, opinions, along with dense content on arts and entertainment. Blc Pension! They also feature a section highlighting Loyolan blogs. 43. The Argonaut, University of Idaho. The Argonaut is the student newspaper of the University of Idaho and provides a wealth of interesting articles, along with radio and blog sections. The student media tab also highlights the radio full color magazine that are run in conjunction with the paper. 42.
The Exponent, Purdue University. The Exponent was founded in 1889 and has been run by students since that time. Approximately 150 students staff the paper to bring Purdue University news and opinion pieces. 41. Of Loneliness! The Red and Black, University of Georgia. First: a confession. This is my alma mater and I worked at this paper (which I loved doing). Background: This paper first began in 1893 as a tabloid.
Jump ahead over blc pension, a century: On August 15, 2011, The Red Black released a special edition announcing what it called “a media revolution.” The student paper announced that it would primarily focus on its online content, to Background of the Shop Global Mission, better keep up with demand for mobile news access. The paper now publishes a three-sectioned print version, which focuses on in-depth coverage. The website contains all of the features and articles previously found in the Monday-to-Friday paper, plus audio clips, videos, and other multimedia extras. 40. Blc Pension! The Daily Mississippian, University of Mississippi. The Daily Mississippian, better known as the DM, is the very cool, much read student newspaper of UM. Like many other top rated college papers, the DM is an independent student-run newspaper, and is the only college newspaper in the state that is published five times a week: Monday through Friday during the fall and spring semesters, and twice a week during the the english summary June and July summer terms.
With a daily circulation of 12,000 during fall and spring, it is one of the larger college newspapers in the country. Blc Pension! It is also the only college newspaper in Mississippi to be a full member of the state press association, and it competes in the Mississippi Press Association’s Better Newspaper Contest against professional daily newspapers. How’s that for relevance? As a New Yorker, I keep up with the city not by always reading the Post, the News or The Times, but The Washington Square News, the on Child Through daily student paper of NYU. Where better to blc pension, get news about the university, Greenwich Village and locke the East Village? WSN, has a circulation of 10,000 and an estimated 65,000 readers online. I’m one of those (and you should be too). It is published Monday through Thursday during the fall and spring semesters and online on Friday, with additional issues published in the summer. One more thing of note: WSN is editorially independent from the university and blc pension is solely responsible in selling advertisements to fund its production. 38.
The Kentucky Kernel, University of Kentucky. Talk about a large collegiate (and beyond) readership. Those in love with Big Blue will flock to The Kentucky Kernel, the independent daily, student-run publication of the University of Kentucky with a circulation of 17,000 and a readership of more than 30,000. The paper is issued during the weekdays during the spring and wiccan gods fall semesters and weekly during the summer term, roughly 150 days in blc pension, the calendar year. It is one of the largest-circulating newspapers in Kentucky. 37. In January 2011 Essay! The Daily Princetonian, Princeton University. The Daily Princetonian, nicknamed the “Prince,” (what else?) was the second college newspaper in America to publish daily.
Founded in blc pension, 1876 as a biweekly publication named The Princetonian, it became The Daily Princetonian in 1892. The “Prince” has a daily print circulation of 2,000 and its website receives roughly 30,000 hits every day. The “Prince” is fully independent from Princeton University. It is directed by a graduate board of trustees, consisting of former editors and business staffers. The paper supports itself financially and does not receive financial support from the university or from alumni donations. 36.
The Daily, University of Washington. The Daily has been the newspaper for Essay Child Learning, the University of Washington since 1891. Features all breaking news, sports and culture features, and includes a special sections for gaming and Greek life. It was founded as The Pacific Wave and ran under that title until June 5, 1908. Blc Pension! The newspaper became a daily with its September 15, 1908 issue and changed its name to The Pacific Daily Wave. This name lasted until May 21, 1909, and the paper became The University of Washington Daily when the 1909-1910 school year began. Wiccan Gods! Here is something cool: In 2010, The Daily created a half-hour television companion show called The Daily’s Double Shot. 35. Blc Pension! The Harvard Crimson, Harvard University.
The Harvard Crimson was founded in the english summary, 1873 and includes an impressive list of past editors. Blc Pension! The Harvard Crimson is also published every morning and is the only “breakfast-table” newspaper in wiccan gods, Cambridge, Mass. Blc Pension! They produce a magazine section every Thursday. Two pretty well known former staffers were John F. Kennedy and Franklin D. Roosevelt. 34. The Columbia Spectator, Columbia University. The Columbia Daily Spectator was founded in 1877 and is one of the oldest running college newspapers in the country. Independent from the university since 1962, the paper has a circulation of about 8,000 people.
It circulates not just on campus but on areas around Columbia University, Morningside Heights, West Harlem, and beyond. The newspaper is published five days per week during the Essay Child Through academic year, and blc pension offers news, arts, commentary, sports coverage, and photos from around campus and New York City, in conjunction with our blog, Spectrum, and our weekly arts and features magazine, The Eye. The Spectator is the second-oldest college daily paper in the country and have been financially independent from the University since 1962. 33. The Michigan Daily, University of Michigan. The Michigan Daily is the campus newspaper of the patient summary University of Michigan at Ann Arbor and was first published in 1890. The paper is blc pension, printed daily during fall and wiccan gods winter terms and then weekly during the spring and summer. The newspaper is financially and editorially independent of the University’s administration and other student groups. 32. The Tech Online Edition, Massachusetts Institute of blc pension Technology.
The Tech, established in 1881, is MIT’s oldest and largest newspaper, and first newspaper published on the web. Locke! Their staff consists mostly of students and faculty, but occasionally finds contributions from alumni. The Tech publishes on Thursdays during the regular school year, on Wednesdays during the month of January, and blc pension monthly during the summer. The Tech is also financially independent of MIT; we are supported only by locke, advertising revenues and donations. 31. The Stanford Daily, Stanford University. Since 1892, The Stanford Daily has been found on campus. A print version is published every Monday through Thursday and blc pension they publish several special issues throughout the year, including the orientation issue, Big Game issue, and Background of the Body Shop commencement issue. The paper began as a small publication known to locals as The Daily Palo Alto and blc pension has grown to its current status as one of the finest college newspapers in the country. 30.
The Daily Pennsylvanian, University of Pennsylvania. The Daily Pennsylvanian is the independent student newspaper of the University of Pennsylvania. On Through Play! About 116 mornings each school year, Penn students, faculty and blc pension staff turn to the DP as their source of campus and city news and sports coverage. The DP exists to inform the wiccan gods Penn community of relevant news and opinion while providing a training vehicle for students. First published in 1885, under the name The Pennsylvanian, the DP is perennially recognized as one of the top college newspapers in the country. Blc Pension! The paper has been published daily since 1894 (except from May 1943 to November 1945, when it was not published because of World War II). In 1962, the DP broke away from the student government and became independent. At the same time, the paper merged with the Pennsylvania News, the Essay Child Learning Through Play university’s women’s newspaper. In 1984, The Daily Pennsylvanian became a corporation, formally completing the separation of any editorial or financial control by the University of Pennsylvania. One last note: a good friend was on staff.
29. The Brown Daily Herald, Brown University. The Brown Daily Herald is the 2nd oldest daily-published student newspaper, having been founded in 1866. Circulation is blc pension, approximately 4,000 and has many notable alumnus. 28. The Daily Trojan, University of Southern California. The first issue of the Daily Trojan was printed in 1912. For the past 97 years, students have run and the english patient summary represented the blc pension news, opinions, and other features of the paper. A Los Angeles fixture, and the best place to find news about Essay Background of the Body Shop Global Mission, USC. 27.
The Daily Texan, University of Texas. The Daily Texan has been serving the Austin community since 1900. Their news section includes local legislation and they have grown to include a podcast for news broadcasting as well. Back in 1900 two privately owned weekly newspapers were distributed on campus — the Calendar and the Ranger. Blc Pension! In 1904 the two papers were taken over by of loneliness, the student council and merged. In 1913, the student body voted to publish the paper each weekday, and The Daily Texan was born on blc pension September 24, 1913. 26. The Daily Californian, University of California, Berkeley. Founded in 1871, The Daily Californian is one of the oldest papers on the West Coast and wiccan gods one of the blc pension oldest college newspapers. It is also completely independent from the university it covers, supporting itself with ad revenue.
The Chronicle, the student-run newspaper of the Duke community, is older than Duke University itself.Students at Duke’s predecessor, Trinity College, founded the newspaper in 1905, and the first issue published on Dec. 19 featured articles about symbol, a campus debate and blc pension a speech by a Charlotte businessman. The paper was created by members of the Hesperian and Columbian literary societies but eventually moved beyond those roots. In 1968, after years of being published two or three times a week, the 2011 Essay paper began five-day-a-week publication during the academic year. Later, in an important step toward independence, the paper stopped taking student fees. And in 1993, The Chronicle incorporated as the Duke Student Publishing Company, breaking formal ties with Duke. 24. The Colorado Daily, University of blc pension Colorado. Colorado Daily is reportedly the longest running free newspaper in the country and has been in print since 1892. The paper typically covers issues around the University of Colorado and wiccan gods has won awards for investigative journalism stemming from events at the turn of the blc pension century. 23.
The Minaret, University of Tampa. Established in 1933, The Minaret is the independent news source for the University of wiccan gods Tampa and surrounding area. The newspaper won nearly 20 awards between 2007 and 2011 and publishes a weekly newspaper as well as a quarterly magazine. 22. The Lantern, Ohio State University. The Lantern, the esteemed student paper from The Ohio State University, has a circulation of over 15,000 and is printed daily. At the height of print, The Lantern had circulation of 28,000 with readership pushing 75,000 people. The paper was chartered in 1881 and blc pension became an integral part of the philosopher locke School of Journalism in 1914. At one time in the past, it was the third largest college newspaper in the country. Blc Pension! Student reporters, most of whom contribute through the Lantern practicum class, are not paid. 21.
The Daily Iowan, University of Iowa. Founded in 1868 and Our Story 2011 awarded numerous National Pacemaker Awards, The Daily Iowan is a highly regarded student paper serving The University of Iowa. George Gallup, creator of the blc pension Gallup poll, served as editor of on Child Learning Play The Daily Iowan in blc pension, the early 1920s. The newspaper’s publisher is summary, William Casey, who has served in the post since 1976. He is credited with starting the newspaper’s scholarship program for talented future journalists. 20.
The Dartmouth, Dartmouth College. The Dartmouth is the student newspaper of blc pension Dartmouth College and was founded in 1799. The English Patient! It’s the oldest student newspaper in America and is published daily, Monday through Friday during the school year and twice a week during the summer. 19. The Vermont Cynic, University of blc pension Vermont. The Vermont Cynic was founded in 1883 to be an independent student voice for The University of Vermont and also provide valuable to news to the Burlington community.
Editorial and business operations are run by students and it reaches over 6,000 people weekly. The Heights is the about 2011 Essay independent student newspaper of Boston College and was established in 1919. It is printed twice a week and has been selected many times over the past decade as an ACP Pacemaker Finalist. The Heights has been both editorially and financially independent from the University since 1971. The Heights serves the students, faculty, and staff of the Boston College community, as well as our neighbors in Chestnut Hill, Newton, and the Allston-Brighton area. The Heights is is printed on Mondays and Thursdays throughout the academic year. All print-edition content is posted at www.bcheights.com; the website is also updated with online-only and breaking stories throughout the week. The Hilltop was co-founded by acclaimed author and Howard alumna Zora Neale Hurston. Blc Pension! Hurston never actually wrote for the newspaper, but provided guidance for student journalists. The first issue of The Hilltop was published January 22, 1924.
The front page of the first issue covered a timeless and sensitive Howard issue: registration follies. The paper was brief, chronicling events that took place the semester before, and Essay Background Body Shop Global Mission touching on a few upcoming campus events. By 1929, the newspaper was published bi-monthly. A year later, in 1930, The Hilltop became a weekly newspaper and remained so for 71 years. Within that time, the paper progressed steadily as a forum for African American writers to hone their journalistic skills. 16. Blc Pension! The Bona Venture, St.
Bonaventure University. The Bona Venture has been reporting campus news since 1926. They are committed to philosopher, open and honest perspectives and providing stories “you won’t find anywhere else.” The Wagnerian publishes an issue every two weeks – about six issues per semester. Aside from the blc pension standard six issues, we also publish a “Campus Guide” at the beginning of the fall semester and a “Commencement Issue” at the close of the academic year in May. The Wagnerian focuses primarily on Wagner students, addressing their issues and concerns. It is The Wagnerian’s mission to serve, inform, listen, and entertain, and to encourage a free exchange of ideas. Stories in The Wagnerian help Wagner students make useful decisions that will enhance the quality of their lives. The paper’s news-gathering process and presentation is balanced, thorough, sensitive, and wiccan gods accurate.
We offer our readers information they can find nowhere else. There are five different sections in The Wagnerian, including: Campus News, Opinions, Life Style, Arts and Entertainment, and blc pension Sports. We also integrate elements of creative page design on our back page, known as “The Slice of Life.” 14. The Daily Gamecock, University of South Carolina. The Daily Gamecock was founded in 1908 and is an editorially independent newspaper that serves the wiccan gods University of South Carolina. The newspaper is blc pension, renowned for quality content and in 2011 was featured by the Princeton Review as a “Top 20 School Newspaper.” 13. The Independent Florida Alligator, University of philosopher locke Florida.
The Alligator was founded in blc pension, 1906 as The University News, which was an Essay on Child Through, independent, student-owned newspaper created to serve the University of Florida when it opened in Gainesville. Blc Pension! In 1912, the newspaper became a part of the University of philosopher locke Florida administration, and blc pension was renamed the Florida Alligator. h212. The Daily Kansan, University of Kansas. The University Daily Kansan is an editorially and financially independent student paper serving the University of Kansas. It was founded in 1904. Its distribution is currently only within the university’s campus. It is of loneliness, published daily during the spring and fall semesters and blc pension weekly during the summer months. Its circulation is about 12,000.The Kansan also includes a weekly lifestyle magazine named Jayplay. Its online counterpart, Kansan.com, began operation on the Web in Fall 1996.
Originally called the UDKi (for interactive) it adopted the naming convention of its parent publication three years later. 11-10 (tie) The Daily Cardinal, University of Wisconsin, Madison. In print since 1892, the Daily Cardinal has been a source of news for the University of symbol Wisconsin-Madison students. From the blc pension tragic and personal news of a student death to the national opinion coverage of gun control, the wiccan gods Daily Cardinal reports on it. 10-11 (tie The Badger Herald, University of Wisconsin, Madison.
The Badger Herald was founded in 1969 by a group of blc pension four students seeking a conservative alternative to the UW–Madison’s primary student newspaper, The Daily Cardinal, which editorialized against the Vietnam Ware and had close ties to leaders of the radical campus protest movement. The Daily Cardinal would later become more moderate in response to wiccan gods, pressure from local media, the UW Board of Regents, staff members leaving, declining advertising revenue, and the radicalism of the 1960s and early 1970s dying down around the country. 9. The Daily Tar Heel, University of blc pension North Carolina, Chapel Hill. Launched in 1893, The Daily Tar Heel noq circulates 18,000 free copies to more than 200 distribution locations throughout campus and in the surrounding community – Chapel Hill, Carrboro and Durham. Its estimated print readership of 38,000 makes it the largest community newspaper in Orange County. The student journalists are solely responsible for all content under the direction of the wiccan gods student editor-in-chief.
The 2014-16 editor is Jenny Surane. A new editor is selected each spring and serves for one year. 8. The Daily Athenaeum, West Virginia University. The Daily Athenaeum is West Virginia University’s award winning daily newspaper. For 127 years, The Daily Athenaeum has been the voice of the Mountaineers. It is published Monday-Friday and is the 11th largest circulation newspaper in the state of West Virginia. This newspaper is blc pension, staffed entirely by students with supervision from wiccan gods, a set of six full-time staff employees. 7. The Tufts Daily, Tufts University. The Tufts Daily, known on campus simply as The Daily, was first published on February 25, 1980. The paper covers news, arts and sports both on campus and in the Boston area and blc pension allows members of the Learning Through Play Tufts community to blc pension, submit op-ed pieces about any campus or global issue. Unlike other student organizations and publications at Tufts, the Daily is financially self-sustaining, and does not receive funding from the student activities fee.
During the Daily’s first two decades, it was engaged in competition with a weekly campus newspaper, the Tufts Observer. Essay Background Mission! The two newspapers co-existed until 2001, when the Observer changed to a biweekly newsmagazine format. 6. The Daily Collegian, Penn State University. Forgive my prejudice, but half the writers I know either worked at the Daily Pennsylvanian (U. of Penn) or The Daily Collegian, a student-operated newspaper that is published independently at Penn State University. Blc Pension! The newspaper is printed on weekdays during the of loneliness Fall, Spring, and blc pension second Summer semesters.
It is distributed for free on campus. As of 2010, the off-campus cost for the english patient summary, a copy of the newspaper is 30 cents. The mission statement of Collegian Inc. is “to publish a quality campus newspaper and to provide a rewarding educational experience for the student staff members.” 5. Blc Pension! The Maroon, Loyola University New Orleans. Since 1923, the wiccan gods publications of the Loyola Student Media have worked to serve “A Greater Loyola.” That was the mission laid out by founding editor Harold A Dempsey, and blc pension that is the goal of the student journalists who work long hours and Essay Play late nights producing The Maroon, The Wolf, The Maroon Minute and The Maroon Online. Student-run, student-produced and blc pension student-managed, the publications within the Loyola Student Media serve both as a community news outlet for Loyola University, and as a learning laboratory for aspiring young media professionals. 4. The Daily Bruin, University of California, Los Angeles (UCLA)
A great college newspaper. When classes are in session, the Bruin is Essay Child Through, published Monday through Friday during the school year, twice a week during finals week, and once a week on blc pension Mondays in the summer quarter. The Bruin’s staff also publishes Prime, a quarterly lifestyle magazine. The DB is overseen by the ASUCLA Communications Board, which sets policies for the newspaper and other campus communications media. The Daily Bruin editorial team has 13 editorial departments: news writing, sports writing, arts entertainment writing, opinion writing, news radio, graphics reporting, blogging, online development, video journalism, copy editing, photojournalism, page design, and cartoon and illustration. 3. The Cornell Daily Sun, Cornell University. The Cornell Daily Sun was founded in 1880 and about 2011 Essay is independent from the university. Kurt Vonnegut was the associate editor in 1944 and the paper is blc pension, published Monday through Friday. 2. The Daily Orange, Syracuse University. A fertile ground for some of the wiccan gods best journalists in America. This newspaper began in 1903 and went independent in 1971.
They have a readerships of blc pension 20,000 and publish 117 issues a year. 1. The Yale Daily News, Yale University. Founded January 28, 1878, the Yale Daily News is the nation’s oldest college daily newspaper. The News now publishes Monday through Friday during the academic year and serves the philosopher communities of blc pension Yale University and New Haven, Connecticut. In addition to on Child, the daily newspaper, the News publishes WEEKEND, a Friday supplement with reviews and blc pension articles about arts and culture, and Sports Monday, a Monday section providing expanded, in-depth sports coverage.
The News also publishes several special-occasion issues every year, including the Parent’s Weekend issue, the Harvard-Yale Game issue, the Freshman issue and the Commencement issue. The News is produced by a very dedicated, all-volunteer undergraduate staff. Most reporters are freshmen and on Play sophomores, while the editorial board is mainly comprised of juniors. The News is the primary division of the Yale Daily News Publishing Co., which is headed by the News’ editor in chief and its publisher. In addition to the daily newspaper, the YDN Publishing Co. produces the monthly Yale Daily News Magazine and the Insider’s Guide to the Colleges.
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Farm business and financial planning. Business plans, account management, benchmarking and planning for blc pension, farming businesses. If you run a farm, there is a wide range of 2011 Essay, advice available to blc pension you, including how to write a business plan, run your accounts, benchmark your business and plan your future activity. This guide explains where you can find specialist business and financial support to help you run your farm as efficiently as possible. There is also information on business and financial planning tools available to you, as well as information on the standards and Essay on Learning, schemes that you must comply with. A good business plan gives credibility to your farm, and to your skills as a farm owner or manager. Even if you do not intend to blc pension make any changes to symbol of loneliness your farm, you should still write a business plan. A good farm business plan can highlight weaknesses in how you plan and blc pension, run your farm, which can provide helpful insight for later improvements. Before writing a business plan, it is advisable to thoroughly research the sectors that you are currently working in - or plan to work in Essay on Play - including any future economic prospects for these sectors.
You should also familiarise yourself with the relevant regulations for your business. When writing your business plan, consider including: your short-term and long-term aims a timescale for achieving your aims who will be involved how you will manage the money. It may also describe your farm’s unique characteristics, for example, its: location soil type management eg whether it is family run. Most business plans contain: financial forecasts your marketing and sales strategy information about blc pension your management team and Essay of the Body Shop Global, staff an operations plan.
Financial forecasts should show what you predict will happen to blc pension your business financially when you implement your new plan. For example, you should think about: how much external funding you may need what you can offer as security against loans - if needed how much income you are expecting what your expected profits and losses will be. Your financial forecasts should include a cashflow forecast, and projected profit and loss account. The operations plan is a description of the farm itself, and how it is run.
It can include details about: the land, buildings and symbol, facilities equipment, vehicles and blc pension, machinery used on philosopher the farm materials and supplies what is produced and when plans for blc pension, new facilities any environmental assessment plans, eg for soil conservation or to symbol of loneliness improve water quality relevant regulations and licences. It may also be useful to prepare an executive summary - a synopsis of key points from your entire plan and a short description of blc pension, your business opportunity - for presenting to third parties such as your bank, potential investors or suppliers. Adapt an existing farm business plan. Changing circumstances may prompt you to Our Story the Flooding Essay adapt your existing farm business plan. If you are looking for a new source of funding - eg through the Rural Development Programme for England - you may need to blc pension consider adapting the way your farm is Essay Learning Through Play, run. Even if your current farm business plan is successful, you should always consider reviewing it for blc pension, possible growth opportunities and improvements to farming operations. For more information on growth opportunities and patient summary, changing farming operations, see the guides on ideas and funding for diversification and ideas and funding for diversification. When adapting your existing farm business plan, you should think about: Your goals - what do you want to achieve by reviewing your plan?
For example, do you want to increase your profits, or be eligible for certain payments? What changes you want to make to your business - for example, bringing in blc pension different livestock or plants. Locke. How to best make these changes to your farm. How you will carry out this change and at what cost? Any financial implications of this change - and how long will it take you to make a profit? How long the changes will take you to blc pension implement. Of The. Potential risks - financial or otherwise - to your business.
Once you have finalised the changes to your business plan, you should then test whether the plan is possible. You can then work out whether you have enough resources, you can meet the demands, and whether your new plan is realistic. Financial figures: assess the viability of your farm business. One of the major roles of the Defra is to help the farming industry operate as efficiently as possible. Defra publishes a range of guides to help you get started in farm management accounting. The first of these covers how to use your farm accounts to assess your financial situation. Blc Pension. This booklet is an important first step in helping you to understand what your accounts tell you about the english patient summary your farm’s viability, and blc pension, how to make better use of Essay Body Shop, that information. In order to be viable, your farm needs to generate enough income to cover: money you draw for your own use tax re-investment repayments on borrowing. Defra ’s booklet shows you how to use your profit-and-loss account and balance sheets to assess the viability of blc pension, your business. It guides you through the principles of basic accounting, explaining terms and giving examples of Essay of the Mission, how to enter figures into your accounts.
Knowing how to interpret these figures is key to managing, budgeting and planning the future of your farm business. To make the best use of the booklet, it will help to have a copy of blc pension, your latest farm accounts. Financial figures in wiccan gods whole farm planning. Once you have assessed your farming business and its success, you may consider making changes to blc pension the way your farm operates. Summary. Your decisions - and blc pension, those of potential lenders - will be based on the english the financial figures you have drawn up for your business. Defra has published a booklet on blc pension mapping out the future of your farm, which provides guidance and information on using financial figures in the english patient summary your overall farm business plan. This booklet will help you to:
make partial and major changes to your whole farm business make changes to your business planning documents yourself reflect risk, feasibility, viability and future performance in your financial figures in blc pension order to determine whether changes will help to make your business more profitable. Plan a partial change to your current system. You can also use your financial figures to work out whether partial changes to your farm system will enhance your profitability. There are several steps to this process: decide on goals - eg increasing production or profitability make a list of the changes you could make to achieve these goals outline the strengths, weaknesses, opportunities and threats in your plan make a complete list of the the english summary resources you will need to achieve your goals use a profit and loss table to calculate the financial gain versus the blc pension cost of these changes determine the effect your changes will have on cash flow quarter by of loneliness quarter evaluate the risks involved in your project and whether you can reduce them. You should try to write down as much information as possible as this will help you to develop your plan and share your ideas with others.
At each stage, take time to ensure you have included every possibility. Convert your farm’s financial accounts into management accounts. Financial figures are vital to blc pension running any farm, but they can be much more useful to you if you convert them into on management accounts. The third booklet in the Management Accounting for Farmers series published by Defra is a step-by-step guide to blc pension converting your figures into management accounts. Working through the guide will help you to understand your business more clearly and will equip you to deal more effectively with your bank, accountant and wiccan gods, farming business consultant. This practical guide looks at: the terms used in financial and management accounting how profit and loss accounts are structured in blc pension management accounting using the profit-and-loss accounts and wiccan gods, balance sheet as management tools why stock appreciation and herd depreciation are important for livestock farmers. Using benchmarking tools will allow you to compare your results with those of other similar farm businesses. This helps you to find out how your business is performing compared with farms of a similar size and type, and in blc pension turn will help you identify areas for improvement. Farm benchmarking is an online tool from Defra . Child Play. You can use it to compare your farm with other farms in blc pension Defra ’s Farm Business Survey and with farms in similar surveys in other European Union countries.
Farm business benchmarking lets you compare your: financial data with farms of a similar type and wiccan gods, size performance in terms of revenue, cost and profit business results with average or above-average farms. The tool is based on Defra ’s annual Farm Business Survey. This survey gathers information from farmers and growers each year about various aspects of their business. The tool will also help you decide if there are areas of blc pension, your business that could be improved - eg by reducing costs or increasing output. You will need up-to-date financial accounts in order to use the tool. Our Story Essay. For more information on farming accounts, see the section on blc pension using financial figures to the english summary assess the viability of blc pension, your farm business. The Red Meat Industry Forum (RMIF ) has set up local Farm Business Clubs, which give access to a specialist benchmarking service for red meat producers. Registering for the online RMIF benchmarking service will allow you to compare your farm’s physical and financial performance against those of other club members or other groups. Milkbench+ is an independent service to symbol of loneliness help milk producers calculate their net margins on milk, and work out how well their business is performing compared to other producers. Cross compliance requirements for farming businesses.
Cross compliance requires you to observe two main sets of regulatory standards in your farming business: Statutory Management Requirements (SMRs ) for environmental, public, plant and animal health, and animal welfare requirements to keep your land in good agricultural and environmental condition - with specific reference to blc pension soils and maintaining a variety of habitat and landscape features. To find out more about cross compliance, see the guide on cross compliance: the Essay on Child basics. The Rural Payments Agency may inspect your farm more than once a year to check your farm, records and other documentation, as part of their cross compliance inspections. You must comply with cross compliance requirements to qualify for: project funding under the Rural Development Programme in England Single Payment Scheme (SPS ) funding any other direct farm payments, such as Environmental Stewardship payments from Natural England. Cross compliance and business planning. You must ensure that you consider cross compliance requirements when creating a farming business plan, including: how your SPS payment could affect your profits, losses and income whether meeting SMRs would affect the financial aspects of blc pension, your plan - for example, you may need to budget for Essay on, the identification or registration of livestock how your business plan would be affected if you don’t meet cross compliance requirements and therefore do not receive your Common Agricultural Policy payments. All cross compliance payments are subject to meeting specific criteria.
You should not rely on blc pension these payments in your business plan, or include them as guaranteed finance. The Farm Advisory System advises farmers about cross compliance. For further information, you can call the of loneliness Cross Compliance Helpline on Tel 0845 345 1302. Organisations dealing with farm financial planning. There are several organisations that can offer support and advice to farmers about farm financial planning. You can also use this site to find out about regulations, licences, standards and trade bodies relevant to specific business sectors, for example: arable cattle sheep and goats pigs poultry fish farming beekeeping other animal farming, eg game or pets farming support services. Find out how to comply with all the regulations and blc pension, licences that apply to you in the section on your business sector. The Department of Environment, Food and Rural Affairs (Defra ) administers European support policies that provide around ?3 billion to UK agriculture.
It also oversees a number of agencies that work with arable farmers, imports and exports of summary, crops and implement pest and disease controls. You can call the Defra Helpline on Tel 08459 33 55 77. The Carbon Trust provides interest-free loans of between ?3,000 and ?20,000, for blc pension, farmers in England to upgrade to more energy-efficient equipment. These loans are designed to pay for themselves, over a period of up to four years, through direct energy savings. You can find out about interest-free loans on the Carbon Trust website. The Rural Development Programme for Essay on Child Learning Through, England 2007-2013 (RDPE ) is jointly funded by the Government and the EU.
Under this scheme the government will allocate a total of ?3.3 billion to agri-environment and other land management schemes. The introduction of the blc pension RDPE has changed the way payments are made under the wiccan gods Environmental Stewardship and Energy Crops schemes. In England, the Farm Advisory System advises farmers about cross compliance. Blc Pension. For further information, call the Background Shop Cross Compliance Helpline on Tel 0845 345 1302. Alternatively, find information on cross compliance requirement on the Cross Compliance website. The National Farmers’ Union (NFU ) represents the farmers and growers of England and blc pension, Wales. It aims to of the Body Shop Mission promote successful and blc pension, socially responsible agriculture and horticulture, while ensuring the long-term viability of rural communities. Natural England is an philosopher locke, agency of Defra . It administers a programme of financial incentives for farmers and land managers, aimed at protecting and blc pension, enhancing the natural environment. These include: the Environmental Stewardship scheme cross compliance requirements land management wildlife management and licensing Countryside and Rights of Way Act.
Defra also makes grant funding available to certain woodland projects under the English Woodland Grant Scheme (EWGS ). These are administered on Essay Child Through behalf of Defra by the Forestry Commission. Published: 11 September 2012. Updated: 13 June 2013. 13 June 2013 Fixing references to blc pension specialist guides 11 September 2012 First published. All content is available under the in January Essay Open Government Licence v3.0, except where otherwise stated.