panic disorder

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It is hard for me to digest the events of July 14 in Nice, France, as I feel especially close to them.

I was present at seven such annual patriotic ceremonies during my tenure as a student of medicine in a French government facility.  I loved the street-fair atmosphere, where I sang at the top of my lungs and danced with a whole heart.

As a medical student in government service, a terrorist attack would have mobilized me into service of France, a nation I can only love, which gave me a medical education essentially free of charge, asking only for me to prove on an exam that I had what it takes.

I wear a tiny Eiffel Tower around my neck — I stroke it as I write. Read more on Terrorism In Nice…

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I was poking around, looking for what is brewing in psychopharmacology; a field I am no longer particularly proud I spent a lot of time studying and working in.  Strange, or maybe not so strange, that I’ve met both of the principals allegedly involved in this pharmacological ghostwriting scandal.

Ghost WriterI saw Dr. Schatzberg when he led various sessions at a large professional meeting on the coast.  My main memory of him is that he looked tired, maybe even a bit depressed.  I was told I had to write a lot of articles and do a lot of research projects, so maybe someday when I grew up I could do this kind of work.  I was told, often and a lot, that I had plenty enough neurons, so it would only take work, and a lot of it.  Dr. Nemeroff actually came to Kansas between visits to the coasts.  He was friends with my preceptor in psychopharmacology.  He came to speak at our grand rounds, where we were awe struck by the large amount of patients seen, as well as the large amount of numbers and lovely statistics.

Read more on Who Knows Who Writes This Stuff?…

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The patient was no Paris Hilton, and the clinic where I saw her is not someplace Ms. Hilton would ever frequent.  But one thing the two women had in common was carrying a dog in a handbag.

I often see ladies carry in more than one bag – a standard handbag and perhaps a sack full of medical records.  I’d never had anyone bring a purse-dog in to an interview, though. Read more on Is There Anything A Service Dog Can’t Do?…

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Ahh – 19 years old!  It is a magical age.  At least it has been my experience in public mental health clinics.

You see, almost without exception any male of 19 years who appears in my office – is a really messed up and sometimes just, plain rotten fellow.

I don’t know what it is about 19.

Caffeine addict sitting at computer with IV drip of coffeeOne of the typical cases – though legally an adult — was functionally a kid, living with his parents and acting out the same kind of adolescent rebellion that most go through at 14 or 15 and out-grow by 17.

Oh, he had it all — One of those cylinders in his earlobe, spreading a hole from a small piercing to the size of a basketball. He told me it was “tribal.” He was a music major at a local, broken down branch of the state college.  He wanted to be a performance artist.

Read more on Yes, Virginia — Coffee Can Cause Illness…

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I try really hard to make my time with patients count. I talk to them just like I would talk to a family member or next door neighbor. Although this occasionally frightens them, they generally get pretty relaxed and ask me questions I can’t believe they would come up with. I think they do this — and I connect with them — because I do something called “mirroring.” Yes, you can try this at home.

I will always be happy that at some point in my residency I dragged myself to Kansas City to sit in some hotel function room and study Neuro Linguistic Programming, now known colloquially as “NLP,” with one of its originators. Read more on NLP And Mirroring…

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People who have panic disorder go to doctors to take care of it.  I have had maybe hundreds of patients, more than I can count over my years of practice, who have come to me with this.  Most of them do well. Usually the panic disorder runs its course.

That is not to say that panic disorder is not terrifying.  Often people believe that their first panic attack is a heart attack.  Often they have come to me already addicted to benzodiazepines by emergency room physicians who (understandably) worry a lot more about the immediate comfort of the patient than about the long term situation. Here is the official government take on panic disorder. Yes, find a psychiatrist you can trust. Yes, they recommend family and support groups.  Good stuff, but free and easy to recommend. Yes, there is some exciting new research but as long as insurance companies and HMOs determine how people get treated, it is unlikely that research will be quickly translated into treatment.

Most people who go with the mainstream treatment do pretty well. Here is another description of mainstream treatment, a little more complete. Read more on A Real Doctor — Like House MD…