Panic disorder test

Instructions:
Several of the following questions refer to panic attacks and limited symptom attacks. For this questionnaire we define a panic attack as a sudden rush of fear or discomfort accompanied by at least 4 of the symptoms listed below. In order to qualify as a sudden rush, the symptoms must peak within 10 minutes. Episodes like panic attacks but having fewer than 4 of the listed symptoms are called limited symptom attacks. Here are the symptoms to count:

* Rapid or pounding heartbeat * Chest pain or discomfort * Chills or hot flushes * Sweating * Nausea * Fear of losing control or going crazy * Trembling or shaking * Dizziness or faintness * Breathlessness * Feelings of unreality * Fear of dying * Feeling of choking * Numbness or tingling

Think you might have panic disorder? This questionnaire, designed to gauge the intensity and frequency of your panic attacks and related anxiety and avoidant behavior, will help you find out. Looking at it, I'm thankful I'm no longer in a place where all of my answers are all out at the life-is-hell end of the spectrum, in a world of "extremely distressing," "extreme, incapacitating impairment," and "extensive modification of my lifestyle was required."

Score 8 or higher? You may have panic disorder. Leave your score in the comments if you dare...

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Early Drafts of Famous Clichés Now Discovered in a Cache Near the Dead Sea!

These early drafts of famous clichés were recently unearthed in a cache near the Dead Sea, proving once and for all that all writers—even those of famous clichés—must undergo an arduous revision process. The notes contained many crossings-out and occasional curse words in the margins, and I have attempted to replicate them here as accurately as possible.
Those who live in a house of meat must not throw forks.
Those who live inside an egg should not peck with their sharp beaks at others who live outside the egg, for they will surely crack their own egg in the process, and be sad, and will be born before their time as chickens.
Those who live in glass houses should not throw stones.
[Writer's margin notes: I am going to get representation for sure with this beauty. Agents, take note!]

Depressed losers generally like to hang out with other depressed, pathetic losers.
That miserable shithead John is dating that wretch Sally. They are frigging perfect together! I sort of hate them both, and their long mournful faces.
Misery loves company.
[Writer's margin notes: I am feeling kinda low myself. Hey, maybe I will seek out the company of other writers! But writers are weird. Sometimes they gaze out the window and spill soup down their shirtfronts while they obsess about this character or that. I hate writers. But I am a writer. Damn it, this cliché is so good I cannot stand it. I need a martini.]

My white friend Bill called my other white friend Jim "white." It seemed kinda dumb.
That's like the squirrel calling the ferret a rodent!
That's like the pot calling the kettle black.

[Writer's margin notes: My kettle is stainless steel. This doesn't really work. I'll fix it in the next draft.]

Caught between my winkie and my anal aperture.
Caught between Scylla and Charybdis. Shit, that's been used. Why can I not be ORIGINAL?
Caught by my wife in bed with another woman, and unable to attend to the dinner that is currently burning on the stove and setting off all the smoke alarms.
Caught between a rock and a hard place.[Writer's margin notes: No one will buy this. My writing sux. "Rock." "Hard Place." How much more boring can I be?]

Worth one's weight in pork products and fatty sausages.
Worth one's weight in doubloons, unless one is really skinny or even anorexic.
Worth one's weight in gold.
[Writer's margin notes: My professor will like this allusion. I will get an A. Not that HE ever wrote anything so spot on. Are clichés like this selling these days? Who can predict the whims of the market. I have to have faith.]

A crazed toddler in a store filled with expensive breakables.
An angry marmot inside the pants of someone with a weenie made of porcelain.
A big machine running roughshod over a person who has porcelain arms and legs! And also a porcelain head!
A bull in a china shop.
[Writer's margin notes: Nailed it. But, will editors be familiar with bulls? Perhaps I should use "rampaging pony" or maybe "stompling lion." Too wordy. I am riddled with doubt, as always.]

Laughter makes me piddle my pants and forget about my sorrows and failings, so busy am I changing my pants and doing laundry, endless laundry, as well as changing my underwear. Could I be incontinent? Damn it! I should not have had all those children, for they damaged my undercarriage.
Laughter is the best medicine.

On fear of flying

Bill McGee of USA Today recently wrote a very thorough article all about the fear of flying, from what causes it...

...the "fear" of flying may in fact be comprised of separate and distinct fears, including fear of heights, fear of loss of control, fear of losing one's balance, and fear of death itself, in addition to claustrophobia, panic disorders and social phobias. Many travelers suffer from two or more of these conditions at once, so an effective diagnosis is critical.

...to a variety of ways it can be coped with:

Some nervous fliers simply choose to medicate, though counselors say this may not always be effective. For those concerned about side effects, some travelers prefer homeopathic products, which offer a non-addictive alternative to many prescription sedatives and other medications. Homeopathic remedies for fear of flying symptoms are offered through a variety of health stores and online.

Counselors I spoke to question the effectiveness of hypnosis, but those who are receptive to such procedures may find comfort in this option. In-person visitation is the preferred method, but patients who don't have the time and/or money and/or access can purchase a variety of audio tools. Also, synchronized breathing might help some find relief and calm their nerves. Ancient exercises—such as Qi Gong—are proven stress relievers, but may not work for all nervous fliers, particularly once they're airborne. However, under certain conditions such practices could provide a low-cost and natural remedy.

One of the simplest of all solutions may prove effective for some fearful fliers: Listening to soothing music on an iPod or other electronic device can ease the stress and anxiety of flying. In addition, some recordings can be overdubbed with subliminal therapeutic advice.

Of course, psychological counseling is always an option as well.

The piece also links to fear-of-flying clinics and seminars across the country and around the world.

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Those Big Bad Benzodiazepines

Rare events in the midst of really large numbers of people are still quite common

I often get into debates with Pharma-brainwashed doctors and addiction specialists about the relative dangers and abuse potential of benzodiazepines like Klonopin, Valium, and Ativan. Even the DEA recognizes that they have low abuse potential by classifying them as Schedule IV, which literally means "low abuse potential." Adderall and opiates, in contrast, are Schedule II, which means high abuse potential.

Well, low abuse potential still means that some people will abuse them, but with any drug, risks must be weighed against benefits.

As to the risks, unless you are mixing them with other central nervous system depressants like opiates or alcohol,  the worst thing about being addicted to a benzo is that you are addicted to a benzo. For the vast majority of people, they don't cause any inebriation, and they have almost no side effects. For the few who do get troublesome side effects, the doctor can in those cases discontinue prescribing them. Just like with any other drug!

Benzodiazepines are worth their weight in gold in the treatment of panic disorder with agorophobia. Antidepressants can also help, but often not as much. And they have many moreside effects, including destroying a patient's sex life.

At the VA, where benzo's are discouraged, I literally saw veterans who were housebound since Vietnam because of comorbid PTSD and panic disorder (the two conditions are co-morbid in 50-70% of veterans with PTSD according to the only two studies). If antidepressants did not stop their panic attacks, doctors would not prescribe benzo's! If you had choose between having no life and being addicted to a benzo, which would YOU choose? I know what I would do.

For patients with borderline personality disorder who self mutilate - the "cutters" and "burners" for example - benzodiazepines can be combined with SSRI (or MAOI) antidepressants. This combination often results in either complete elimination of or a significant decrease in the frequency of this behavior. Much better and far more quickly than dialectical behavior therapy does, by the way.

There are no clinical trials that support that last statement because the pharmaceutical companies will not do them. Benzo's and antidepressants are generic and cheap, and they'd rather that docs prescribe drugs like antipsychotics that have far more risks. But I've been treating this population for forty years in two states, and in a variety of different clinical settings (private practice, academia, public mental health centers and inpatient units, and the VA), with tremendous results. And other doctors who do this get the same results that I do. So tell me it's anecdotal. So is the belief that parachutes reduce the number of deaths and injuries after falls from airplanes.

A common retort to my position has to do with emergency room admissions caused by misuse of benzodiazepines, as well as the fact that methadone and suboxone clinic patient love to mix those drugs with benzos. On the latter point the solution is simple: be careful prescribing the drugs in that population. And the former?

According to JAMA Psychiatry, there are an estimated 271,000 visits to emergency rooms annually for non-medical uses of benzodiazepines (and how many of these involve simultaneous use of other substances of abuse such as alcohol or opiates is not quantified, but it is probably very highly significant).

That sounds like (and is) quite a few - until you also learn that about 5% of adults between 18 and 80 are taking the medications, which is roughly 12.25 million people. So only about two percent of users end up with severe medical issues per year. Not zero, but a relatively small percentage, and btw, there were also an average of about 78,000 annual ER trips for problems during the same period related to...Tylenol. Maybe we should we ban it.

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