According to several epidemiological ...

According to several epidemiological studies of older age groups (65 and older), up 35% of the elderly and the elderly exhibit the problems associated with sleep. Dissatisfaction with sleep is seen in 25% of men and 50% of older women. More than 25% of patients late age regularly or frequently use sleeping pills. Sleep disturbance is one of the factors in assessing the quality of life for the elderly. The main manifestations of sleep disorders in the elderly: persistent complaints of insomnia, persistent difficulty falling asleep, interrupted sleep surface and, the presence of bright, multi-dreams, sometimes painful content, early awakening, a sense of anxiety of anxiety upon awakening, difficulty or inability to sleep again, lack of feeling of rest from sleep. Elderly patients with disorders dissomnicheskimi awaken frequently during the first hours of sleep, more anxious, tend to exaggerate the duration of sleep and underestimate the duration of sleep. The main causes of sleep disorders in the elderly and the elderly in later life is most often recognized as multifactorial nature of sleep disorders, the interaction of psychosocial, medical and psychogenic factors in combination with organic brain dysfunction. However, modern classification of sleep disorders provides their division into primary and secondary. To primary sleep disorders in the elderly are nocturnal myoclonus, nocturnal leg restlessness, and sleep apnea (breath holding during sleep and subsequent awakening). It should be noted that sleep apnea is generally more characteristic of old age or becomes more frequent with age. Usually this is preceded by a long period of snoring in his sleep, and then joins apnea. It is well known that this syndrome is observed primarily in obese men during the second half of life, but often occurs in women in old age. Secondary sleep disorders due to somatic diseases, neurological injuries, mental disorders, in which dissomnicheskie disorders are a symptom of these diseases. This is most often cardiovascular disease (hypertension, coronary heart disease) when there is a nocturnal hypertension, nocturnal angina. Often, sleep disturbances occur in patients with heart failure with inadequate treatment of this condition, and the correction of therapeutic tactics of heart failure can adjust and sleep disturbances. Sleep disorder may be caused by increased frequency of night asthma attacks or exacerbations of chronic obstructive pulmonary disease, various pain syndromes in elderly and old age often with polyosteoarthrosis. Sleep disorders can be a symptom of endocrine disorders (hyperthyroidism, diabetes mellitus). Interrupted sleep caused by nocturia in patients with benign prostatic hyperplasia. Restless legs syndrome accompanied by disturbances in falling asleep, may be secondary (B12 deficiency anemia, chronic renal failure, diabetic neuropathy, etc.).

The problem of theft as a form of ...

The problem of theft as a form of behavioral addiction, like a wood louse secrecy, uncertainty, fenced off. This problem can be solved without glare candid conversation, trust and respect. The first steps are in this vein. Find out what needed money. - To find out the true motives. They can be found out only through trusted contacts. Yet to understand why he did it, it is necessary. If a child confesses honestly, there is reason to rejoice. Talk about the needs of a son or daughter, explain that you are the needs are clear, but it would be much better if he / she just asked / and money. That is the main line of conduct is nothing super-terrible has happened, everything's fine, but if he / she told me it would be even better. - To develop alternative ways to meet the needs for recognition, a self-affirmation, recognition through creativity, school, sports or other forms of expression and constructive use of leisure time. Friends and a good attitude to afford to buy for the money or get a candy or gifts - it is impossible. - Look at the life of his child that was happening to him. Talk about how he lives in general, make friends with anyone that worries those who do not understand bullying and so on. Look for the cause together and eliminate it. Certainly, the phenomenon of child stealing unpleasant. But hardly fatal. Many of today is quite affluent adults probably remember at least one such episode from their childhood. Most likely, you, too. "The largest object ever stolen by a man (one without helpers), was the ship" Orient Trader "capacity of 10,639 tons. One summer night in 1966 a Mr. William H. Kennedy, made their way into the bay of the Gulf of St. Lawrence in Canada, overlogging mooring ropes, and the vessel safely otdreyfovalo to lift, stand by. This fact has taken its place in the Guinness Book of Records. The scale of the action is truly admirable, despite the fact that it is based on criminal acts theft "(the newspaper" A and F, 12/13/2001). More by this author: oniomania: a passion to fly http://www.medlinks.rurticle.php?sid=21076 workaholism: work - the drug and the tyranny of debt http://www.medlinks.rurticle.php?sid=20719 Adrenalinomaniya http:/ / www.medlinks.rurticle.php?sid=20229 Dependence of gambling http://www.medlinks.rurticle.php?sid=20528 Tackling gaming addiction http://www.medlinks.rurticle.php?sid=19908 Television - the online drug http://www.medlinks.rurticle.php?sid=18454 What brought horse? (Drug prevention in schools) http://www.medlinks.rurticle.php?sid=18396 soul captive of my desires (psychology of dependency) http://www.medlinks.rurticle.php?sid=13305

Violations sleep in elderly and senile age. Clinical guidelines for treatment

MD NM Mikhailova Research Center of Mental Health, RAMS problem of sleep disorders in the elderly for a long time remained unheeded, despite the more frequent complaints of poor sleep and increased consumption of hypnotics.

Thing, according to the teenager lifting ...

The thing is, according to the teenager lifting a credibility in the eyes (no matter what), it becomes very important, but in the eyes of parents such a choice seems a complete nonsense, since for them it is meaningless, so it's difficult to scrounge money for the purchase. This makes an insurmountable conflict to go on stealing. Eagle Eye Teenage Racket: Children grow up, grow and their needs. The easiest way: Take away the younger. Well, not directly. Television teaches us how to do it: with a small charge for the "protection and security." "Protection racket", as a hidden way to suppress the weak strong very common in urban schools. For example, Max saw off the girl, which he really liked. But this girl liked and Vetalyu. Vetal with friends thrashed Max. Max asked for support to older, they moved the deal in the commercial mainstream: you give us money, and if you to someone bugging you, we will deal with him harshly and immediately. With Vetalem really "understood" fast-scared. But Max was reminded of the payment. Max began to beg for money from my mother, ostensibly for the purchase of ultra-featured computer game. But my mother promised to give money to pay. Money for the promised "protection racket" had expired, were appointed penalty interest, Max began to steal money from his mother's purse. Once again delayed the payment for "protection racket", while the young racketeers were fined: Max was supposed to pay their mobile phone. Parents have noticed the loss of money, loss of phone and only then became possible to discuss the situation entirely and seek a way out. The first step in solving the problems parents have done very competently. On the fact of extortion have been issued statements to the police, and psychological problem behaviors Max we face together: parents, Max and your humble servant. When a teen makes stealing drug addiction - another group of reasons for stealing. This is a whole separate issue and we will discuss the themes of our mailing issues on drug addiction. Now we are interested in unmotivated Theft. TIPS FOR PARENTS: What to do when a family faces the unmotivated Theft, as a form of behavioral addiction? - On the fact of the theft to your son or daughter need to sit quietly and very discreetly look around. Tears, hand-wringing, name calling and billing of personal assessments - are useless. Tantrums and moralizing is not needed, they worsen the situation. So, if your child has stolen money, does not mean that he is thorough scoundrel. Statements like: "Your life will end in jail!" - Further add fuel to the fire and increase the alienation between parents and teens. Physical punishment and house arrest - from the arsenal of the last century. Such tactics as extreme, which should be deleted immediately. Unmotivated Theft - not a reason to put a cross on their child's future. - The other extreme: to portray the complacency and make forks that everything is fine and well - also exacerbate the situation.

Now, there was always time ...

Now, there was always time to listen to each other. Could make friends with a classmate who tried to protect Evelyn. And with the class teacher and other parents (there was a theme for the parent meeting) could improve the atmosphere in the classroom. immediately labeled as: a criminal, a wretch, what a shame? wayside: Quietly sort things out with these hidden motives. What is behind the "domestic thefts"? Well, of course, the lack of understanding. Usually between parents and children in these cases is formed "wayside." Why did it come about? - ask yourself this question. Does your son or daughter is an urgent need to seek your help. You have not found the time to listen quietly, "thirsty in the desert", the child too shy to express, not wanted, I could not ... "Myself, myself ..."- also a way of self-affirmation. Meeting the needs: Each child has their needs. As far as he knows how to satisfy them? What methods he chooses to do this? Many parents may not realize that a son or daughter has their own needs. In many cases this requires money. Originally, there was no trust in money: or even a child No pocket money or give them a little. Children often have no concept of value for money, and therefore can not dispose of them. Just vague notions, there is no difference: the satisfaction of the desires and needs, coupled with the need. PROTESTS: Strange phenomenon : a child among friends and relatives in his family, but he - alone. There is no understanding, the same roadway - it creates frustration in communication, recognition, acceptance. theft in this case - a protest, a desire to punish their parents in this way. very close to this "negative narcissism", which we have already said, as a way to attract attention and get a "stroking" a form of punishment. AMORPHOUS TARGETS: "As kids, do not understand what they do" - a rough sense of biblical sayings. When a person does not understand or does not distinguish between what is good and what is evil, what is justice - a sure sign of moral infantilism. They are vague idea of ??moral values ??and do not distinguish between what may be behind the line of what is permitted. So hard for children to realize and truly appreciate larceny, a misdemeanor: "I did not steal, I just took the money from my mother without a demand." Many reasons exist theft as a form of behavioral dependence. there is a lot of combinations of these causes. Each case - special. And with all this must be very delicately deal. To understand the motivation of unmotivated Theft try to understand: what to buy your child with stolen money? "What does he spend it?" Mom, I was necessary! "But it was necessary to look for your child. a thing as a sign of prestige: sign of prestige can be Mobile phone, pen, player, video game, CD - ROM, branded T-shirt and so on. One sign of the little, little one mobile phone, you need 3-4; little player-player - you need more, same goes for pens and pads and discs and Pokemon and laser pointers, branded caps and so on; sign of prestige must be many, not one, two, and the whole entire deposit. "If I have such a / exists, so immediately ...".

In this case, contact the law enforcement ...

In this case, contact the police. Unmotivated Theft: case report. The family was at a loss, things began to disappear. It never occurred to release, explains this phenomenon. Adults, bewildered, were simply discouraged. And when mom was gone from her purse a piece of paper is 500 euros (equivalent to 30 euros), the entire family gathered for an emergency round table. Evelyn 13 years old, quiet, quiet, kept for a long time, and then in a tense silence as it burst on the flow of tears. Sobbed on vzryd. Adults long time to calm down. And when the flood of tears stopped, hovered over the table the question: "Why did you do?" Evelina act does not fit into the structure of a family. The family is not rich, but it was necessary, especially needs daughter met fully and even beyond that. Eveline always bought toys are what she wanted. The clothes also had a free choice. This act has puzzled everyone: what Evelyn bought on stolen money? Again, a waterfall of tears. Now we need more time to the emotional element girls calmed down. It turned out that Evelyn at all to steal money for sweets (candy, chocolate, lollipop, chewing gum), and they dispensed almost the half of the class. As explained by Evelyn: "To me were friends." ?? So my mother, Evelyn and dad were in my office. In cases of unmotivated theft causes always hidden away deep in the subconscious of the child. Cautiously began to understand. Evelyn in the new class (nearly a year, she studied at the New School) stood out of his shyness, and together with the responses to the lessons have been accurate and always on the "five", and homework assignments were carried out carefully and with great diligence. That was enough to classmates disliked her. To make Evelina "Scarecrow", the girls tried to pick a nickname, a label, but are more offensive. Showed their contempt for all: in a grin, a grimace, a tone of voice, constantly throwing bits of paper in her direction. A boy who tried to protect Evelyn and dared to sit at one desk, the classmates were subjected to even more cruel ostracism. I asked my parents: "Evelyn turned to you about unhealthy relationships in the classroom?". First - bewilderment. Then it turned out that appeals. Evelyn Pope then dismissed: "Be patient, with brand new is always such problems." Long to ask her daughter did not, somewhere in a hurry. Mom did not find the time to listen to her daughter until the end. Evelyn in his own way was "solved" my problem: half the class load with presents sweets to placate to their relationship and to indulgence. Not consciously, of course. Money was taking by stealth, to justify itself in feelings: "I am not for myself." Small amounts pulled from her purse, my mother did not notice the first time was scary, the second - not so, the third ...- not even conceived. Classmates ate sweets, for a short time, I temper justice with mercy, but for a short time and openly laughed at the Evelyn, persecution continued. Parents and Evelyn worth out of this situation, they did not blame each other, but instead were able to calm a heart to heart talk.

The child is not an object of education ...

A child is not the object of education, and a developing personality, whose opinion must be considered and equally respected. - It is important to learn to build trusting relationships, which would always remain a place for understanding the point of view of each other. The discussions give preference to open dialogue, although it might be for you and will be harder to do. Parents give preference to a notation-moralizing monologues as "the movement in one direction" seems to hold is always easier, but it gives the opposite result. An example of an explicit negative impact is pressing bad company, under whose influence also goes the formation of behavioral dependence - theft. When a teacher becomes a street, the company peers, it is easiest to dump their responsibilities on friends, on the bad company: "I was forced to steal ...". Even so, cause look at yourself and family, of course. Not every teenager goes on about someone's bad influence? Initially, the role of "victim" repudiation forms in the child's family. It is from these seeds then germinate seeds depending on the company, the germs of theft as a form of behavioral addiction. Another important point: what forms of self selects a teenager? Here's an example, two brothers - same age. Senior assert itself through the football club through training, through the achievement of its football team, through the limitations (maybe he missed a few blockbusters, some disco, a concert, etc.), but he achieved his goal, his team achieved the title of "Champion" and went into the final for the year winner. Jr., contacted the company to prove myself and to him was, he was due to pickpocketing in the sight of his new friends. He has long prepared for such an initiation, coached movement, "sleight of hand, trying to get rid of fear. And the day "test" has come: the whole company went into the back door of the bus, "examinee" passed through the cabin bus to the front door, the path of "liberated" someone's purse from the purse and handed it to a conventional sign: "Come out!". Exam passed brilliantly! And now, practical advice to parents: - review your priorities in life. Explain what is - a real friendship, which forms of creative self-assertion and which are self-destructive. - Patiently and consistently speak with your child about what real friends in life are not so much: A person who wishes you evil and brings you a criminal offense, can not be called your friend. "- Set off together to study an interesting book entitled Criminal Code, "and then let your son (or daughter) honors the Criminal Code itself is useful not only for overall development. - Included along with a child in search of new friends, new entertainment, (self-actualization themselves through creativity, through overcoming himself in the sport). Let it be realized, will open a new talent, go to the sports section, a creative studio, a circle of interests. - Stand up to protect her child, when part of the company, which terminated the relationship, continuing extortion, blackmail, extortion, threats and beatings, etc.

One has a son 12 years old ...

One has a son 12 years old. Engaged in business in the small business trade and quite successfully. Has one shop, one bar, cafe and several kiosks. For days on the job. Invited to a dinner party business partners. Son were allowed to sit at the table with his guests, he got a big piece of cake, which is neither as he could not overpower, the son then rose from the table, went to his room again to sweets. When the guests were about to leave home, they discovered the theft of a purse from a purse left in the hall under a mirror of one of the guests. Immediately began a detective investigating the crime scene. It was enough at a glance the mother that her son has confessed. Unmotivated theft: the conditions of formation of this dependence can be added, and the fact that often children do not have enough attention. In psychiatry, there is such a term: "negative narcissism" (the child is doing everything to get the inevitable punishment and after it gets the attention). And yet. When going to steal, anyway - the child is an adult or, in this situation there is always the risk of being caught in flagrante delicto or shortly thereafter. Involuntarily idle state, anxiety and fear against the selection of a large amount of adrenaline. This mix of emotions and peak physiological state (adrenaline) and is an "agent" of behavioral addiction, besides, this dependence occurs in the attraction of opposite emotional charge: the fear of being punished for stealing a (negative) - with one hand and on the other hand - the subconscious desire to take risks (positive). And this mix of adrenaline with the emotions of fear, anxiety, expectations began to work as a drug, creating a kind of "buzz" that want to repeat. These subconscious motives are usually not recognized, but felt good, like an obsessive desire. Authoritarian and directive techniques increase the anxiety and stress, included a paradoxical reaction and attracted only from this stronger. Therefore, any struggle, taboos, moral exhortations only complicate the situation, and therefore useless. Instead, the relationship with your child a healthy alternative to Build Relationships: - offer interesting case, which could be carried away by your child, and where and you might be (work, sports, communication with nature, photography, video, photography and much more). - Arrange a family council, which could be held after dinner or after dinner at the weekend, where the atmosphere of trust and respect for all of the events discussed in the family, worries and difficulties, successes and disappointments of children and adults where everyone is equally loved and significant. - Make it a rule to discuss current affairs son or daughter during the daily half-hour walk, where you can express your thoughts and feelings face to face and talk heart to heart. - Try to be a friend of your child, ask his anxieties, doubts and anxiety. Try to help him cope with these feelings. - Tune in to the joint search for solutions to any problems, please be patient in building partnerships.

Parents who work from morning until ...

Parents who work from morning till night, and raising more and a second daughter, 13 years old, realize that all the time eaten up work and attention to their daughters is not enough. And so, knocking out the last effort, lack of love, trying to compensate for the various presentations. Psychologists have found that a mother working in the industry, can give your child attention, fully communicating, only ... 12 minutes a day. But what about the desired satisfaction of vital needs in communication, decision-making, in recognition of parental love, emotional warmth? Instead, the children offered a substitute of love in the form of purchases, gifts (doping) (parents are trying to atone for their guilt or pay off). But no things are not able to replace those children's emotional needs, but create the impression of "satisfaction." Quickly formed a dependence on doping and children begin to steal. Factors contributing to the formation of psychological behavior in the form of pre-programmed unmotivated Theft, repeated in many episodes of the children get older, each of which carries a certain semantic units with a plus sign or minus sign, in other words formed a definite relation to the most action - to steal. That outweighs: negative attitudes towards him or moral tolerance, "it is possible, though it is impossible, but very much want." Such behavioral dependence as unmotivated Theft can be formed as early as 12 -13 years, and parents perceive these new tendencies as a "bombshell" when children begin to have father, mother or grandfather, grandmother to steal money. Some children seem obvious negative external effects are not. They grow and are educated in the outwardly prosperous families. But only - appearance. People are wondering - where did such a tendency: to steal? (Hidden negative impact) Other children are affected by pressure bad company, under the influence of which also are being formed in the behavior of the deviation, such as theft (a distinct negative influence). The first group of external well-being of the family covers the emotional feelings of deficiency and child spiritual dissatisfaction begins to grow. In a child's life, more and more "dewatering" of love, attention, affection, recognition, acceptance. They carry their "feelings of hunger," the material world and the signs of its importance: clothes, stuff, toys, food (especially sweets), toys, etc. They know that stealing - it's not good, but try to compensate for a deficiency of positive feelings - the equivalent of negative emotions (recognition of his offense creates a sense of guilt, resentment, fear of punishment, the desire to avenge his parents for his "emotional hunger, the desire to attract attention to themselves, though they know that they will receive the punishment for theft. On the streets they do not steal, when there are visiting - also ruled out robbery. These kids are stealing just at home. Case study: Galina, divorced.

About 20% of theft from shops is committed ...

About 20% of theft from shops is done - is not motivated (motivation are not recognized, hidden in the subconscious). 70% of burglaries committed professional thieves, and only about 5% of burglaries committed people who are in a situation of desperation, 5% of burglaries committed kleptomany (about them - a separate issue). In all these cases, people understand and realize what is happening and can consistently describe what actions they committed. Very special cases of the theft - in a state of insanity, when a psychotic state or interfere with a person to account for their actions and control them. Such cases are very rare and considered remains the prerogative of psychiatrists in the forensic psychiatric examinations. Unmotivated Theft - at first glance, the motives are absent, in reality the motives of theft in such cases are not recognized and deeply hidden in the subconscious. Let's try to solve this. Everyone, especially children, need to meet their basic survival needs: shelter - shelter in a house or apartment, food and drink to quench their thirst and hunger, clothing and footwear that was what the walk. We need to meet the emotional, intellectual and spiritual needs. And children need toys, books, paints and a lot more then. For example, sections, clubs, art lessons. For all this you have to pay money. Not all parents are able to provide their children with everything they need. Children grow up, grow their needs and requests. My friends in Italy, England, France, children of school age if they want something in excess of the minimum necessary, work part time and not because their parents can not afford, and to the consciousness of the child fit the desires and proportionality opportunities. In such training, their offspring are my foreign friends as if to say: you can only have the one and only so much what you comply with our own hands. To envy the place remains. What struck me when I was visiting his colleagues in Rome, London and Paris: the wealthy family in a life lived very modestly. Children know, you want something to have in excess of the minimum - earned. I am often in St. Petersburg, Moscow, in these cities, and we in Estonia among children and adolescents is very much a game released in the comparison: That would be a CD-player like Peeter, that would be a cell phone as Nastia, That would be such an outfit like Edik, etc. And the family budget is not rubber, but when at the head of family law was the principle: "the desire of the child - above all!" - Here the problems begin. Annie, a student of 9 th grade parents threw a tantrum over the fact that they could not buy her panties and bra on the bustier as she was ashamed to appear before the knight their underwear on the Tallinn factory "Marat." Dad girl, an engineer by training who lost their jobs on the railroad, had to work a janitor and my mother-scholar, who has lost work on reducing and working on the very same factory "Marat" feel guilty in front of his daughter.

Psychopharmacotherapy agoraphobia ...

Psychopharmacotherapy agoraphobia and social phobias (with their predominantly chronic course) is constructed using high doses of selective serotonin reuptake inhibitors (80 mg / day. when using paroxetine, citalopram and fluoxetine) for a long time, and in cases pronounced "avoidant behavior" shows a long-term antidepressant. When established therapeutic resistance is the most effective combination therapy with the inclusion of antipsychotic drug regimens. When it is selected as appropriate to take into account the safety of: typical antipsychotic drugs are used in low doses, atypical - in the middle. It should be noted that in a series of selective serotonin reuptake inhibitors, not all drugs show equal efficiency in relation to anxiety disorders. Thus, antidepressants with a strong stimulating effect (eg, fluoxetine), in some cases may increase the severity of acute anxiety disorders (the first weeks of therapy is sometimes observed exacerbation of the manifestations of panic disorders). Accordingly, the most optimal use of drugs in the balanced actions, which include paroxetine. Many years of experience in the use of this drug has shown its high protivotrevozhnuyu activity even in cases where the clinical picture recorded frequent and intense panic attacks. Thus, modern approaches to the treatment of anxiety disorders, regardless of specific therapeutic strategies (mono-or combination therapy) can be constructed taking into account the priority use of antidepressants with pronounced protivotrevozhnoy activity and the maximum safe to use. The article was published in the Journal of Pharmaceutical Bulletin

steal - so the boat? (larceny: the behavioral dependence)

Vladimir Kukk psychiatrist, psychologist, social activist web: http://www.DrKukk.com http://www.dr.kukk.wrk.ru e-mail: vladimirkukk2000 @ mail. ru Theft - a frequent feature of behavior among both children and adults alike. I immediately dismiss the cases of theft when the theft are due to abject poverty, people are desperate, facing a dilemma: either they have to steal to not to starve to death or actually dead (the moral principles of "Thou shalt not steal" means to earn a living by working - for various reasons they did not come to mind because of the state of desperation), professional thieves, people chose a path of social parasitism and fashion enrichment (live at the expense of others.) Society morally condemns and regards such acts as crimes and demanded justice, because in any case there is an alternative - not to steal. Whatever the reasons did not exist in those cases when a person crosses the line of moral prohibitions theft but one goal: to steal and use this value or a thing to their advantage. We are primarily interested in the cases of theft, when such a purpose no person has all the essentials and still knowingly commit theft, and then he fell and remorse and guilt and remorse and yet he continues to commit these thefts (not motivated by theft).

The necessity of using high ...

Need to use high doses of tricyclic antidepressants for long treatment courses (from six months and above) is largely limited by the side effect profile of these drugs. Such undesirable phenomena such as sedation, weakening of concentration, decreased the reaction rate, lead to certain difficulties in social and professional spheres (education and other intellectual activities, work that requires speed and precision of action, including driving). These circumstances are responsible for high risk patients with non-prescribed treatment regimen until the refusal of medication. Moreover, adequate use of tricyclic antidepressants can not be in patients with several concomitant somatic diseases (severe cardiovascular disease, benign prostatic hyperplasia, open angle glaucoma). As a result of anti-depressants are used either in the notoriously inefficient doses, either through short courses, which invariably leads to poor therapeutic response and risk of recurrence of anxiety disorders. Antidepressants are the next generation, because of their greater security, were more than adequate to treat anxiety disorders. Currently, the most commonly used drugs of the selective serotonin reuptake inhibitors (paroxetine, citalopram, fluoxetine, fluvoxamine, sertraline). Selective serotonin reuptake inhibitors with tricyclic antidepressants with equal effectiveness for anxiety disorders are significantly more favorable spectrum of side effects. To date, clinically proven that prolonged use of selective serotonin reuptake inhibitors does not lead to a significant change in the social activity of patients and does not require professional limitations. Drugs in this group proved to be significantly safer in patients with concomitant somatic diseases. To date, selective serotonin reuptake inhibitors are first-line drugs in the treatment of anxiety disorders. They are used in monotherapy and in combination with other medications. In the treatment of panic disorder is most common combined use of antidepressants and anxiolytics. Recent nominated short (no more than two weeks) courses in order to relieve panic attacks. Selective serotonin reuptake inhibitors are used for a long time - not less than six months. It should be noted that the daily dosage of an antidepressant significantly higher than the doses used for relief of depressive disorders. For example, if the average dose of paroxetine in treating depression is 20-40 mg / day., Then in cases of panic disorder drug is used at a dosage of 40-60 mg / day. (This dosing regimen and stick to the use of citalopram and fluoxetine). To prevent a recurrence of panic disorder (in cases of chronic course) is carried out maintenance therapy reduced (usually twice) doses of the drug used previously.

It is these negative emotions ...

It is these negative emotions, and mismanagement of their experiences can drive me crazy, sent to jail or do the terminally ill. We know how to read and write, cross the street, driving a car, and resentment, or anger are not able to survive. Wisdom - is power, power over the emotions and feelings on himself. Power - this is non-violence and peace. It is also easily accessible to everyone, as it became available to me. Wisdom in everyday life I have learned here in Russia, this knowledge has long existed and brings people to bear fruit. This knowledge is not a secret. Find me and I will reveal it to you because it is inherent nature. Institute of Conduct

Current approaches to pharmacotherapy of anxiety disorders

Elena Kolyutskaya Doctoral. med. Science, leading researcher of the Centre for Mental Health, RAMS Anxiety (anxious-phobic) disorders are one of the common variants of borderline mental pathology. On the modern principles of pharmacotherapeutic correction of these states said Doctor. med. Science, leading researcher of the Centre for Mental Health, RAMS Elena KOLYUTSKAYA. According to epidemiological studies, the prevalence of lifetime anxiety disorders (panic disorder, agoraphobia, social phobia), an average of 1,5%. Anxiety disorder characterized by a complex psychopathological structure, which includes both acute manifestations of anxiety (panic attacks, provided vegetative paroxysms, accompanied by a pronounced fear of death) and "avoidant behavior" (the desire to avoid a situation fraught with repetition panic attack). Most anxiety disorders characterized by a chronic course is due to formation of pronounced "avoidant behavior." In cases of agoraphobia is fear of independent travel, based on the avoidance of situations where the patient may be left without assistance in cases of social phobia - avoidance of any social contact. Chronic anxiety disorders lead to severe social maladjustment of patients up to the counter and disability. Feature of the dynamics of anxiety disorders - the tendency to chronicity and recurrence, which largely determines the complexity of their therapy. The traditional therapeutic approach based on the preferential use of anxiolytics (benzodiazepine derivatives), is justified only in cases where the clinical picture is dominated by acute anxiety disorders (eg, uncomplicated panic attacks). In the presence of persistent phobic disorders (agoraphobia, social phobia) monotherapy anxiolytics, usually ineffective. Since the mid XX century. in the treatment of anxiety disorders are increasingly being used antidepressants. As shown by numerous studies, the use of classical (tricyclic) antidepressants (amitriptyline, imipramine, clomipramine) gives a more pronounced and long-lasting clinical effect. However, this treatment option is associated with more complications.

Any living creature safely ...

Any living creature is alive and well survive if it pleasant to live when life is fun. And if not, then life becomes very different colors, and out of nowhere, there are intractable problems. A person is happy when he feels happy, and that requires the most conventional wisdom. What is it? Let's talk. If we accept that happiness - a feeling, you'll have to agree with that, too, a sense of unhappiness. And all that we feel is not somewhere else, but in ourselves. Say, when I hurt I feel a lump in my throat and tears, I feel like my hands went down. And say, when I'm ashamed, I feel that I blushed, and how to burn my face, so much so that I press in his shoulders. And in the fear I feel my heart beating and shaking hamstring. And angry my blood is boiling, and I'm getting stronger. Remember how often you talk to your friends: Relax, do not activate and you'll feel better. You are certainly right. Now tell me how. Not sure? That's why, and give advice: Let's go get something to eat, and you ease, and even better drink (tablets or alcohol). You do not wonder why there was another ulcer, or let's say diabetes? But in vain! If I remove the tension in the abdomen, arising from the offense with food, ulcers can not escape me, but then something else is worse. If I am, always afraid of something - my tachycardia does not cure any doctor. And if I am infinitely angry - my blood pressure is provided. Too simple you say, but clearly. So, what is called the emotion, is born in my head, but survived the whole body. While I was experiencing an unpleasant emotion, my body will feel bad. Feel nothing is impossible. Even a crazy experience. No feelings there only corpses. Such is the nature. I just think the body. I think that is I am thinking. Thinking of the word "muscle". See how simple. So it turns out, I think, because I feel so alive. Good or bad. Wisdom in the correct management of their thoughts, ie, control the muscles of your body. You know that no one experience does not pass without a trace. We think the body. This is the process of thinking, I mean the tension and relaxation of my muscles in response to life events. Now the main thing. Who knows how to properly experience, he is healthy and resilient, and to live well. But that's a bad head, as you know, foot rest does not. Proper use of own thinking, supports my pleasant mood and health. Wrong thinking creates in me stress and carries disease, and among them are incurable, and even the modern classical medicine. Use of thinking means to control it, in other words, to manage itself. As long as I live, I will relive the feelings and emotions. They will be in me, I want to or not. It's like my legs and hands. If I do not feel any emotion, consider me a cripple with no arms or legs. If I do not know shame, virtue in me does not appear! If I do not feel guilty, I'll be lonely.

Improve the quality of training athletes ...

Improve the quality of training of athletes is possible through the emotional stability of the athlete, through training of its self-regulation skills, with one hand. Through the ability to set a task to quickly learn and improve, it is easy to correct errors at a lower physical and mental stress, through the ability to dispense with injuries and only get pleasure from both training and competition from the other side. Here the question arises: how does it do? Is it possible both to build the training process, to dispense with the trauma, emotional breakdowns, without the need to retrain and, in general, without coercion and debilitating stress, without sacrificing the quality of an athlete? Yes, definitely. To solve this problem is possible with existing methods of psychological support: sanogennykh method of thinking and an iterative method of rehabilitation. Referred to psychological methods developed on the basis of knowledge on the physiology of higher nervous activity, they exist and are practiced in more than one year. Their effectiveness is not in doubt, but athletes, for some reason not in a hurry to use them. Application work of Academician YM Orlov in the field of psychology, behavior, would facilitate the training of athletes, to make it more efficient by reducing the emotional stress and the formation of the correct way of thinking and the right mental habits of athletes. Specified development are fundamentally different from all other methods of psychological support that they produce in man sustained skill solving internal problems, achieving goals and self-improvement. Application of these methods does not place any athletes or coaches in their personal dependence on the specialist, and solves problems much faster in time in comparison with other methods. In addition, these methods allow for a short time to eliminate the unpleasant state, and errors in the performance of instrumental actions (ie working skeletal muscle) by the extinction of these emotional reactions and technical skills. Thus, it seems necessary to pay attention to these methods to prevent the consequences of disruptions caused by mistakes in managing the athlete by his behavior, including emotional, which may be sad for both health and life of the athlete as a whole, not to mention his personal achievements in the sport. ANO <>

I think, therefore I live

How often do we talk to each other: Do not worry! Did you get from stress because of nerves, calm down and everything goes! Pull yourself together! But none of us (alas) does not know how to do it. For example, how to calm down when I even medicines are not helping? And tell me, I can pull myself together if I can not stop thinking about it? Yes, stop the thought is not easy. She runs, races, jumps and comes back to me countless times. It's exhausting and devastated souls. You will object - not always. Very accurately noticed. And you know why? Because only pleasant does not tire and want to repeat.

My mind fills with new experiences ...

My mind fills with new experiences, new skills to help calm and without the hassle of finding a way out of the most difficult situations. Like the time that I lost, entangled in a maze of problems coming back to me opening up new possibilities to experience again the most wonderful feeling. [DOWNLOAD FULL]

Psychology in sport

Every athlete and his coach knows what it takes to success in sports, how hard and what hardships he had achieved. Often the athlete and his coach underestimate the importance of their own moods, your emotions and your mental habits in sports and life in general. Well-meaning coach requires an athlete: if the patient - be patient if you do not want and tired - all the same train, tempered will not have the strength to - accept the drug. A similar approach for self-improvement for today are not uncommon. Educating the athlete goes through the exercise of will and the will of trains, according to how coaches and athletes themselves through hardship, overcome yourself, your feelings and desires, in other words, by violence on himself. The question arises - whether these are justified deprivation of what consequences we have in reality? To improve, we must exercise. To exercise, it is necessary to overcome the pain, fatigue, fear of failure. And to overcome them, too, need to train. Circle. In fact, improvement is possible when it is pleasant and enjoyable. If this is not fun, then the athlete's training takes place through the efforts to overcome the unpleasant feelings that hinder the improvement of his skills. In this case, the internal stress caused by these unpleasant experiences, preserved, and each subsequent violence over a requires more effort than the previous one. This contradiction may be referring to a psychologist, that addresses the problems of psychological preparation of athletes, without resorting to exercise its will through violence, and overcoming hardships. After all, in fact, will is the desire to do something, and its manifestations do not require effort. Thus, the will to train, educate and develop the personal character each athlete's ability to solve some problems. Personal emotional problems athletes and coaches in the first place, the problem of self-improvement in the second. Because, not eliminate, the improvement of emotional problems is almost impossible, because athlete will not be improved, and if they will, then by force. This is inefficient and unnecessary, because the compulsion is a person protected from violence against yourself, but it is perceived as laziness. Athletes also can not be lazy, so some stress associated with overcoming their unpleasant experiences with the need to overcome himself, is secured in the body, and developing so-called occupational diseases. A disease for an athlete - the loss of form, which in turn affects the results and achievements of the athlete.

I used it for all time ...

I used during this time all the means at my disposal to return to their former comfortable state of mind. Sat on a diet to lose weight, then gained it back. Regularly went to the pool, swam a half mile per session, but temporary relief, which is felt after the swim, quickly disappeared. Painful thoughts darkened my mood and did not work distractions, even on vacation. All of what I owned in their vision of family life, and I had by then built a new relationship, it was the experience of a family in which I grew up and my first marriage, which lasted sixteen years. Expectations that I have endowed their loved one did not come true, and I found it increasingly difficult to take these do not match expectations with reality. Bumping into the misunderstanding and feeling at this sad feelings, I wondered why I had all been very different. Accumulated destructive anger, which translate into tears or showdown. I could not even clearly express in words and explain their mood, suggesting that man can guess how I feel bad. It becomes even more bitter. If occasionally I have heard from friends, depression and despair were heard in my words, and sad eyes betrayed my depression. Outwardly, my life seemed all happy and arranged. Could not see the pain I carried in my heart, as if she had settled in me hacking abscess. Therefore, to share experiences and tell someone else about how bad I did not want to. Prolonged depression kept my nerves a hot, sore and stuck with me mercilessly. In the cycle of life, it became increasingly difficult to resist the attack. I tried to adapt to the circumstances in which provided, used to do their full potential and desire to survive. I'm not sitting in the saddle, managing your time, and frantically try to keep him by the tail and dragged along the dusty road of their feelings. Losing strength and tearing the soul, I had almost come to terms with their situation and stuck in negative feelings. Changes in my life was just at the very moment when it seemed that there was no way out. I met people who helped to look at life differently. Taught in a different way to think and perceive reality in a different way to treat yourself and others, thereby healing not only of spiritual but of physical pain. Getting rid of suffering, understanding their underlying cause, I get an invaluable opportunity to come back without injuries in the past, and without fear to look into the future. Comprehending the course of life, understanding of what the images lined up my dead-end situation, I was able to review many of their mistakes and errors. Dropped out on my share of serious car accident that served as a catalyst, clarifying to the end of the full value of human life. I have not had years to recover and painfully suffer physically and mentally. Shake, that happened to me, helped to find the shortest way way to overcome the difficulties in a very short period of time.

It was very interesting and exciting ...

It was very interesting and exciting. Real life causes in me the need to seek and find those romantic images in the books, which I was lacking in reality. Taught by their parents to walk and talk, understand and respond, then at school to write, read and count, I've filled up your inner world, not only spiritual values, but also create for themselves the illusion of another life. My sensitive nature needed a manifestation of tenderness, and I despite parental prohibitions ringleader of animals or birds. Parents meet certain requirements views, which should grow a daughter, were very categorical, rigid and sometimes drove me stumped. Fulfilling their requirements and following their education, I continued to act in their needs for understanding and accepting of my personality different creative hobbies, trying to get recognition of relatives. I was sitting in a spirit of contradiction, that I do not want to be like everything, but it's not particularly happy with my mom, that many features of my character were formed not because of, but in spite of home education. I was in a hurry to grow up, gain the ability to be yourself, so many memories of my childhood retained a no serenity, and feelings and defend itself. No wonder that from parental custody, I flew out to marry very early, I was barely eighteen. Heading into the solo flight, so I tried to build relationships in his young family to avoid disputes and misunderstandings. The more so because my husband was much older, had a life experience. Incorporating the best features of the parents, I could always make their own decisions in any situation and find a way out of complex problems that were happening in my life. Another thing is that the strong emotional turmoil that I experienced at the same time, cause suffering and often ended with diseases or frequently repeated minor injuries. The time it started rapidly after thirty-five years, when it did not have time to meet the start of the week, as an upcoming weekend. And in this race time was not as easy as a young man to recover from the stress and new experiences. Despite the fact that I had no time to sink into depression, the daily hours of work demanded attention and dedication, I stoically took the blows, paying for it is great. Those reserves which still remained in me kept me from the stall in a minor state. But even closer to the forties, when all my aspirations to build a new life and be happy, no excuses, I increasingly began to ache and feel depressed and low. Tension has grown, capturing in their prehensile paws, I would not let anxious expectation of unpleasant change. They attacked, as if to order, I change the appearance, gained weight, lost interest in life, lost his optimism, became isolated in their feelings and less and less frequently met with friends and acquaintances.

These aspects involve multiple ...

These issues are associated with multiple losses from HIV / AIDS faced by society. Experienced clinicians are well informed about the problems of grief and AIDS in homosexual men, may help develop ways to solve these problems. Loss of dear people you are very painful, but pain can be relieved, if not lose a sense of humor, indifference and resist to perceive reality. As Robert Cody: "Have the courage to live, die and everyone can."

'Mirror spiral'

ANO Institute of behavior "in adolescence, we rush time, that they might be older. We wish to plunge into adult life and their freedom of action, going out of control parents. We never think that this very tedious wait adulthood robs us of the opportunity to enjoy the present. We build our expectations of those images, which were surrounded from childhood. If the mother during a showdown with his father can not keep finding fault, we remember how offended his father, and drag his feelings toward you. Next time, when similar accusations have already dealt to us, we begin to reproduce the same pattern of behavior father during resentment by painting their reactions with individual manifestations of nature. Thus, in our habits are formed to respond to unpleasant situations have already implemented. We begin to lock and hold a grudge, or vice versa, to explode with anger at injustice, should a similar situation, my father has done so. Proof of this was my surprise when my older sister, she at that time was twenty-one, and I was sixteen, screaming at his daughter polutoragodovaluyu mother's words, literally giving those same tirade, which my mother had once called us to order. Young, we were bright enough and brought a lot of trouble. Mom suppress our activities highly artistic expressions, in which the images were so visible that correspond to them did not want to. Sister with amazing accuracy in a specific sequence enumerated all my mother's epithets and expected punishment, which is then followed by, if my daughter would not change his behavior. A little girl, imitating his grandfather, supila eyebrows and folded sponge sad bracket, stubbornly continued to make mischief. It was very strange to listen to the same words, which once told us mom, they are not tied in my mind with the image of nurses, who in her childhood she was very militant and stubborn. Then she burst into educational copying our mom was this so convincingly that my father often repeated, "All in the mother, all in the mother." The characters and actions of the mother and father, sisters and grandmothers are the closest and I perceived the images on which the knowledge and first experience. There was also a school, girlfriends and their families, with their family tradition. Surrounded by a large number of books, which are always in abundance in the house, I very early became addicted to sink into a wonderful and rich world of literary characters, adding to its perception of a lack of life experience book wisdom.

How to overcome the sorrow How can ...

How to overcome the sorrow How can we help man depressed with thoughts of sorrow grievous losses, keep in touch with his friends and social services to be able to continually discuss all their problems? Expression in the presence of a good listener is the best prerequisite for recovering from grief. What do you think about that sometimes take a little break from HIV / AIDS? This is the time when you will not be constantly reminded of the disease. Perhaps talking to your doctor, you may at some time to stop taking all medications. To pay homage to the dead, you can light a candle and remember the role they play in your life. You can also light a candle for those living with HIV or someone who loves people with AIDS. This will help to return to life and hope. Remember and use as often as possible certain Dr. Solomon in 1988, features people who have long lives with HIV. For example, think of the attending physician as an assistant, do not stay in the role of passive compliance. Remains committed to living in terms of unfinished business, outstanding tasks or even nepostignutogo experiences and unmet desires. Find a new meaning under the influence of the disease, to perceive reality AIDS diagnosis in conjunction with the rejection of its perception as a death sentence. Patients with long-term living with HIV are able to find a way out of the predicament, and learn all yourself. They are assertive and are able to say "NO". Develop rituals, symbolizing the significance of the loss suffered. Participate in them as much as possible. Active participation enhances personal opportunities. Learn how to focus their anger in a way that it expands your capabilities and not overwhelm you. Acknowledge the existence of anger and direct it into useful channels. Dance. Sing out loud. Learn how to draw. Use it all to explore their deepest emotions, which you could possibly neglected. Volunteer to help others, can not achieve such success, as you can. Be careful with personal care, including care for appearance, physical exercise, nutrition, fluid intake and rest. Remember that you always have choices and learn how to choose the best. This creates a sense of control, as outlines of tasks for which you are still liable. You can not change the disease or prevent death, but you can change your attitude towards them. Be realistic, anticipating possible outcomes for themselves. Learn how to find a new life for those who died so that their uniqueness has continued to enrich you. Do not lose your sense of humor. George Bernard Shaw said: "Life does not cease to be fun, when people die, and it ceases to be serious when people laugh." Religious activity, belief in the spiritual life after death can save you communicate with other people. Examine your own faith and take on new commitments. There are special considerations with regard to homosexuals, experiencing losses.

We're seeing a lot of anger, and he ...

We're seeing a lot of anger, and he seems the most prevalent emotion in the grief of this kind. We know that anger is also growing ravages of disease, neurological complications, duration of disease and, of course, disability. Along with the anger, despair - the second word, most often come to mind in this regard. These repeated losses leave a person feeling as if he had deleted all the pre-existing emotions. Characteristic syndrome of multiple losses There are many symptoms that we associate with pathological grief. These include a heightened sense of guilt or rage, intensified the physical symptoms, denial, delayed reaction, destructive to themselves behavior. Most of the time these symptoms are not recognized. People do not realize that they do and do not realize that this is due to the continuing grief. Many people do not believe others when they talk about so many losses, and some time wondering how those can be so familiar, until it begins to happen to them. Some people try to cope with the problem, looking at the positive side of what they are familiar with so many people. They feel that they love themselves and are loved by some truly wonderful people. Often there are complaints about the lack of affection toward others, including a reluctance to make new friends. When this happens, people feel more isolated, and then weakens his support system, and he finds himself in a trap - a rotating wheel of the senses, even more lonely and isolated, afraid to go outside. We also know that there are other losses: loss of sexual freedom, hope for the future, dreams to live and grow old with her partner, loss of stability of employment, loss of family support, loss of privacy and personal power, because often, when it became known diagnosis of HIV infection , a person deprived of privacy, against his will. Premature sad Premature sadness - a term used to describe the mourning before the actual death. The term also applies to the situation with the apparent lack of reaction to grief when death has already happened. We know that death from AIDS is rarely a sudden and prolonged nature of this disease predisposes to the development of premature sadness or "suicide" of grief. So far, no clear evidence that it facilitates the mourning after the death of loved ones but it can affect the depth of feeling. It is also important to assess a person's ability to cope with problems, suicidal risk and other destructive tendencies. Of course, it is important to reconnect people with support services. With all the many losses short period of time is desirable to understand in detail each of the losses, finding out what place in the patient's life took a deceased person. For grieving people is important to find a place where they can, do not hesitate to share your feelings to yourself to better understand the loss.

Thus, it becomes imperative ...

Thus, it becomes imperative to identify the needs of those who survived the loss, understand the characteristics of the many losses and to train people to cope with their problems. Syndrome of multiple losses consists of three elements: the grief, experienced people, a response similar to post-traumatic stress syndrome, "burnout" that affects a person's ability to maintain presence of mind. Woe end of the period of grief is compounded by repeated losses, which occur at short intervals. It is also complicated by the attitude of society towards homosexuals, drug addicts and minorities, those populations that are most affected AIDS. Private grief is rarely recognized in the absence of acceptable relationships. Rejection of such relationships in the community served as an impetus to the creation of an unusually strong associations in many cities. Because of their closeness numerous losses were much heavier burden for some people, killing more than 50 friends for a few years. Other responses of healthy people is very difficult to grasp the problem of multiple losses caused by AIDS is probably best to compare it with a natural disaster, when many people are killed simultaneously. In such cases, we see the effects, horror and post-traumatic recovery. Multiple losses from AIDS are different from other losses that the continuing deaths among people aged 30-50 years have become commonplace. Long-term planning and goals for the future no longer be discussed with enthusiasm, if any, are discussed. Unlike conventional weight-loss syndrome multiple losses has some important differences from the heavy loss because the person is experiencing one loss after another, in fact, can not get out of this state. Each posle1 blowing the grieving process overrides the previous one. People experiencing multiple losses do not have enough time between the injury to examine their feelings in a period of grief that would bring them relief. Their feelings seizes a major loss. After each new loss people seem to continue to grieve the loss, which they consider most significant, and the attitude to it is as if the loss was the only one. If during the grief process you have adopted a similar character, then exit from it is not possible, because each loss there is some a process that needed to go from beginning to end. Effect of burnout syndrome multiple losses can be characterized by a sense of numbness, perhaps, the inability to express or feel emotions, or express feelings differently, pessimism, cynicism, fatalism and a sense of insecurity. It must be remembered that if people are experiencing similar feelings, their behavior may become irresponsible and destructive to themselves. One patient told me that he felt the snowball effect, "when death started to happen one after another. "I felt depressed and commit treason in the sense that I was not made to pay tribute to each of my friends."

The plan should also include a list ...

The plan should also include a list of names and telephone numbers (daytime and evening) of the people on whose assistance you can expect during the illness (to go to the pharmacy for medicine, heat the food, feed and even walk pets or get a massage). And finally, it must contain some comforting rituals to ensure peace and promote recovery (eg, wrapped in a blanket on the couch, having tea at hand, a selection of fresh magazines and TV remote control). 3. Lack of understanding of health issues associated with HIV. All those who provide care for HIV-infected patients would agree that a better feel those who are actively concerned about their health. They spend time trying to understand how drugs are taken and why it is important to obey the rules physician. Often they are studying different types of alternative or additional treatment. They learn how to regularly discuss issues with their health proxies, not related to medicine. should put a lot of effort to raise awareness among patients about HIV infection and its treatment that they take actively involved in caring for themselves and achieved maximum results from the therapy. 4. Passive relationships with people, provide first aid. Much better feel those patients who actively cooperate and seek to establish and maintain good relationships with those who provide them with first assistance. They develop the ability to trust and sincerity in relations with those who patronizes them. They also develop the ability to notice the slightest change in their health, so they can immediately draw the attention of their caregivers on issues until they are at early stage and are easier to handle. These patients effectively use consultation, often coming to every meeting with a prepared list of symptoms, questions and comments. The extreme passivity in the face of serious illness is a sign of desperation and negatively affect the physical and emotional state. Patients defining few questions, show little interest, apathetic, withdrawn and closed, prepared to die, probably in a state of crisis. They must examine the psychiatrist or a counselor to give advice on how to interest these patients in their own treatment. Those Who takes care of HIV-infected persons should make a contribution, involving these patients in a discussion at each meeting by asking them specific questions about their clinical status and their attitudes to their health. Grief and numerous losses as more people die in result of AIDS, the emotional aspects of grief and loss are complicated. Numerous losses occur in many communities, provoking a growing rejection, depression, fear, isolation and anger. This can lead to destructive behavior towards himself and increased morbidity and mortality.

He needs to explain what these ...

He needs to explain that these abuses can harm the immune system. Interested patients should be persuaded to refrain from the use of these harmful substances are less interested persons should be advised to develop a plan for reducing harm, gradually reducing the number or frequency of their use. Many agencies, groups, clinics and other organizations to offer treatment for substance abuse. 6. Inadequate or insufficient exercise. Mild or moderate exercise are needed for people living with HIV for a long time. They are even more important to them because, apparently, increase the number and cytotoxicity of cells - natural killer cells. All HIV-positive patients should be aware of this. They should also know that even a moderate exercise, such as the 20-minute walk three times a week, reduces mental stress and improves immune system function. Recommend HIV-positive patients with insufficient physical exercise to join social groups, clubs, participate in various activities related to physical activity. Medical Aspects 1. Repeated contact with HIV and other infections. Many HIV-infected people do not believe that they should adhere to the rules of safe sex, because they are already infected. They can not understand that re-infection can be extremely damaging to their immune systems. Risky sex can lead to infection of the patient more virulent virus strains that are resistant to the drugs he takes, or lead to infection of other sexually transmitted infections. Some of them, like hepatitis C, a potentially life-threatening. Dangers of risky sex must be discussed with the prime. simple language with all sexually active people living with HIV. HIV-positive people should also know how to avoid unnecessary contact with germs and how to avoid infection. They should be able to cook and store food in such a way as to make sure that does not catch an infection through unwashed foods, raw eggs and poultry, and not contaminated with microbes of prepared foods. They must also develop a hygiene skills, such as washing hands before and after meals or after using the toilet. Cycle training on the basics of health can be very useful in this regard. 2. Limited ability to care for themselves during the illness. All people living with HIV need to know how to take care of themselves when they fall sick information on this topic varies widely from very general (to provide the necessary amount of water consumption of the organism to the most complex (like myself intravenous sterile solutions). Is necessary to help all adults living with HIV infection, develop a plan for self-power, which would help them understand what they can and can not do, taking care of themselves during the illness. In this regard should be taken into account the need to stockpile medicines, bandages, food, simple to prepare a sufficient period of isolation for the patient (a week or more).

Quite useful is sticking ...

Quite useful is sticking to phones, mirrors and desks used by patients, notes with a reminder. 2. Insufficient intake of fluids. Most people consume insufficient amount of liquid. There is a simple rule: Drink 8 glasses of fluid per day. During the heat, during physical activity, as well as vomiting and diarrhea fluid intake should be increased. Few people regularly drink 8 glasses of fluid per day. A small number of patients taking indinavir. lack of fluid can lead to the formation of kidney stones. For others it's slows down detoxification, overloading the kidneys and puts stress the body. Due to the fact that tap water may be contaminated with biologically and chemically, to patients with levels of CD4-below 50 cells/mm3 should be encouraged to use boiled water or water from a bottle. 3. Poor appetite and eating patterns. In advanced stages of HIV infection, loss of appetite and absorption is common. Evolving depletion may be an early cause of death. Disorders of appetite may occur in mnogih1 patients receiving antiretroviral therapy. In fact, some drugs and their combinations cause digestive disorders and diarrhea. With nausea, dyspeptic symptoms and diarrhea can be managed with medications stimulate appetite megestrol, oxandrolone and other drugs. Interested patients certainly benefit from specialist advice on nutrition. We must strive to ensure the patient's diet according to his tastes, believing that its choice reasonably balanced and provides sufficient kalorazh, even if his tastes seem eccentricity and contrary to the scientific approach. 4. Sleep disorders. Recent studies have shown that even one sleepless night can cause a material breach of certain immune system functions. Typically, one or two nights of normal sleep restore these functions to normal. Patients experiencing occasional, but strong sleep disorders need help. Sedatives do not violate the immune system, so they can be used to provide patients with HIV infection a good rest. Patients who complain that they can not sleep without sleeping or still awake after their admission, may benefit from counseling, whose main task is to determine the causes of insomnia and their elimination. 5. Misuse of some substances. People caring for patients with HIV infection and attempts to identify their sources of physical and psychological stress should be very broadly interpreted the term "substance abuse". List of substances that can be abused, is not limited to drugs, alcohol, amphetamine and marijuana. It also includes caffeine, nicotine and ordinary sugar. A patient who uses excessive amounts of one or more of these substances, provokes stress in your body.

Lack of confidence ...

Lack of confidence. Self-confidence is one of the usual traits of people living with HIV for a long time, and it is necessary to acquire insecure patients who wish to work with qualified consultants. Even the least confident people can be made to understand that with meekness and humility you can not achieve much. Patients need to learn to be active in taking care of their health, in search of support and stress management. Introduction of HIV-positive people with the law on patients' rights can help not confident individuals realize that they are entitled to certain services at a certain level of quality care and a concern for those who work with them. 8. Lack of reliable support. The presence of a spouse (wife), partner, trustee, or a trusted friend in the life of HIV-infected person can provide a buffer effect against the negative effects of stress, grief and depression on the psyche and the immune system. The old adage that "a lonely dying faster" is especially pertinent in relation to this category of patients. For this reason, any patient, emotionally isolated, voluntarily or by chance, is exposed to additional risk. People who have AIDS, picked favorite people, especially those who have survived many such losses, are reluctant to go for a rapprochement with a new person. However, all people living with HIV, you need someone to whom you can rely on a critical time. If the patient can not be called a reliable source of support, people who care about him, should help him to establish such contacts. 9. Problem with the overcoming of difficulties at a critical time. It is easy to determine that a patient crisis, often he does it for you. It is difficult to provide him with adequate support during the crisis. Urgent need for her to meet the various aid organizations. Typically, the best help these patients in a difficult time for them to mental health counselors. Into second place as a source of help can be put those who've been through something like this - the other patients. You can be sure that in your practical work is useful to separate out the number of patients who have the best ability to overcome difficulties. Invite these people to conduct informal interviews in your organization and advise those who doubt their abilities to cope with problems, come and learn from experts. Behavioral Aspects 1. Inadequate breath. Many people, while under the influence of strong or prolonged stress, unconsciously hold their breath or breathe lightly. First, it causes fatigue and apathy, and eventually may lead to more serious consequences. Patients with respiratory problems, should be instructed in relation to employment simple deep breathing exercises every morning and before bedtime. Can also be useful yoga classes, aerobics and other exercises where breathing play a big role.

Chronic impatience. Haste ...

Chronic impatience. Haste leads to losses, as applied to HIV-positive people, related to personality type A, haste leads to loss of cells CD4 +. Type A individuals should be advised to hold regular sessions of deep relaxation. It does not require a special program on meditation, it is enough warm bath, a nap for ten minutes, or just sit for a few minutes in a quiet darkened room. 3. Long-existing stress. Stress, many months (and it often occurs in HIV infection), finally has a destructive effect on the immune system. Patients suffering from chronic intense stress, must be persuaded to develop a concrete plan to combat the known sources of stress in their lives. Simple preparation of such a plan in itself reduces stress, since it allows that the stress factors can be addressed. 4. Prolonged grief. Patients experiencing severe grief, in connection with the death of the patient, more than six months should be encouraged to organize a farewell ritual. It needs to be held in a special day at a specific time and place that has great significance for the patient. The event should involve the appropriate people. This event will give tribute to the deceased in the expressive form and will complete his period of mourning. To stop a prolonged period of mourning is often useful short-term counseling. 5. Depression. People living with HIV, depression is often unrecognized and untreated flows. This is partly explained by the fact that the classic symptoms of depression - fatigue, sleep disturbance, decreased libido, impairment of concentration - also characteristic of HIV infection itself. As a result, these symptoms are wrongly attributed to progressive disease rather than depression. Many people who provide care for patients mistakenly believe that symptoms such as general demoralization, sense of deep hopelessness, loss of orientation, purpose and self-esteem are manifestations of common emotional reaction to the harsh reality of living with HIV and therefore do not require treatment. In view of this widespread misconception, it is necessary to repeat emphatically that chronic depression is never normal. For the treatment of clinical cases of depression commonly used drug therapy, and the emergence of new, safer and better tolerated antidepressants, has opened new possibilities for choosing drug. Health care workers should be aware that all patients with clinical depression need regular counseling. 6. Lack of goals and objectives. Studies conducted in humans for a long time living with HIV, show that most of them occupied a meaningful, purposeful activities. Patients devoid of any purpose, should be encouraged to return to some realistic short-term value problems from which they had previously refused when they learned they had been infected with HIV. (Many people living with HIV for a long time, proud to call volunteer activities as a goal in their lives.) Alternatively, you can invite to the planning of new short-term objectives and to renew and modify some cherished long-term goals that may not seem so unrealistic, before the introduction of HAART. 7.

The last thing to touch ...

The last thing to touch the power of attorney. This empowers the patient, another person to participate, along with the doctor in deciding on treatment if the patient is unable to do it myself. As with the discussion of medical tactics, power of attorney is better to issue in advance, without waiting for an advanced disease stage when they can show psychiatric disorders. How to help patients reduce stress in their lives Stress pursues all people living with HIV. Initially, it can be severe, caused by the loss of a loved one, or a host of other, smaller losses: pet rental promotion. Stress can be the inevitable result of living with HIV, but that does not mean that it can not cope. If stress causes headaches, gastrointestinal disorders, sleep problems, fatigue and depression - these classic symptoms of severe stress - we strive to treat him just to reduce the severity of the symptoms and improve quality of life for patients. But now we know that a prolonged stress affects immune function and accelerates the development of AIDS. This knowledge gives us an added incentive to treat stress as intensely as we treat viremia in seropositive patients. In many cities there are now "hot lines, health services and support, created to help HIV-positive people to cope with the most stressful moments of life with their illness. Several recently developed programs currently offered by participating in these patients the means to mitigate the psychological and social factors that cause stress and damage the immune system. First observations show that these programs have a positive impact on psychological status, behavior and immunity functions. These programs and services can be very useful for people trying to cope with chronic stress caused by living with HIV. All patients (newly diagnosed and those who have not the first time on antiretroviral therapy, and those who are at intermediate stages) should be strongly encouraged to contact a qualified consultant. In doing so, health workers play an active role in assisting the seropositive patients, reducing the number and intensity of stress in their lives. Sources of stress are listed below along with specific tips on how you can help their patients protect themselves from the destructive action of stress. Psychological and social stressors Psychological Aspects 1. Fatalism. Death is an inevitable part of life. People living with HIV, morbid fixation on the issue of death and dying accelerates the development of AIDS. Patients should be encouraged, fatalist conversations with people living with HIV for a long time, and with those who have learned to keep their fears and anxiety under control and who is concentrating its forces on the achievable, useful, short-term problems. 2.

Thus, there is hope ...

So there is hope for the prolongation of life even in patients with advanced stage disease. When reporting on the patient revealed he was HIV-infection before a doctor has a difficult task: to remain honest and at the same time not depriving patients of hope. The tone of the doctor should be as optimistic, but not at the expense of withholding evidence. Practical support in the first place the physician should pay attention to the practical needs of the patient. Upon learning of his diagnosis, the patient often suffers from severe emotional stress. He needs to know where to turn for help. Often this help is simply to talk to someone about aspects of their diagnosis. HIV often infects people who have few close friends and family members. Therefore, many HIV-infected patients administered first aid to provide such volunteers, nonprofessional organization for counseling, which give a person the opportunity to "speak out" about his diagnosis in an individual or group conversation. This helps many, although such assistance is not suitable for all newly diagnosed patients. Doctor should make sure to refer a patient to where assistance will be provided accordingly. In addition, during this difficult period greatly assist patients can nurses and social workers. HIV-infected patients may also need shelter, emergency financial assistance or food. As in the case of consultation, the existing social organization can meet these needs, and again at the doctor's responsibility to refer patients to the appropriate agency. Probably the most difficult questions, disturbing newly diagnosed patients are those that relate to death. When will I die? How will this happen? Will I still suffer from pain? I'll die alone? To some extent, the physician should have foreseen this and elaborate on these often look look. Doctor should not discuss the time of death until the moment when it will be inevitable, but it should reassure the patient that he will receive all the necessary pain medication, and when the time of death, next to him will be his family members, friends or medical personnel. Such a discussion should be conducted calmly, without haste, in disposing to this quiet setting. It would be wrong to discuss these issues with all patients on the day when they learn about their diagnosis, but also affect their need - in advance rather than in the last days of life. Responding to questions about death, the physician should determine a patient's wishes regarding medical tactics in extreme situations, for example, in the case of respiratory failure if the patient wishes to mechanical ventilation? These conversations may seem abstract to the relatively healthy outpatients, and their decisions may later change, but it's very important that the patient thought about these questions in advance, especially given the frequency of mental disorders in the last days of life in patients with HIV infection.

It takes time, but ...

It takes time, but in return you get a higher level of trust between doctor and patient. This confidence and active involvement of the patient can facilitate the adoption of many difficult decisions that need often arises in the course of HIV-infected patients. In discussing the diagnosis should begin with an assessment of patient awareness and the degree of concern. Many people at high risk of infection, are already aware of cases of HIV infection and death caused by this infection, among friends and acquaintances. Thus, this disease may be familiar to them. Yet they need information relevant to their particular case. The physician must submit the required information. carefully selecting an expression. appropriate medical knowledge the patient, not forgetting about how emotionally vulnerable is the patient at this time. The first discussion of the diagnosis to be frank, with unprofessional terminology, and brief physician must understand that the patient does not "hear" a detailed description of various options for treatment of the disease. This should be deferred until the next visit, scheduled for the next few days if the patient is not hospitalized. If a patient has a close friend or family member should be invited to participate in the discussion of the diagnosis, as he, having no direct relation to what is happening, can hold more data in memory in order to inform and support the patient after the visit to the doctor. Medical information for patients with newly diagnosed HIV infection should include the exact wording of a medical diagnosis of HIV-related (eg, PCP), as well as a simple description of the disease. The doctor should explain in accessible language the relationship with a specific diagnosis of HIV infection (for example, "Available pneumonia indicates that you have AIDS, an advanced stage of HIV infection"), without an accent on the word "AIDS". Doctor should tell the patient that HIV infection is a progressive chronic process on the availability of various treatment options at different stages of infection. Necessary to emphasize the need for urgent action to address the clinical problems. The physician should not try to downplay the importance of HIV infection, but at the same time, we should not indulge in arguments about the prognosis for the future, especially not need to count the remaining time of life. Realistic optimism Although prognosis of HIV infection generally unfavorable, it is not universal. Patients with newly diagnosed sure it should be emphasized that the statistics on the probability of death can not be directly transferred to a specific case. It is also important to explain to the patient that the amount of knowledge about HIV and its attendant diseases is increasing rapidly, there is an intensive development and testing of drugs in the future be able to stop the destructive action of the virus. One could also mention that the treatment of cancer and infections associated with HIV are also improving.

Exercises on relaxation and guided ...

Exercises for relaxation and guided presentation could also be useful methods to reduce symptoms for practitioners who have this experience. Applying this technique teens turn out to be able to identify signs of stress caused by stress and exercise control over their symptoms. Referral to a hospital for pain control or in the center is useful for patients with complex symptoms do not respond to other interventions. Warning Warning psychosomatic problems of psychosomatic problems is the desired goal. Concept of what stress is an inevitable part of human life should be conducted in early adolescent age (or before) as a preventive measure. Discussion of how everyday stressors especially those of you out to be changes may affect all the sensations the patient and his welfare should be included in a program of preventive visits to children and adolescents. Clinicians can also watch the efforts of young people to resist physical symptoms and can change the expression of the reaction in the small symptoms of the disease. Discussion of strategies to enhance the competence and experience of conflict are also helpful. For example, a teenager can be taught, that a single symptom such as headache or abdominal pain, may be a warning signal schim-stress and do not necessarily indication of organic disease. Once such a connection becomes clear and there is a symptom, should include strategies to reduce stress. The main strategy is to talk with the trustee of the stressor and symptoms. Family physicians and other health professionals working with interest with experience and time to develop relationships with the young person may well fulfill this important role. Summary of Psychosomatic problems quite frequent in adolescents and often stress plays an important role in their development and maintenance. Armed with the knowledge of the stressors experienced by adolescents, individual vulnerability and competence and their level of social support physician can systematically evaluate each of these factors. When the assessment is completed plan should be developed for treatment direction for a psychosomatic problem. Withdrawal symptoms, lowering stress and promote competence are key interventions that can start a family physician. When consulted, and other methods of treatment of stress a family physician must maintain contact with the patient and his family and remain an integral part of the team conducting the treatment. Brief discussion on the potential role of stress in health and disease prevention with a doctor's visit may also help prevent the development of psychosomatic problems in adolescents. Source: John W. Green and Lynn S. Walker - PSYCHOSOMATIC PROBLEMS AND STRESS IN ADOLESCENCE / PEDIATRIC CLINICS OF NORTH AMERICA, 1997, vol. 44, N. 6 Translated from English - M. Bogdanov article was published on the website http://www.medafarm.ru

How do I report a patient of a positive test for HIV?

Honesty First of all, introducing a patient with a diagnosis of HIV infection should give him the opportunity to participate in subsequent decisions, providing it with necessary information in an intelligible form.

Questions about possible life ...

Questions about the possible stresses of life shows that the conditions of life-or teen is important. Careful listening can facilitate the patient's ability to think through the situation and determine an effective strategy of confrontation. Improvement in symptoms may occur when the teenager would be able to see new perspectives and learns new ways to confront stressors. Treatment for the treatment of stress and advice Appeal to psychiatrists about stress management and counseling may be indicated in some cases. The attending physician should clearly explain what he or she will remain an integral part of the team treating. Therefore, follow-up visits with a clinician should be designed so as to make progress, to demonstrate commitment and ensure follow-up with any consultant. While many parents recognize that this stress may play a role in psychosomatic complaints, few people perceive counseling as potentially fertile. This rejection of the advice may be associated with an incorrect interpretation of that consultation is required only suffering from severe psychosocial problems. According to the authors' experience, many families are taking recourse to a psychologist or other specialist on health behavior if the purpose of this is to help the teenager cope with its symptoms. Definitive observation of a doctor, such as "The value of portable discomfort you must be great to protiovstoyat he" may initiate a discussion on the acceptance consultant. In cases where symptoms are long and complex useful advice to both patient and family. Some therapists prefer to see as a teenager and his family. Others believe that useful for the consultant to see the teenager, the other that family. Other methods of intervention excitation and depression is often accompanied by psychosomatic symptoms. Doctors familiar with the use of psychotropic drugs obychnm can write their teens surveyed psychologist or social worker for psychotherapy. Others are less familiar with the use of anxiolytics and antidepressants may send their patients to a psychiatrist for medication. Physical or okupatsionalnaya therapy may be beneficial for adolescents with musculoskeletal pain, and sometimes those with the lethargic, chronic fatigue syndrome or generalized weakness. We found that adolescents with chronic musculoskeletal pain respond well to a combination of rehabilitation and counseling. This approach allows under-shoots of gratitude and gradually rehabilitate the musculoskeletal system, directing the psychosocial care through competing conversation. Biofeedback is beneficial for some patients, particularly those capable of responding to specific visible evidence of stress reduction. Biofeedback may be an acceptable addition for families who refuse advice, but wishing to invest in a method aimed at reducing symptoms in adolescents.

For example, a parent can help ...

For example, a parent can help the hobby new hobby or activity to encourage the aspirations of the teenager and to facilitate acquisition of new capabilities. Such attention is a positive alternative to focusing on symptoms and impotence. Back to school and work Skipping lessons common in adolescents with psychosomatic complaints, failure to return to school can lead to increased feelings of helplessness and perpetuation sick role. If a teenager was missing school a return to class and other activities should be scheduled as soon as it will only be possible, but adolescents and their parents may resist returning to school, resulting in a number of reasons. A teenager may feel fear returning because he or she have academic debts. Some also fear the return of a peer group and explain their otsutsvtiya friends. It is useful to a gradual return to school. Stay in school the day it would be a good start, which made it possible for a germ-a gradual entry into the academic, physical and social environment of schools. Academic difficulties including the inability of training should be evaluated in patients undergoing long-term difficulties with poor grades. Psihouchebnoe testing clinical psychologist may help to differentiate between low achievement associated with school absence, and those associated with learning disabilities. Often, adolescents with somatic complaints asking exemption from physical education or gymnastics. So it may be useful for some in terms of reducing the duration of their physical activity, the presence of physical education classes should be encouraged to further the return to full load. Should maintain contact with the school to coordinate efforts to vozvrascheiyu teenager in the class and discuss the possibility of relating to home instruction. Many teenagers observed in the clinic of the author, engaged in clinical somatic complaints, received instructions to return home, given by the physician. Often, the continuation is the primary cause of his visit to the clinic. When given home instruction is best to set some time limit. The authors consider it useful to consult individually with the family to continue the home lessons. The role of family doctor family doctor may choose some of the cases and treat them completely and others in the team. Depending on the experience and interests of the doctor's brief focused and psychologically informed treatment in first aid can be very effective. Consultation at the office may have the character of the support and focus on the current situation and ways to overcome them. Does the physician self-treatment or act within a team of young people benefiting from the fact that they have an affordable, credible and unbiased confessor outside the family. Professionals to perform this role can have a positive impact on the system of social support the adolescent.

Non-narcotic analgesics preferable with respect to ...

Non-narcotic analgesics are preferable with respect to those developing the habit. Antispasmodic and changes in diet, as increasing acceptance of products containing an increased amount of fiber may have beneficial effects on patients with chronic abdominal pain and IBS. Patients with indigestion syndromes can receive therapy to H2-blockers. Antidepressants can be used in some patients with psychosomatic problems including recurrent pain and depressive symptoms, even if they do not meet all the criteria of major depression. Tricyclic drugs, or selective serotonin inhibitor drugs seizure (SSRI), such as fluoxetine and paroxetine may be useful in some adolescents. Stress reduction Many teenagers and their families are able to perceive the possibility of stress in the development and maintenance of symptoms. Should therefore be planned intervention aimed at promoting adolescent stressors and to withstand stress. If possible it is desirable to delete specific stressors. For example, the removal of a teenager from a difficult life situation to protect adolescents from the source tyaezhlogo distress. On older adolescents may adversely affect high adult responsibilities such as work after school, nyanchanie younger brothers and sisters and everyday chores. Reduction and change some of these teenagers of responsibility may reduce stress and eliminate somatic complaints. Many parents have great both direct and indirect pressure on their teens both in terms of physical development and academic achievement. In some cases, symptoms can be a teen message to parents behind. Teen-athlete who participates in the early years of the competition may be tired from the competition but could not make it sovim ambitious parents. A teenager may feel fear that parents will be disappointed. Reducing academic pressure as a decrease in the number of prestigious occupations may be desirable for the release of some successful young schoolchildren. Fostering competence Teenagers regard themselves as incapable for social academic or athletic activities have a greater propensity to maintain their symptoms. For those with in-takmi acceptance normal activities may threaten self-esteem and regarded as stressful. Interventions to support and facilitate adolescent competence in various activities has two potentsalnyh blagodeystvuyuschih points: (1) increased competence can increase the ability of teenagers to engage in potentially stressful activities, and (2) engaging in various activities may divert attention from the symptoms of a teenager. A doctor can help in identifying areas of current and emerging kompetenetnostey and help parents in the development of special interests and abilities of a teenager in these areas.