Make a Complete Diagnosis

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Panic Away Handbook

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We discussed the difficulties with making a diagnosis in part I. Nevertheless, you need to come to some understanding about the difficulties you are having in order to figure out how to help yourself most effectively. The conclusions you reach will affect the treatment you choose. For example, if you've suddenly begun to experience panic attacks and you feel that nothing in your life causes them, you are more likely to look for medication as a solution. On the other hand, if you connect the panic attacks with the feeling of being out of control ever since your father died of a sudden heart attack, you will probably be more open to psychotherapy and relaxation techniques. If you see schizophrenia strictly as a brain disease, then medication can seem like the only sensible treatment. If you see it as an illness that strongly affects you as a person, however, you are more likely to see the additional value provided by psychotherapy and rehabilitation to help you cope successfully with the illness.

Assess the Etiology, Pathogenesis, and Syndrome Use all the information you can gather about the etiology, pathogenesis, and syndrome. For example, if you are feeling sad and hopeless with tearfulness and insomnia, it's likely you will decide that you have depression (the syndrome). You've been somewhat depressed all your life, and you believe you may have a biological/genetic vulnerability to depression because your mother, aunt, and grandmother have also experienced depression (the etiology). You wonder if your depression is due in part to your parents' divorce when you were a child, but believe it's mostly due to your recent separation from your spouse (the pathogenesis).

Perhaps your seven-year-old boy is hyperactive and disruptive at school and his teacher suggests that he needs evaluation for medication. After learning about attention deficit/hyperactivity disorder (ADHD) from your doctor and some books from a bookstore, you decide that he does have ADHD. You know your son has always been very active, but he's worse since he began first grade. You feel that the etiology may be biological in nature, but the recent worsening in his symptoms (pathogenesis) is really due to the restrictiveness of full-time school.

Assess the Biological, Social, and Psychological Realms of Your Life

Your diagnosis should include consideration of the three areas of life that shape psychiatric problems: the biological (your brain), the psychological (your mind), and the social (your life). Consider each one separately as you try to understand what is contributing to your problems.

Could you have two disorders? It can be confusing if you have symptoms that suggest two disorders. For example, perhaps you experience hallucinations and delusions, as well as symptoms characteristic of manic episodes. Do you have bipolar disorder with psychotic thinking or schizophrenia with manic episodes? The diagnostic label often given to such people is schizoaffective disorder ("schizo" for psychotic thinking, "affective" for mood disturbance of either mania or depression), but no one really knows whether certain difficulties are best understood as a disorder of thought or mood.

There is substantial debate over how to understand multiple syndromes in the same person. The current practice in the field of psychiatry is to isolate each syndrome with its own separate diagnosis. This often makes no sense. For example, some people with chronic psychotic thinking and depression also experience panic attacks. Three diagnoses could be applied: schizophrenia, depression, and panic disorder. It seems unrealistic to think they have three illnesses, however, each with its own separate etiology, pathogenesis, and syndrome. Only a good understanding of the underlying biology and psychology, which we do not yet possess, can help us to sort this out, so there is no satisfactory solution at present.

On the other hand, isolating each syndrome ensures that each problem becomes a focus of treatment. This is clearly a good thing. If you feel that you have symptoms of two or more disorders, say anorexia and depression, make sure you don't lose sight of either one. Try to sort out the etiology and pathogenesis as best you can, keeping in mind that your focus is on your treatment, not a sterile exercise in psychobiology.

Keep an Open Mind As you make your diagnosis, be open to new information. Be prepared to change your mind as you gather more information and begin treatment. Maybe you'll come to believe that your depression isn't "biological" at all but instead is due to emotional deprivation during childhood. Maybe you'll come to believe that your son doesn't have ADHD, that he really is just rambunctious, and that the school needs education about how to manage high-energy boys.

Come to an Agreement with Your Doctor about Your Diagnosis It's most beneficial if you agree with your psychiatrist about your full diagnosis, that is, sharing what you believe is the syndrome of symptoms, the cause of your illness, and what has made it worsen to the point that it now needs treatment. You may have some ideas about your difficulties and what would be most helpful based on something that you recently read or heard about. Discuss what you have learned with your physician. Although your doctor or psychiatrist may have one view of what the problem is, you may have another. For example, you may feel that your problems are primarily due to your current situation while the doctor may think you have more long-standing difficulties. You won't get much help if you begin therapy with the idea that your problems will be solved in a few weeks while your doctor thinks it will take months or even years.

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Do Not Panic

Do Not Panic

This guide Don't Panic has tips and additional information on what you should do when you are experiencing an anxiety or panic attack. With so much going on in the world today with taking care of your family, working full time, dealing with office politics and other things, you could experience a serious meltdown. All of these things could at one point cause you to stress out and snap.

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