Problems

Anxiety is a very common problem. About 15% of people suffer with it over their lifetimes as either acute, chronic or episodic.

Panic Attacks can be situational, biological, episodic or chronic. They are best treated with Clonazepam or Clorazepate and psychosocial treatments that include self-hypnosis.

Generalized Anxiety Disorder is characterized by physical symptoms that are episodic or chronic. It is treated with psychosocial treatments and anti-depressants.

Obsessive Compulsive Disorder is typically a lifetime condition that responds to medications that enhance serotonin.

Social Phobia, excessive shyness, is characterized by blushing, sweating and tremor. It responds to drugs that enhance serotonin and psychosocial treatments.

Post Traumatic Stress Disorder (PTSD) is associated with exposure to extreme events. It responds to psychosocial treatments and may also respond to medications.

Depression may occur singly, episodically, or seasonally and can be triggered by conflicts or secondary to medical problems. The best results are usually obtained with anti-depressants, education and psychosocial treatments including cognitive therapy.

Bipolar Disorder, manic depressive illness, occurs classically with euphoric, manic symptoms alternating with depressive symptoms. A more common variant is one with high irritability alternating with depression characterized by lethargy, weight gain, and excessive sleep. The primary treatments include use of mood stabilizing agents and education that includes family.

Psychosis is a general name for being out of touch with reality, having delusions and hallucinations as well as apathy and social withdrawal. Schizophrenia is the most common disorder. Schizoaffective disorder appears as a blend of schizophrenia and bipolar disorder. Other problems that include psychotic thinking are delusional disorder and some depressions. Medication, psychotherapy and family education are used with a rehabilitative focus.

Alcoholism and substance abuse can occur singly or in combination with other disorders. In addition to conventional treatments that focus on social support like 12 step programs, individual and family treatment can be enhanced with innovative medications that can block cravings.

Cognitive Difficulties can be hereditary, traumatic or secondary to illness.

Developmental Disabilities begin in childhood with cognitive impairment and may include behavioral problems. These include Down’s Syndrome, Asperger’s Syndrome, Autism and others. The treatments are targets at the particular symptoms.

Attention Deficit Disorder presents with or without hyperactivity in childhood and includes symptoms of inattention, distractibility, poor concentration, difficulty with organization and forgetfulness. Other symptoms may include impulsivity, impatience, restlessness, and difficulty with task completion. The treatments most commonly include use of stimulants or Strattera as well as focus on acquiring appropriate skills and behaviors.

Dementias include Alzheimer’s Disease, Multi-infarct dementia and others. There are two classes of drugs that may slow progression and/or help with memory. If other symptoms of anxiety, depression or psychosis develop, they are treated symptomatically.

Head Injuries may be followed by problems of memory and/or concentration, which may respond to medication for these problems as well as behavioral focus on adaptations.

Relationship Problems occur in the family settings of couples, siblings or parent/child relationships.

Couples Conflicts in common areas like money, sexuality and parenting frequently arise from unclarified assumptions. A typical path to improved communication and to find stable compromise comes from dialogue about the patterns and “rules” in each person’s family of origin. A focus on the styles of communication in conflict works as well.

Parent-Child Conflicts most commonly come from lack of parental agreement and consistency. They can also come from significant differences of temperament and from developmental steps such as emancipation.

As parents age, the adult “child” can experience role reversal. Their role in parental care may create conflicts with their parents, siblings or nuclear family. Open discussion of these conflicts can lead to constructive problem solving.

Work Concerns may be relational with superiors, peers or subordinates. These may be related to managerial styles or to personal issues. Family business relationships pose a special set of problems related to boundaries and expectations. Other areas of concern include job seeking, promotion, retirement, education, training and security.

With Physician leaders, I offer consultation regarding the psychological issues of group dynamics, governance, and conflict management.

Sexual Concerns can be biologically, psychologically, or relationally based. Typically, a clear explicit discussion of the problem is a start to the problem solving process. Other problems include, but are not limited to, anxiety and self-esteem as they may interfere with initiation, arousal or satisfaction. Problems of abuse or incest as well as addictive behaviors commonly cause blocks to intimacy and sexual satisfaction.

Character and Attitude difficulties are treatable with psychotherapy when the individual is able to maintain focus on the problems caused by their behavior.