Amateur Pshrink VI: Major Depression

Major Depressive Disorder

Signs & Symptoms

• Persistent sad, anxious, or "empty" mood
• Feelings of hopelessness, pessimism
• Feelings of guilt, worthlessness, helplessness
• Loss of interest or pleasure in hobbies and activities that were once enjoyed
• More about Signs & Symptoms »

I am currently taking Cymbalta as an antidepressant, Zyprexa sedative and antipsychotic, and Zonegran antiseizure medicine. I was taking Seroquil but quit using it. I was also taking Klonopin but quit using it too. It has some unpleasant side effects.

I take Verapamil, quite a large dose, twice daily, because the calcium channel blocker mechanism seems to prevent my basilar type attacks, as well as lowering blood pressure. I also take Plavix which does something to prevent blood clotting as normal.

Without the Seroquil I was only able to sleep for an hour or two per day. Apparently some brain mechanism that regulates my sleeping was damaged in one of my brain stem strokes.

Amateur Pshrink III

This one sounds like fun too! I wanna get all of em!

Better than collecting old comic books!

Münchausen syndrome is a psychiatric disorder in which those affected feign disease, illness, or psychological trauma in order to draw attention or sympathy to themselves. It is in a class of disorders known as factitious disorders which involve "illnesses" whose symptoms are either self-induced or falsified by the patient. It is also sometimes known as hospital addiction syndrome.
In Münchausen syndrome, the affected person exaggerates or creates symptoms of illnesses in themselves or their child/children in order to gain investigation, treatment, attention, sympathy, and comfort from medical personnel. In some extremes, people suffering from Münchausen's Syndrome are highly knowledgeable about the practice of medicine, and are able to produce symptoms that result in multiple unnecessary operations. For example, they may inject a vein with infected material, causing widespread infection of unknown origin, and as a result cause lengthy and costly medical analysis and prolonged hospital stay. The role of "patient" is a familiar and comforting one, and it fills a psychological need in people with Münchausen's. It is distinct from hypochondriasis in that patients with Münchausen syndrome are aware that they are exaggerating, whereas sufferers of hypochondriasis believe they actually have a disease.
In 1951, Richard Asher was the first to describe a pattern of self-harm, where individuals fabricated histories, signs, and symptoms of illness. Remembering Baron Münchausen, Asher named this condition Münchausen's Syndrome in his article in The Lancet in February 1951, quoted in his obituary in the British Medical Journal:

"Here is described a common syndrome which most doctors have seen, but about which little has been written. Like the famous Baron von Münchausen, the persons affected have always travelled widely; and their stories, like those attributed to him, are both dramatic and untruthful. Accordingly the syndrome is respectfully dedicated to the Baron, and named after him."

—British Medical Journal, R.A.J. Asher, M.D., F.R.C.P.

Originally, this term was used for all factitious disorders. Now, however, there is considered to be a wide range of factitious disorders, and the diagnosis of "Münchausen syndrome" is reserved for the most severe form, where the simulation of disease is the central activity of the affected person's life.

Risk factors for developing Münchausen syndrome include childhood traumas, and growing up with caretakers who, through illness or emotional problems, were unavailable.
Medical professionals suspecting Münchausen's in a patient should first rule out the possibility that the patient does indeed have a disease state, but it is in an early stage and not yet clinically detectable. Providers need to acknowledge that there is uncertainty in treating suspected Münchausen patients, so that real diseases are not under treated. Then they should take a careful patient history, and seek medical records, to look for early deprivation, childhood abuse, mental illness.
Medical professionals should avoid surgical and diagnostic procedures, if they do not seem absolutely warranted – this may well anger the Münchausen patient who seeks out such procedures and attention. At the same time, providers should attempt to form an alliance with the patients, identifying with the emotional pain they may have suffered leading to this behavior.
Medical providers should consider working with mental health specialists to help treat the underlying mood or disorder and well as to avoid countertransference, Therapeutic and medical treatment should center on the underlying psychiatric disorder: a mood disorder, an anxiety disorder or borderline personality disorder. The patient's prognosis depends upon the category under which the underlying disorder falls; depression and anxiety, for example, generally respond well to medication and/or cognitive behavioral therapy, whereas borderline personality disorder, like all personality disorders, is presumed to be pervasive and more stable over time ^[5], thus offers the worst prognosis.
If a patient is at risk to himself or herself, inpatient psychiatric hospitalization should be initiated.

Illnesses and conditions commonly feigned by Münchausen patients

• Acid reflux
• AIDS
• Anemia
• Anxiety disorder
• Arthritis
• Back pain
• Bipolar disorder (manic depression)
• Cancer
• Cushing's Syndrome
• Depression
• Dissociative identity disorder
• Eating Disorders
• Fibromyalgia
• Heart disease, heart attack
• Immunodeficiency
• Infection
• Joint pain
• Lupus
• Muscle pain
• Migraines
• Kidney disease
• Post-traumatic stress disorder
• Seizures
• Sexual abuse
• Spousal abuse
• Suicidal ideation or suicide attempt

• May have multiple scars on abdomen due to repeated "emergency" operations

Note that many of these conditions do not have clearly observable or diagnostic symptoms.

See also

• Fabricated or induced illness, also known as Münchausen Syndrome by Proxy
• Histrionic personality disorder
• Munchausen by Internet
• Mythomania
• Psychosomatic illness

Amateur Pshrink II

I like this one too. Can I be both? Huh, can I, can I ?

Histrionic personality disorder (HPD) is defined by the American Psychiatric Association as a personality disorder characterized by a pattern of excessive emotionality and attention-seeking, including an excessive need for approval and inappropriate seductiveness, usually beginning in early adulthood. These individuals are lively, dramatic, enthusiastic, and flirtatious. They may be inappropriately sexually provocative, express strong emotions with an impressionistic style, and be easily influenced by others.

People with this disorder are usually able to function at a high level and can be successful socially and professionally. People with histrionic personality disorder usually have good social skills, but they tend to use these skills to manipulate other people and become the center of attention. Furthermore, histrionic personality disorder may affect a person's social or romantic relationships or their ability to cope with losses or failures. People with this disorder may seek treatment for depression when romantic relationships end, although this is by no means a feature exclusive to this disorder. They often fail to see their own personal situation realistically, instead tending to dramatize and exaggerate their difficulties. They may go through frequent job changes, as they become easily bored and have trouble dealing with frustration. Because they tend to crave novelty and excitement, they may place themselves in risky situations. All of these factors may lead to greater risk of developing depression.

The cause of this disorder is unknown, but childhood events such as deaths in the immediate family, divorce of parents and genetics may be involved. Histrionic Personality Disorder is more often diagnosed in women than men; men with some quite similar symptoms are often diagnosed with antisocial personality disorder.However, Psychiatrist Dr. Rhoda Hahn supposes that it may be more often diagnosed in women because attention-seeking and sexual forwardness are typically considered to be less socially acceptable for women than for men, and, as suggested by Jonathan Oore, a more efficient means of initial social advancement.

Little research has been conducted to determine the biological sources of this disorder. Psychoanalytic theories incriminate seductive and authoritarian attitudes by fathers of these patients.

The symptoms include:

* Constant seeking of reassurance or approval.
* Excessive dramatics with exaggerated displays of emotions.
* Excessive sensitivity to criticism or disapproval.
* Inappropriately seductive appearance or behavior.
* Excessive concern with physical appearance.
* A need to be the center of attention (self-centeredness).
* Low tolerance for frustration or delayed gratification.
* Rapidly shifting emotional states that may appear shallow to others.
* Opinions are easily influenced by other people, but difficult to back up with details.
* Tendency to believe that relationships are more intimate than they actually are.
* Making rash decisions.
* Threatening or attempting suicide

The person's appearance, behavior, and history, along with a psychological evaluation, are usually sufficient to establish the diagnosis. There is no test to confirm this diagnosis. Because the criteria are subjective, some people may be wrongly diagnosed as having the disorder while others with the disorder may not be diagnosed. Treatment is often prompted by depression associated with dissolved romantic relationships. Medication does little to affect this personality disorder, but may be helpful with symptoms such as depression. Psychotherapy may also be of benefit.

The Diagnostic and Statistical Manual of Mental Disorders, a widely used manual for diagnosing mental disorders, defines histrionic personality disorder as a pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1. Is uncomfortable in situations in which he or she is not the center of attention
2. Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior
3. Displays rapidly shifting and shallow expression of emotions
4. Consistently uses physical appearance to draw attention to self
5. Has a style of speech that is excessively impressionistic and lacking in detail
6. Shows self-dramatization, theatricality, and exaggerated expression of emotion
7. Is suggestible, i.e., easily influenced by others or circumstances
8. Considers relationships to be more intimate than they actually are.

A mnemonic that can be used to remember the criteria for histrionic personality disorder is PRAISE ME:

* P - provocative (or seductive) behavior
* R - relationships, considered more intimate than they are
* A - attention, must be at center of
* I - influenced easily
* S - speech (style) - wants to impress, lacks detail
* E - emotional lability, shallowness

* M - make-up - physical appearance used to draw attention to self
* E - exaggerated emotions - theatrical

Histrionic Personality Disorder shares a divergent history with Conversion disorder and Somatization Disorder. Historically, they are linked to the ancient notion of hysteria, or "wandering womb." (Note, however, that according to the Online Etymology Dictionary, the word "histrionic" derives not from the Greek hystera, but from the Latin histrionicus, "pertaining to an actor.") Ancient Greeks thought that excessive emotionality in women was caused by a displaced uterus and sexual discontent. Christian ascetics during the Middle Ages blamed women's mental problems on witchcraft, sexual hunger, moral weakness, and demonic possession. By the 19th century, medical explanations proposed a weakness of women's nervous system related to biological sex. Thus, "hysteria" reflected the stereotype for women as vulnerable, inferior, and emotionally unbalanced. The extent to which the definition of Histrionic Personality Disorder currently reflects gender bias remains the subject of a controversy.

"Hysteria" differentiated into conversion hysteria (later to become Conversion disorder) and hysterical personality (later to become Histrionic personality disorder) in the psychoanalytic literature as well as with the writings of Kraepelin, Schneider, and others. Sigmund Freud wrote primarily about conversion hysteria. Wilhelm Reich wrote about hysteria as a set of personality characteristics and differentiated conversion hysteria as a transient disorder from hysterical character. These early conceptualizations of both kinds of hysteria carried notions of women's deficiency due to penis envy and feelings of castration. Paul Chodoff has written about the ways in which these diagnoses paralleled the misogynistic sentiment of the times.

The concept of hysterical personality was well developed by the mid-20th century and strongly resembled the current definition of Histrionic Personality Disorder. The first DSM featured a symptom-based category, "hysteria" (conversion) and a personality-based category, "emotionally unstable personality." DSM-II distinguished between hysterical neurosis (conversion reaction and dissociative reaction) and hysterical (histrionic) personality. In DSM-III, the term Hysterical Personality changed to Histrionic Personality Disorder to emphasize the histrionic (derived from the Latin word histrio, or actor) behavior pattern and to reduce the confusion caused by the historical links of hysteria to conversion symptoms. The landmark case of Ruth E. helped to fully define and emphasize the characteristics of the current DSM-IV diagnostic. DSM-III-R attempted to reduce the overlap between Histrionic Personality Disorder and Borderline Personality Disorder by dropping three overlapping criteria and adding two criteria that emphasized histrionicity. DSM-IV dropped two more criteria that did not appear to contribute to the consistency of the diagnosis, according to research done by Bruce Pfohl.

Associated features may include egocentricity, self-indulgence, continuous longing for appreciation, feelings that are easily hurt, and persistent manipulative behaviour to achieve own needs.

Because of the lack of research support for work on personality disorders and long-term treatment with psychotherapy, the empirical findings on the treatment of these disorders remain based on the case report method and not on clinical trials. On the basis of case presentations, the treatment of choice is psychotherapy aimed at self-development through resolution of conflict and advancement of inhibited developmental lines. Group therapy is not recommended for those with HPD because it provides the person with an audience to play to (perform for), giving opportunity to perpetuate histrionic behavior.

* Family therapy
* Medications
* Alternative therapies

The HPD is highly reactive. If there is another major disorder present, such as delusional disorder, then emotional intensity will create anger, rage, abuse and distance in relationships.

It is important for the therapist and family members to monitor and record all situations that trigger the HPD so that the deep underlying overload of pain can be accessed and released for therapeutic change.

Amateur Pshrink

Who fits this characterization?

Narcissistic personality disorder (NPD) is a personality disorder defined by the Diagnostic and Statistical Manual of Mental Disorders, the diagnostic classification system used in the United States, as "a pervasive pattern of grandiosity, need for admiration, and a lack of empathy."

The narcissist is described as turning inward for gratification rather than depending on others, and as being excessively preoccupied with issues of personal adequacy, power, and prestige. Narcissistic personality disorder is closely linked to self-centeredness.

DSM-IV divides personality disorders into three clusters based on symptom similarities. This clustering categorizes the narcissistic personality disorder as a cluster B personality disorder, those personality disorders having in common an excessive sense of self importance. Also in that cluster are the borderline personality disorder, the histrionic personality disorder and the antisocial personality disorder.

A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1. has a grandiose sense of self-importance
2. is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
3. believes that he or she is "special" and can only be understood by, or should associate with, people (or institutions) who are also "special" or of high status.
4. requires excessive admiration
5. has a sense of entitlement
6. is interpersonally exploitative
7. lacks empathy
8. is often envious of others or believes others are envious of him or her
9. shows arrogant, haughty behaviors or attitudes

Signs of a Stroke?.....

I copied this info from here, but much the same can be found about the health network on the internet.

Stroke: Know the Symptoms
The warning signs of a stroke may include:

• Visual problems like a sudden change in vision or sudden double vision
• Numbness of the face, weak arms or legs, weakness on one side of the body
• Disorientation, problems with speech (e.g., slurred speech), and/or trouble understanding others
• Trouble walking, dizziness, loss of balance or coordination
• Painful headache that comes on suddenly and has no known cause

Stroke: Risk Factors
Some stroke factors can be controlled; others can’t. Here are some key risk factors that you should be aware of:

• Age. Once you turn 55, your risk of stroke practically doubles every decade.
• Family and personal history. If a close family member has had a stroke, or if you have had a stroke, TIA ( transient ischemic attack, a small stroke that causes little or no damage), or heart attack, your stroke risk is increased.
• Other health conditions.High blood pressure, high cholesterol, diabetes, heart disease, atrial fibrillation, and sickle cell anemia are all factors that increase your risk for stroke.
• Your lifestyle.Smoking cigarettes, eating a high-fat and/or high-sodium diet, being obese, and not getting enough exercise can all increase your risk of stroke.

Stroke: Early Treatment
Every second counts when restoring blood flow to the brain because with every second lost, more brain cells die. Early recognition of stroke symptoms is crucial — the sooner treatment is given, the better.
One of the best treatments for blood clots — the cause of ischemic strokes — is tissue plasminogen activator, or t-PA, a clot-busting drug that works quickly to dissolve a clot and restore blood flow to the brain. But it must be given within the first few hours after symptoms start. While t-PA is not appropriate for people who suffer a hemorrhagic (bleeding) stroke, about 80 percent of strokes are caused by blood clots.
Anti-clotting medications and other blood thinners may also be given to people who have had an ischemic stroke, to help reduce the risk of another blood clot forming. Emergency surgery may also be done to open a blocked artery or repair a burst blood vessel.
The best thing to do if you or someone you know may be experiencing symptoms of stroke is to call 911 to get the most immediate medical attention possible.

Signs of a stroke?... Maybe, maybe not...

On Wednesday afternoon, I was taking a short nap, and when I woke up I felt very groggy and sick like I had before when I was having a stroke. I tried to get into the house from my bedroom, but had a very hard time walking. My right leg was very uncooperative, and my whole body felt numb, especially my head. It felt detached and light, like it was floating off somewhere separate from the rest of me. My face was undergoing the numb tingling feeling like a plastic mask over my nose and cheeks.

I stumbled into the house, and could only mumble stupid noises at my dad, who told me to lay on the couch. I laid down for a while, but the bad feeling and confusion continued to build. Finally I tried to speak to dad to tell him I thought something was wrong, but by that time my words were coming out as unrecognizable gibberish syllables. I sat helpless and gibbering for a time while dad deliberated with mom about what to do, and they finally decided to call 911 for help.
I was about past noticing by then, but I understand that a whole herd of friend and neighbors showed up to guide the ambulance and help load me up.
I don´t remember much of the long night, after that, but apparently after some deliberation st Sanpete Valley Hospital, I ended up riding in the ambulance with Shannon Nuttall and friends to Utah Valley Regional Medical Center, where I was admitted for suspected stroke.
To make a long story short, the Neurologist, Dr. Butrum, ordered a MRI brain scan, and found no new stroke damage. Either the new deficits are short-term artifacts of basilar migraine spasms, or they are products of TIAs affecting areas previously stroke-damaged brain stem areas with new deficits. In any case, the major aphasia cleared up fairly quickly, after a rather frightful episode of speechlessness.
Let that be a lesson to all. The call to 911 was exactly the right thing to do, because there is no way short of MRI scan to distinguish quickly between symptoms of ischemia and other neurological weirdness. In this case, MRI is the right tool, at the right time. I spent another night in the hospital, under the watchful care of several kind and compassionate staff, then was released to go home on Friday. Thanks to doctors and care providers for quick thinking and acting -- it might have been otherwise.