Wednesday, February 6, 2013

anxiety disorder test

There are many situations that cause anxiety, but there are some, such as public speaking, have a job interview or examination, in which a large percentage of people with high levels of anxiety. Generally no one likes to be evaluated, the connotation of "judgment" involved any review, makes people who have to submit to it not usually be comfortable. All students feel anxiety when they have to take an exam, in fact this is one factor that motivates them to study. There are different levels of anxiety ranging from mild nervousness or restlessness nervousness up that can make us feel paralyzed.

It has been shown that students who experience high anxiety about examinations suffer from a significant decline in performance, tend to defer study or pay and get lower scores than if they were able to manage their anxiety, even getting ready properly ,
It is estimated that approximately 15% and 25% of students have high levels of test anxiety.
The causes of anxiety about exams can be related to external factors such as the type of examination forms of study, time management study, the number of reviewers, or personal factors that are related to the assessment and personal meaning students do on the state exam. So the same situation review, different students taking different valuations make a wide range of reactions, including anxiety would.
The anxiety about exams is manifested in four ways and in different degrees and forms. Are four areas affected:


Gastrointestinal symptoms.
Frequent urination.
Increased or decreased appetite.
General tension.
Shortness of breath and chest tightness.

Fear of failure.
Fear paralyzed.

Stuttering and / or difficulty speaking.
Nervous tone.
Insomnia and / or difficulty sleeping.
Increased consumption of snuff, drugs and / or alcohol.
Avoidance behaviors and / or flight.

Difficulty concentrating.
Feeling confused.
Phenomenon blank mind.
Concern for performance.
Concern about the negative consequences of failing.
Concern for the physical sensations.

A cognitive or mental anxiety begins to activate early when the student begins to worry about the exam. The types of concern that students often have high levels of anxiety are related to negative expectations about one's performance on the test ("If I stay with a blank mind, I disapprove"), the negative consequences of failing ("If you disapprove, do not get the job I want"), to concerns about the possible emergence of physical sensations ("If I decompose, I can not finish"), managing time ("I do not reach the time") and the judgment of others ("If I do not pass, they will think I'm useless").
Such concerns may occur before or during the examination, interfere with the resolution of the task and produces a lower yield than expected, as well, avoiding the study or examination, obtaining temporary relief.

A very common phenomenon is related to test anxiety is procrastination. Many students, postpone the exam or "leave for the next date" by the anxiety that generates them having to go through a test or to study. Procrastination is the tendency to postpone the study or examination caused by excessive anxiety, fear of failure, perfectionism ("If not all, I do not show"), anticipation and expectations catastrophic proportion. The person feels intense anxiety postponed by merely thinking about what to do, then resort to avoidance calming, obtaining temporary relief. But the delay has devastating consequences when the problem becomes chronic dropouts chances are career or academic failure, not because the person is not capable, but because this bad habit to believe that one is good for studying.

People who suffer from test anxiety may see their performance deteriorated, too, by the problems of storing and organizing information as problems in retrieving stored information.
There are students who use good study skills and that despite this, at the time of recall or retrieve that information suffer the "phenomenon of mind blank", caused by anxiety. The person focuses attention on internal aspects (such as negative thoughts) or physical sensations rather than the resolution of the task or the exam, reducing their test performance. On the other hand, the anxious student may have difficulty studying, storing information superficially, presenting problems to select the most important aspects of information, because ineffective study strategies. This causes perceived lack of preparation or insecurity that increases your anxiety when held.
In our clinical experience in treating people with anxiety problems, we note that 70% of people with an anxiety disorder, also suffer from moderate to severe anxiety before exams. In fact the situation in anxiogenic exam is for those suffering from an anxiety disorder and those who do not suffer. For a person with social phobia, a fear of being negatively evaluated by others or you notice your nervousness, can be difficult for the fact an exam, especially if oral and more than one evaluator. Indeed, 50% of patients with social phobia have chronic postponements of examinations. And many of them have abandoned and retaken several times the race. Other people with anxiety disorders such as OCD sufferers have great difficulty when filing multiple choice type tests, as well as studying, by increasing interference rituals, doubts and obsessions, which prevents them from the appropriate concentration.

There are people who tend to be perfectionists and worry excessively, as people suffering from Generalized Anxiety Disorder, and others who fear breaking when an exam, and those who suffer from panic disorder. In our clinical experience, we observed that 44% of patients who consult us have a tendency to avoid the examination situation, so we have developed treatment strategies using specific techniques for each type of student, training in the management of test anxiety with successful results.
The coping strategy is customized and testing arises according to the type of difficulty with the students.

The treatment of this problem consists in training the management of anxiety, which are used for relaxation techniques, techniques to achieve adequate control of worry and thought restructuring techniques are also used techniques for managing time and organization of the study material.

Monday, February 4, 2013

treatment for panic attacks

treatment for panic attacks 

The cause is unknown, although genes may play a role. If one identical twin has the disorder, the other twin will also present the condition 40% of the time. However, panic disorder often occurs when there is no family history.

Panic disorder is twice as common in women than in men. Symptoms usually begin before age 25, but can occur at age 35. Although panic disorder may occur in children, is usually not diagnosed until they are older.

A crisis or panic attack starts suddenly and often peaks within 10 to 20 minutes. Some symptoms may continue for one hour or more. A panic attack can be confused with one heart.

Panic attacks may include anxiety about being in a situation where escape might be difficult (like being in a crowd or traveling in a car or bus).

A person with panic disorder often lives in fear of another attack and may be afraid of being alone or far from medical help.

People with panic disorder have at least four of the following symptoms during an attack:

Chest pain or discomfort
Dizziness or fainting
Fear of dying
Fear of losing control or impending doom
Feeling of choking
Feelings of separation
Feelings of unreality
Nausea or upset stomach
Numbness or tingling in hands, feet or face
Palpitations, rapid heart rate or pounding heartbeat
Sensation of shortness of breath or smothering
Sweating, chills or hot flashes
Trembling or shaking
Panic attacks can change the behavior and performance at home, work or school. People with this disorder often worry about the effects of your panic attacks.

People with panic disorder may have symptoms of:

Panic attacks can not be predicted. At least in the early stages of the condition, trigger no attack begins. The memory of a past attack may trigger panic attacks.

Exams and Tests
Many people with panic disorder first seek treatment in the emergency room, because the panic attack feels like a heart attack.

The doctor will perform a physical exam, including a psychiatric evaluation.

Blood tests will be done. It must rule out other medical conditions before a diagnosis of panic disorder. Also must be considered drug-related disorders, because the symptoms can mimic panic attacks.

The goal of therapy is to help you function well during everyday life. A combination of cognitive behavioral therapy (CBT) and medication works best.

Antidepressants called SSRIs (selective serotonin reuptake inhibitors) are the most commonly prescribed medications for panic disorder and include:

Fluoxetine (Prozac)
Sertraline (Zoloft)
Paroxetine (Paxil)
Other SSRIs
Other drugs that may be used include:

Other types of antidepressants, as inhibitors of norepinephrine reuptake inhibitors (SNRIs).
Anticonvulsants for severe cases.
Benzodiazepines, including diazepam (Valium), alprazolam (Xanax), clonazepam (Klonopin) and lorazepam (Ativan) can be used for a short time.
Monoamine oxidase inhibitors (MAOIs) are used only when other drugs do not work, because they can have serious side effects.
Your symptoms should improve slowly over a few weeks. Talk with your doctor if this does not happen. Do not stop taking your medication without telling your doctor.

Cognitive behavioral therapy helps you understand their behavior and how to change them. You should have 10 to 20 visits over many weeks. During therapy, you will learn how to:

Understanding and Managing distorted views of life stressors, such as the behavior of others or the facts of life.
Recognize and replace panic-causing thoughts and decrease the sense of helplessness.
Managing stress and relax when symptoms occur.
Imagine the things that cause anxiety, starting with the least feared. Practicing in a real life situation to help you overcome your fears.
The following may also help reduce the number or severity of panic attacks:

Eat at regular times.
Exercise regularly.
Get enough sleep.
Reduce or avoid caffeine, certain medications for colds and stimulants.
Expectations (prognosis)
Panic disorders can be long lasting and difficult to treat. It is possible that some people with this disorder is not cured with treatment, but most improvement with a combination of medication and behavioral therapy.

Substance abuse can occur when people who have panic attacks is to face your fear consume alcohol or illicit drugs.

People with panic disorder are more likely to live unemployed, to be less productive at work and have difficult personal relationships, including marital problems.

Agoraphobia is when fear of future panic attacks leads someone to avoid situations or places that are thought to cause the attacks. This can lead a person to put extreme restrictions on places where it goes or who is around. See: Panic disorder with agoraphobia

Anxiolytics dependence is a possible complication of treatment. Dependence involves needing a medication to function and to avoid withdrawal symptoms. It is not the same as addiction.

When to Contact a Medical Professional
Make an appointment with your doctor if panic attacks are interfering with your work, relationships or self-esteem.

If you have panic attacks, avoid the following:

Stimulants such as caffeine and cocaine
These substances may trigger or worsen symptoms.

Thursday, January 31, 2013

Social concerns and attitudes usually feared



The problems begin about three or four years by communication difficulties. There is a shyness with adults and other children. The child fled the confinement or contact instability. The anguish of separation from the mother are part of an ambivalent and sometimes hate. The father is not present and the child tries to avoid it. There may be significant and uncontrollable anxiety that manifests itself in night terrors various fears. Found inadequate educational attitudes and malicious.

Later, around school age appear like symptoms that are actually phobic fears related to archaic mechanisms. There is no intellectual impairment and learning outcomes are not disturbed. Aggression and jealousy are strongly present at this age and occur vis-à-vis the siblings or classmates. These children are unhappy with their grades in school, the attitude of parents and educators, they consider unfair to them. Insignificant facts are magnified and blown up.

In adolescence, the stiffness begins to manifest itself. These are young people complying with strict regulations, not admitting contradiction. Authoritarian and tyrannical vis-à-vis their peers, they profess strong opinions and irrefutable adopt political causes with fanaticism. The downward trend increases. Relationships with others, especially the opposite sex are difficult and conflicting. These young people demonstrate a moralism outrageous. They hide behind religious beliefs, rigid principles.

The paranoid style is manifested in adulthood and it becomes quite easy to spot, because the clinical features are marked.


The subject is likely, he has a hard character, authoritarian, and sometimes delirium.

Some traits are characteristics: pride, distrust, susceptibility, stiffness, unrealistic and false judgment. The paranoid is proud and sometimes contemptuous of others, because he considers himself superior. Aggression is important indirectly expressed by a hint of contempt, or directly as about unpleasant insults. Distrust and suspicion are systematic. The subject is expected to diminish, or other exploit and always feared an attack from them. He questioned the honesty and loyalty of his family, he is almost always jealous.
The paranoid feel easily despised, he fears that he disrespect and sometimes imagine when this is not the case. Likely, it is intolerant remarks and criticisms. Disagreement, an unfavorable judgment of others, triggering anger and resentment. Prestige and social titles, filiations famous real or fictional attempt to compensate for this weakness. The paranoiac is rigid and self-criticism. Hard with himself and with others, he has unwavering opinions. The journalistic term "groupthink", is well suited to describe his way of thinking: it is the only one able to exist and everyone should join. At no time the subject can take a critical distance from him. For the paranoid, the world is obviously and immediately as he thinks.

Lines and relationships

The paranoid gives meanings to behaviors that do not, it casts doubt on others and idealizes a false judgment characteristic. This leads to inappropriate attitudes to the situation raise perpetual conflict. Despite a first glance remote tension in the relationship is fast.
The activity of the individual is normal and sometimes important. It may even have a social success as spectacular adaptation of paranoia is often excellent. It disappears only when it is invaded by delusional concerns. In the usual hierarchical relationships, it is hard to inferiors, respectful and obsequious to superiors, and competing aggressively with peers. It seeks to dominate and move up the hierarchy. The subject can seriously harm and without remorse to those he considers his enemies or rivals (for slander, premeditated vengeance).

Sexualized as a referent object, the other is seen as very different days. It is sometimes perceived as being very good and ideal, sometimes completely wrong. There is little regard for its own characteristics. There is also a desire for omnipotence which is to control, manipulate, use, object-referent. The relationship is burdened by jealousy.

Rationalism and delirium

Rationalism is powered by constant interpretations. It implements a dogma argued by an avalanche of arguments and reasoning assertive entirely at the service of the premise. The themes are ideological, political and social (social protest, racism, death penalty) or relate to the environment (neighborhood, spouse). Rationnalisantes these trends are sustainable. The facts are interpreted, writhe about to give a convincing demonstration.

Rationalism sometimes turns into a frenzy as the dogma becomes constant and unwavering. These delusions can soothe and resume spontaneously or become chronic. They occur in middle age, around 35 to 40 years. Delirium is a delirium sector, systematic, credible and convincing. It feeds interpretations (as fact, such a word, take an obvious meaning for the paranoid) and intuition (immediate sense idea that confirms delirium)

The delusional accumulates facts and evidence, and ruminates constantly nourishes sentiments of hatred against the plunderers. He devises plans to confuse revenge. Crossing the act related to delirium may take various forms: procedure assault to murder, separation from spouse. The passage to the act is the application of delusions and follows the feeling of growing hostility in the world, especially persecutors.

¤ Delusions of claim relate to neighbors, family, entrepreneurs, doctors, employers. This delusion can take the form of pessimism. After an accident, the paranoid claiming compensation, disability pension or annuity. Harasses social security experts responsible for the accident, lawyers, doctors. In the delirium of persecution the patient is convinced that a conspiracy was directed against him. Any word or act outside is interpreted according to the delirium that can lead to violent acts.

¤ Delusions of jealousy for the spouse or an acquaintance. Every look, word, or delay, is interpreted as evidence of infidelity. This is often the spouse who is desperate request. Erotomaniac delirium usually reaches a woman who feels loved by a third party (often a high social rank). The starting point can be a look, a word, etc. ... Then the delirium and organizes the patient builds a story in which she is courted.

¤ Other delusions have organized the theme of politics, religion, justice. Political extremism in recruiting willing paranoid.
For details on these delusions, see § "systematized delusions" in the article on psychotic decompensation in.
The evolution

Middle age brings little change for the paranoid. Traits are accentuated, become stiff and freeze. The trend is the same delusional. In old age, the decline of intellectual faculties gives free rein to delirium at the same time it makes it less convincing and less developed.


The central problem

Difficulties arose around the time of individuation. The object is split into two objects archaic omnipotent, good and bad and there is a prevalence of bad object. The relation to the other as object-referent is dominated by fear and hatred. The relation to the other is not stabilized by law and therefore persecutory fantasy is always ready to emerge and the projection is greatly facilitated.

Defensive reorganization occurs during the second structure. Defense mechanisms like control, retention, désafectisation, ritualization, powerful, erected a bulwark against anxiety archaic. Remote control and are used to counteract the lack of separation from the other. Because of overinvestment anal stage, the homosexual tendency is strong, but it is still suppressed.

Arrived at adulthood, is so fragile, aggressive impulses are important defense mechanisms of projection type predominate, there is a deficiency in the function réalitaire. The ego is weak, the superego and the ideal keep an archaic form. The libidinal fixations are not in the foreground, but the anal and homosexuality strongly tinged character.
Place of the subject in Scheduling human is not ignored, but it is uncertain which gives rise to a claim research and intense search for a site compensatory social (valuing prestigious positions) or even a genealogical research delirious descent.
Father and archaic superego

The paternal function and relationship to the law is distorted. There is a lack of integration in the sense of well-tempered assimilation rules. In its place there is an overvaluation of the paternal imago, poorly differentiated and omnipotent. The ideal and the superego are archaic related to this imago and invested by the deadly instincts. They are the custodians of an arbitrary order powerfully idealized producing totalitarian demands. This set forms a rigid binding instance archaic fed a parental imago very powerful and terrifying. It causes the "groupthink", which it is not possible to derogate for instance invades psychic functioning and I can not play any regulatory role. On the other hand waive subject to sanctions terrible and cause enormous stress.

Narcissistic disorder

Primary narcissism and relationship to the world organize themselves pathological. The existence, the sense of being, as is the independence from the mother, but in a defensive manner, as hateful aspects dominate the libidinal aspects. Relation to the world is organized in a hostile fashion. The child, not having a good protective idealized object, is organized defensively against other always suspected of being hostile. Empowerment is based on a decline and stabilization hate narcissistic remains uncertain. Primary narcissism is a defensive expensive furnishings.

Concerns and wacky themes can all be related to a narcissistic injury. - Harm: The subject feels that he is injured in an existential sense. It will seek to show harm in looking for all occasions, whether practical or moral. Jealousy is also in this vein: the subject thinks that her husband is cheating, but it is especially wrong. - The size unknown: The paranoid safe value and superiority think it is despised. In all cases is, he feels that his being and value are basically attacked ... which is just about psychopathology. He will try all his life bearing on the mode of delusional projection the original narcissistic wound.

Dominates the projection

Delirium is a decline in function réalitaire, but also the importance of projective mechanisms for adaptation to reality is far from being compromised. It is sometimes put at the service of delirium. The initial intuition is made by any concerns of the paranoid. The projective mechanism psychotic tendency specific topic is assigned to another project in general aggressive: he does not like me, he wants to hurt me. The contribution of delirium secondary benefits: Finally there is evidence of injury. The contradiction between certain damage but nonexistent subsides and more aggressive impulses are finally expressing themselves. Delusional themes refer to the narcissistic injury compensation and its megalomaniac.

Psychotic projection is a defensive mechanism archaic. She is steadfast and very specifically for an active tendency of the subject and immediately placed him outside in what is the reality for him. The psychotic plans which belongs to him and he can not recognize. Moreover, the mechanism generates absolute conviction. In jealousy is the homosexual tendency and projected that, in the persecution is the sadistic streak. We see that the function is not abolished réalitaire is how I use it to change: it is more the offsetting change in the fantasy, it is put to its service. Moreover, the judgment of attribution fail: the outcome of this trend can be recognized and attributed to himself, so it is assigned to what is outside oneself (to others or reality in general).


Sensitive form

Paranoia itself generates intermediate sensitive to the shape distanced we'll see then. The term comes from Kretschmer who described three types of paranoia: the paranoid combat, paranoid and paranoid sensory desire. Kretschmer invented this clinical form after connecting the character "sensitive" to paranoia. Sensitive form is characterized by a milder character, a female and sometimes delirium network. This is an opportunity to pay tribute to the author who first connected the character and all of the subject's life at critical moments (crazy). It is the precursor of the idea of ​​decompensation.

Sensitives are sensitive to the reactions of others, easily hurt, fleeing the contact. Fear leads to the establishment of a distance from others, perceived as hostile, which provides a protective search. The subject is on the alert, fearing not to be respected, to be attacked. Without feeling persecuted frankly, these topics have the impression that cares about them in a way that is excessive in their eyes and not caring. Generally dominates inhibition timidity relationship difficulties. The person has a sense of fragility and weakness. She fears not know how to answer, do not know how to fight. She sees herself as superior while having a sense of inferiority one self-deprecation. There is a mixture of pride and humility. Something painful enough to trigger delirium (a look unpleasant, a haughty attitude, a little prejudice).

On a theoretical level we can say that aggression is weaker and tends to turn against itself. Characterological defenses are less pronounced. Failure to meet the requirements of the ideal body archaic superego mixed and impose them on others results in a return of aggression against self and depressive tendency. On the other hand, these requirements exhausted by their binding. Sensitive paranoia can be considered as a transition with psychotic distanced form.

Paranoid type reactions

Sometimes you see these symptoms and traits appear transiently in other psychotic personalities or boundaries. This is called paranoid reaction. In cases of paranoid reactions, there are often circumstances triggering real (prejudice, rudeness, etc.).. They lead the certainty of having been prejudiced or misled. It follows will repair and revenge. The desire for revenge triggers different behaviors of claim whose commitment procedures to the authorities for redress. This way of reacting is favored by chronic poisoning cannabis poisoning and acute amphetamine or cocaine.


The applicants are not paranoid care on the psychic plane. There are not psychotherapy and if by chance it was the case, it would not be because of the indiction projective mechanisms that would hinder it. The psychiatrist usually meets paranoid during treatments somatic delusions or severe requiring hospitalization or circumstances after expertise crimes.

It must be very cautious and do not give rise to interpretations, which is sometimes impossible. The words to the paranoid must be very explicit and free of jokes or double meaning. It is useful to protect themselves using all possible legal and institutional guarantees: scrupulous procedures, safety rules. It may be helpful to be accompanied by another caregiver.

In forms delusional dangerous it is sometimes useful to use the police and the judiciary. It is a rare occasion that paranoids are psychiatric inpatients either HDT or by HO. Neuroleptic treatment can temporarily alleviate aggressive and reduce delirium. The paranoid is generally believed that hospitalization is abusive. In it, he tries to alert the public and the authorities, and after he tries to initiate a procedure vengeance.

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