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No medication is needed and the individual is able to function in all areas purchase proscar online man healthy. The second level of mania is hypomania buy proscar 5 mg amex reduce androgen hormone, which means below mania, and it is more intense, and can be seen by spending sprees, food binging and minor disruption of daily living. There may be some absenteeism from work or school, and the tendency to engage in questionable and impulsive behavior exists. However, it is the degree of disruption of daily life and ability to function that determines the degree of mania. While the patient feels confident, attractive and able to perform above and beyond his normal abilities, this false euphoria is the beginning stage of true Bipolar Disorder. Loved ones and family members often mistake this phase for drug use, and manics will describe this as a cocaine-like high. Typical symptoms of full blown mania include rapid and sometimes violent mood swings, with laughter, crying and even rage. A manic may run outside in shirt sleeves or nightgown in a downpour, or may dress in a provocative and exposing way. As the attention span decreases, the mind continues to race, and the manic likes to think of himself as the most clever and humorous individuals. Frequent jokes with an emphasis on punning and rhyming are classic presentation. Also typical is a train of thought termed tangentialIn tangential thinking the individual in an acute manic phase will "go off on tangents. Mania is caused by a biochemical imbalance in the brain, and there are a variety of mood stabilizing medications used in its treatment. The classic medication is lithium carbonate, a naturally occurring salt, which has a narrow range of effectiveness, and can be toxic at high dosages. Another medication, used for both mania and seizure control is carbamazepine (Tegretol). It is the drug of second choice, but may be used if there are health problems such as heart or thyroid conditions that may preclude the use of lithium. Bipolar patients have difficulty seeing that their behavior is out of line or that they can endanger themselves in an acute manic episode. The massive high, which seems abnormal to us seems normal to them, and there is an unfortunate tendency to self medicate or avoid medication whatsoever. A manic who has been up for days without sleep or proper nutrition is at risk for developing manic related psychosis. Symptoms may include increased vigilance, paranoia, hallucinations such as believing others are whispering about them or are devils. In this phase acute, and frequently locked psychiatric observation and treatment is required. At this extreme level of mania, it is common to find no therapeutic level of Lithium or Tegretol in the bloodstream. Strong medications called anti-psychotics or psychotropic often are given such as Haldol and Thorazine. The goal is to rapidly reduce the mania, using the above medications, anti-manic medications and sometimes tranquilizers in combination with close observation. At this level patients cannot safely be managed in the home environment, and may suddenly turn on loved ones or friends. Some hostage situations and murder-suicides have been linked to this extreme and disorienting level of manic behavior. In an article for BP Hope Magazine, HealthyPlace bipolar consumer expert and mental health author, Julie Fast, describes her battle with anger and bipolar:"There are many people in jail because of their anger and bipolar behavior. Children who threaten their parents, women who punch a co-worker, or men who pick fights with strangers are common among people who have this illness. We don???t discuss it much, because so many people are embarrassed by what they have done. All my life, I???ve lived with the embarrassment of mood swings. Indeed, bipolar affects my moods in so many ways that it???s hard to keep track of what is real and what is caused by faulty wiring in my brain. In addition to the symptoms of bipolar, there are drugs, including various steroids, that are notorious for causing anger. If you are both angry and fear losing control, it is best to separate, protecting everyone from injury. If your relative with bipolar disorder is angry and you are not:Remain as calm as you can, talk slowly and clearlyStay in control. People who care for patients, such as those with Bipolar disease, often experience emotional distress, frustration, anger, fatigue, guilt and depression. Respite care is when a temporary caregiver relieves the person who regularly cares for a patient. This can be for part of a day, overnight care, or care lasting several days. People providing respite services can work for an agency, be self-employed, or are volunteers. If angry outbursts are a recurring problem, wait until everyone is calm and then brainstorm acceptable ways in which the person with bipolar disorder can handle angry feelings and remain in control. Below is a list of suggestions that we hope you find helpful. The more you know, the better equipped you will be to know what to expect. DO realize I am angry and frustrated with the disorder, NOT with you. DO let me know you are available to help me when I ask. DO understand why I cancel plans, sometimes at the last minute. DO continue to call me, even when I only seem to want a brief conversation. DO send cards, notes, and other reminders of our friendship or relationship. DO offer me lots of hugs, encouragement, and love, even when I seem to withdraw. Each of us is different and two people with this disorder can feel totally different. Pain is a relative thing, this includes emotional pain. DO let me know that you understand or that you can relate to what I am saying.
They also get tired -- their body chemistry changes proscar 5 mg free shipping prostatic hypertrophy. These things take the edge off their agitated state and help them get through a bad night order 5 mg proscar amex mens health 100. Avoid arguments, problem solving, advice giving, quick referrals, belittling and making the caller feel that has to justify his suicidal feelings. If the person is ingesting drugs, get the details (what, how much, alcohol, other medications, last meal, general health) and call Poison Control at _______________. If Poison Control recommends immediate medical assistance, ask if the caller has a nearby relative, friend, or neighbor who can assist with transportation or the ambulance. In a few cases the person will initially refuse needed medical assistance. Remember that the call is still a cry for help and stay with him in a sympathetic and non-judgmental way. Ask for his address and phone number in case he changes his mind. Your caller may be concerned about someone else who is suicidal. Just listen, reassure him that he is doing the right thing by taking the situation seriously, and sympathize with his stressful situation. With some support, many third parties will work out reasonable courses of action on their own. In the rare case where the third party is really a first party, just listening will enable you to move toward his problems. You can ask, "Have you ever been in a situation where you had thoughts of suicide? A person who feels suicidal should get help, and get it sooner rather than later. Alan Lewis talks about "Coping With Feelings and Thoughts Of Suicide. Our topic is "Coping With Feelings and Thoughts Of Suicide. What is it in an individual that allows them to cross the line from thinking about suicide to actually committing suicide? Lewis: When someone feels like their pain exceeds their resources and their ability to cope, suicide begins to seem like the only option. Can you describe to us how depressed someone can be, before suicidal thoughts really start to take a grip? Can someone who is suffering from depression really tell how depressed they actually are? They see it as a character flaw or a sign of weakness. David: Could you give us some guidelines on how to measure when you are really in trouble? The difficulty, sometimes, is knowing where and how to get it. If physical factors are ruled out, the next stop is a mental health professional. Usually a psychiatrist or psychologist is what people think of, but there are other disciplines that can certainly treat depression, as well as provide a diagnosis. Lewis: Having a good support system helps, although the problem is that as depression gets worse, so does isolation from other people. Lewis: Yes, one of the things I get very concerned about is if someone has made a previous suicidal gesture. Cirafly: What is the best thing to do if you are feeling suicidal? Talking to a friend, or some resource like a hot-line. The web has definitely made getting information and help easier. The important thing is to use whatever is out there. How can I keep out of the hospital this time and keep suicidal thoughts away? Lewis: It depends on how the depression has lifted and what coping skills you can learn. Remember that suicidal thoughts are a symptom of a larger problem which we have termed depression. She is already seeing a psychologist, but what can I do to help her the best I can? Keatherwood: As an online moderator of various mental health support groups, what do you suggest is the best way to deal with people who come into groups saying they are going to kill themselves, or when I receive E-mail saying the same thing? The E-mail is the most bothersome, as I feel a need to respond, but know they need real life help. Lewis: Yes, that will really grab you when that happens. You can click on this link and sign up for the mail list at the top of the page so you can keep up with events like this. HiddenSelf: Do you feel that self-injury is just a stepping stone towards suicide? Now I just cut, but my friend fears my cuts will get worse. Lewis: Correct, and it brings up the problem that often people are struggling with more than one problem: depression combined with anxiety, personality disorder that complicates or worsens the anxiety and the list goes on. Those differences are usually best sorted out in psychotherapy. Turning things around is usually a combination of the appropriate antidepressant medication and the appropriate kind of psychotherapy (not all psychotherapies are equal). Sarah_2004: Can someone say they are depressed without a doctor saying so? However, those kinds of decisions are usually best done by someone who is qualified to do so. Lewis: The "party line" these days for moderate to severe depression is that a combination of antidepressant medication and cognitive-behavioral psychotherapy is what works best. Some people respond to therapy alone, although it usually takes longer, some people respond very well to medication (after about 2-4weeks, depending on the drug). Bipolar Disorder (also known as Manic-Depressive Disorder) is woefully under-diagnosed in adults and children. The doctors admitted me to a hospital, because I was in pain with severe depression. They were right when they said it was all in my head!
Patients with major depressive disorder (MDD) cheap proscar 5 mg mastercard prostate cancer screening guidelines, both adult and pediatric buy generic proscar 5mg online prostate cancer 30s, may experience worsening of their depression and/or the emergence of suicidal ideation and behavior (suicidality) or unusual changes in behavior, whether or not they are taking antidepressant medications, and this risk may persist until significant remission occurs. Suicide is a known risk of depression and certain other psychiatric disorders, and these disorders themselves are the strongest predictors of suicide. There has been a long-standing concern, however, that antidepressants may have a role in inducing worsening of depression and the emergence of suicidality in certain patients during the early phases of treatment. Pooled analyses of short-term placebo-controlled trials of antidepressant drugs (SSRIs and others) showed that these drugs increase the risk of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults (ages 18-24) with major depressive disorder (MDD) and other psychiatric disorders. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24; there was a reduction with antidepressants compared to placebo in adults aged 65 and older. The pooled analyses of placebo-controlled trials in children and adolescents with MDD, obsessive compulsive disorder (OCD), or other psychiatric disorders included a total of 24 short-term trials of 9 antidepressant drugs in over 4400 patients. The pooled analyses of placebo-controlled trials in adults with MDD or other psychiatric disorders included a total of 295 short-term trials (median duration of 2 months) of 11 antidepressant drugs in over 77,000 patients. There was considerable variation in risk of suicidality among drugs, but a tendency toward an increase in the younger patients for almost all drugs studied. There were differences in absolute risk of suicidality across the different indications, with the highest incidence in MDD. These risk differences (drug-placebo difference in the number of cases of suicidality per 1000 patients treated) are provided in Table 1. It is unknown whether the suicidality risk extends to longer-term use, i. However, there is substantial evidence from placebo-controlled maintenance trials in adults with depression that the use of antidepressants can delay the recurrence of depression. All patients being treated with antidepressants for any indication should be monitored appropriately and observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially during the initial few months of a course of drug therapy, or at times of dose changes, either increases or decreases. Families and caregivers of patients being treated with antidepressants for major depressive disorder or other indications, both psychiatric and nonpsychiatric, should be alerted about the need to monitor patients for the emergence of agitation, irritability, unusual changes in behavior, and the other symptoms described above, as well as the emergence of suicidality, and to report such symptoms immediately to health care providers. Such monitoring should include daily observation by families and caregivers. Prescriptions for SEROQUEL should be written for the smallest quantity of tablets consistent with good patient management, in order to reduce the risk of overdose. Screening Patients for Bipolar Disorder: A major depressive episode may be the initial presentation of bipolar disorder. It is generally believed (though not established in controlled trials) that treating such an episode with an antidepressant alone may increase the likelihood of precipitation of a mixed/manic episode in patients at risk for bipolar disorder. Whether any of the symptoms described above represent such a conversion is unknown. However, prior to initiating treatment with an antidepressant, patients with depressive symptoms should be adequately screened to determine if they are at risk for bipolar disorder; such screening should include a detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression. It should be noted that SEROQUEL is approved for use in treating adult bipolar depression. Hyperglycemia, in some cases extreme and associated with ketoacidosis or hyperosmolar coma or death, has been reported in patients treated with atypical antipsychotics, including quetiapine [See ADVERSE REACTIONS, Hyperglycemia ]. Assessment of the relationship between atypical antipsychotic use and glucose abnormalities is complicated by the possibility of an increased background risk of diabetes mellitus in patients with schizophrenia and the increasing incidence of diabetes mellitus in the general population. Given these confounders, the relationship between atypical antipsychotic use and hyperglycemia-related adverse reactions is not completely understood. However, epidemiological studies suggest an increased risk of treatment-emergent hyperglycemia-related adverse reactions in patients treated with the atypical antipsychotics. Precise risk estimates for hyperglycemia-related adverse reactions in patients treated with atypical antipsychotics are not available. Patients with an established diagnosis of diabetes mellitus who are started on atypical antipsychotics should be monitored regularly for worsening of glucose control. Patients with risk factors for diabetes mellitus (eg, obesity, family history of diabetes) who are starting treatment with atypical antipsychotics should undergo fasting blood glucose testing at the beginning of treatment and periodically during treatment. Any patient treated with atypical antipsychotics should be monitored for symptoms of hyperglycemia including polydipsia, polyuria, polyphagia, and weakness. Patients who develop symptoms of hyperglycemia during treatment with atypical antipsychotics should undergo fasting blood glucose testing. In some cases, hyperglycemia has resolved when the atypical antipsychotic was discontinued; however, some patients required continuation of anti-diabetic treatment despite discontinuation of the suspect drug. A potentially fatal symptom complex sometimes referred to as Neuroleptic Malignant Syndrome (NMS) has been reported in association with administration of antipsychotic drugs, including SEROQUEL. Clinical manifestations of NMS are hyperpyrexia, muscle rigidity, altered mental status, and evidence of autonomic instability (irregular pulse or blood pressure, tachycardia, diaphoresis, and cardiac dysrhythmia). Additional signs may include elevated creatine phosphokinase, myoglobinuria (rhabdomyolysis) and acute renal failure. The diagnostic evaluation of patients with this syndrome is complicated. In arriving at a diagnosis, it is important to exclude cases where the clinical presentation includes both serious medical illness (e. Other important considerations in the differential diagnosis include central anticholinergic toxicity, heat stroke, drug fever and primary central nervous system (CNS) pathology. If a patient requires antipsychotic drug treatment after recovery from NMS, the potential reintroduction of drug therapy should be carefully considered. The patient should be carefully monitored since recurrences of NMS have been reported. SEROQUEL may induce orthostatic hypotension associated with dizziness, tachycardia and, in some patients, syncope, especially during the initial dose-titration period, probably reflecting its ~a-adrenergic antagonist properties. Syncope was reported in 1% (28/3265) of the patients treated with SEROQUEL, compared with 0. SEROQUEL should be used with particular caution in patients with known cardiovascular disease (history of myocardial infarction or ischemic heart disease, heart failure or conduction abnormalities), cerebrovascular disease or conditions which would predispose patients to hypotension (dehydration, hypovolemia and treatment with antihypertensive medications). The risk of orthostatic hypotension and syncope may be minimized by limiting the initial dose to 25 mg bid [see DOSAGE AND ADMINISTRATION ]. If hypotension occurs during titration to the target dose, a return to the previous dose in the titration schedule is appropriate. In clinical trial and postmarketing experience, events of leukopenia/neutropenia have been reported temporally related to atypical antipsychotic agents, including SEROQUEL. Agranulocytosis (including fatal cases) has also been reported. Possible risk factors for leukopenia/neutropenia include preexisting low white cell count (WBC) and history of drug induced leukopenia/neutropenia. Patients with a pre-existing low WBC or a history of drug induced leukopenia/neutropenia should have their complete blood count (CBC) monitored frequently during the first few months of therapy and should discontinue SEROQUEL at the first sign of a decline in WBC in absence of other causative factors. Patients with neutropenia should be carefully monitored for fever or other symptoms or signs of infection and treated promptly if such symptoms or signs occur.
Exercising regularly purchase proscar 5mg on line prostate 9 complex, reducing fat and calorie intake buy generic proscar 5 mg line prostate cancer symptoms signs and symptoms, and losing a little weight can help you reduce your risk of developing type 2 diabetes. Lowering blood pressure and cholesterol levels also helps you stay healthy. If you are overweight, then take these steps:If you are fairly inactive, then take this step:If your blood pressure is too high, then take these steps:Reduce your intake of sodium and alcoholIf your cholesterol or triglyceride levels are too high, then take these steps:Learn how to prevent type 2 diabetes through weight loss, regular exercise, and lowering your intake of fat and calories. Making big changes in your life is hard, especially if you are faced with more than one change. You can make it easier by taking these steps:Make a plan to change behavior. Decide exactly what you will do and when you will do it. Think about what might prevent you from reaching your goals. Find family and friends who will support and encourage you. Decide how you will reward yourself when you do what you have planned. Your doctor, a dietitian, or a counselor can help you make a plan. Consider making changes to lower your risk of diabetes. Being overweight can keep your body from making and using insulin properly. Excess body weight can also cause high blood pressure. Body mass index (BMI) is a measure of body weight relative to height. You can use BMI to see whether you are underweight, normal weight, overweight, or obese. Use the Body Mass Index Table (pdf)* to find your BMI. Move across in the same row to the number closest to your weight. Check the word above your BMI to see whether you are normal weight, overweight, or obese. If you are overweight or obese, choose sensible ways to get in shape. Aim for at least 30 minutes of exercise most days of the week. Set a reasonable weight-loss goal, such as losing 1 pound a week. Aim for a long-term goal of losing 5 to 7 percent of your total body weight. By making wise food choices, you can help control your body weight, blood pressure, and cholesterol. Take a look at the serving sizes of the foods you eat. Reduce serving sizes of main courses such as meat, desserts, and foods high in fat. Limit your fat intake to about 25 percent of your total calories. For example, if your food choices add up to about 2,000 calories a day, try to eat no more than 56 grams of fat. Your doctor or a dietitian can help you figure out how much fat to have. Limit your sodium intake to less than 2,300 mg?about 1 teaspoon of salt?each day. Talk with your doctor about whether you may drink alcoholic beverages. If you choose to drink alcoholic beverages, limit your intake to one drink?for women?or two drinks?for men?per day. You may also wish to reduce the number of calories you have each day. People in the DPP lifestyle change group lowered their daily calorie total by an average of about 450 calories. Your doctor or dietitian can help you with a meal plan that emphasizes weight loss. Write down what you eat, how much you exercise?anything that helps keep you on track. When you meet your goal, reward yourself with a nonfood item or activity, like watching a movie. Regular exercise tackles several risk factors at once. It helps you lose weight, keeps your cholesterol and blood pressure under control, and helps your body use insulin. People in the Diabetes Prevention Program (DPP), a large clinical trial, who were physically active for 30 minutes a day, 5 days a week, reduced their risk of type 2 diabetes. If you are not very active, you should start slowly. Talk with your doctor first about what kinds of exercise would be safe for you. Make a plan to increase your activity level toward the goal of being active at least 30 minutes a day most days of the week. Some ways to work extra activity into your daily routine include the following:Take the stairs rather than an elevator or escalator. Get off the bus a few stops early and walk the rest of the way. Some people need medication to help control their blood pressure or cholesterol levels. Ask your doctor about medicines to prevent type 2 diabetes. We now know that many people can prevent type 2 diabetes through weight loss, regular exercise, and lowering their intake of fat and calories. Researchers are intensively studying the genetic and environmental factors that underlie the susceptibility to obesity, pre-diabetes, and diabetes.