Panic disorder with agoraphobia is a type of anxiety disorder, characterized by frequent and unexpected panic attacks. Panic attacks are periods of intense anxiety or fear that usually come on spontaneously or can be provoked by an event or circumstance. Panic attacks are very frightening events during which a person experiences an increase in heart rate, inability to breathe, and becomes sweaty, dizzy, or nauseated. The person is overwhelmed with a feeling of doom, a fear that they will lose control or even die.

Women are two to three times more likely than men to be affected by this disorder. The average age of onset is 25 years. Many people with panic disorder first come to medical clinics because of the somatic complaints.

Panic disorder is frequently accompanied by agoraphobia. Researchers believe that agoraphobia almost always develops as a complication in some patients with panic disorder. Agoraphobia is a fear of being alone in a public place, like a supermarket, and not being able to rapidly exit if a panic attack occurs.

The following video is of two women with panic disorder, one of whom has developed a very creative way to prevent her anxiety in open spaces from escalating into a full-blown panic attack.

Obsessive-Compulsive Disorder:

Obsessive -Compulsive Disorder (OCD) can be one of the most disabling of the anxiety disorders. The essential features of OCD are recurrent obsessions and compulsions. An obsession is a recurrent, intrusive thought, feeling, or idea that is often recognized as irrational by the person experiencing it. A compulsion is a repetitive behavior or mental act that is used to reduce the anxiety or distress created by the obsession. For example, a person might repeatedly wash their hands to the point of making them raw in order to reduce the anxiety created by the obsessive thought that they have become contaminated by germs when touching money.

These symptoms cause marked distress to the person afflicted and significant impairment in their ability to work and function in life. The following video will show how OCD has affected our patient's life and left her feeling frustrated, angry, and frightened.

The patient in this video is being treated by a behavioral approach using response prevention. The therapist forcefully, but kindly, pressures the patient to refrain from performing the compulsive act, in the hope that her anxiety will gradually be extinguished.

POSTTRAUMATIC STRESS DISORDER

Post-Traumatic Stress disorder, or PTSD, is an extreme response a traumatic event. The syndrome of what is now called PTSD, historically was described during the American Civil War and was called "shell shock" during World War I. But it wasn't until the Vietnam War that the symptoms of PTSD and its name became popularized and familiar to the general public.

For a person to be classified as having posttraumatic stress disorder they must have had an experience that would have traumatized anyone. Such events include but are not limited to combat, torture, natural disasters, rape, assault, sexual and physical abuse, and witnessing a murder. The lifetime prevalence of PTSD in the general population is estimated to be between 1 to 3 percent. The prevalence among Vietnam War veterans is 30%; ten times greater than the general public.

The three hallmarks of PTSD are first, a painful "re-experiencing" of the trauma through intrusive thoughts or recurrent nightmares. Second, patients live in a persistent state of "hyperarousal" and have an exaggerated startled response to sights and sounds. Third, patients avoid any reminders of the trauma and develop a numbness and detachment from their surroundings.

These symptoms of PTSD usually develop within one month of the traumatic event but may be delayed for several years. Patients often develop associated problems like depression, substance abuse, and social and marital discord.

The video we are about to see is of a Vietnam War veteran suffering from PTSD. VIDEO

DISSOCIATIVE IDENTITY DISORDER

Dissociative Identity Disorder is the name given to the disorder formerly called multiple personality disorder. This condition has received much media attention and has been represented in several films like Cybil and The Three Faces of Eve.

It is a serious and chronic dissociative disorder whose cause involves a traumatic event, usually childhood sexual or physical abuse. Researchers believe that developing additional personalities is an attempt to psychologically handle the trauma. Nearly 90 percent of people with this diagnosis are women. While the symptoms of the disorder usually begin in late adolescence it is typically diagnosed much later in life.

People who have this condition have two or more distinct personalities. Each of the personalities has its own distinct style of thought, speech, and behavior. To make the diagnosis, it is necessary to establish that the distinct personalities, called alters, have no memory of the others. The transition from one alter to the other is usually made suddenly and dramatically. The alters are often given names that describe their function, like "The Protector." There is usually one alter that represents the traumatized child. But, it is often the host personality that seeks treatment.

The overall goal of therapy is to fuse the different personalities, getting the patient to recognize her ideas, wishes, and fears as different part of herself rather than as separate personalities.

The following video highlights many of these points. It is interesting to note that the patient believes her alter wants to kill her and regards this as a homicide, not a suicide. VIDEO

BIPOLAR DISORDER

People who experience alternating episodes of mania and depression are said to have a bipolar mood disorder. There is also a genetic predisposition for the disorder. Both men and women are equally affected, unlike in major depression alone, where women are twice as likely to have depression than men. While the cause for the disorder is not known, the biological basis for the condition probably involves an imbalance in the neurotransmitters in the brain, primarily that of norepinephrine.

During the depressive phase of the illness, patients often describe a depressed mood, loss of energy and interest in things, feelings of guilt, worthlessness, and hopelessness, difficulty concentrating, loss of appetite, trouble sleeping, and thoughts of death and suicide. By sharp contrast, a person who is manic experiences a markedly elevated mood, perhaps even euphoria, increased activity, decreased need for sleep, decreased ability to concentrate, rapid thoughts, and uninterruptible speech.

While patients can exhibit psychotic symptoms in either phase of the mood cycle, patients tend to exhibit psychotic symptoms more often when they are in a manic phase. They can develop grandiose delusions about themselves and become irritable and angry if they perceive any attempt to thwart their efforts.

The treatment for bipolar disorder in the acute phase includes the use of lithium, a basic element fortuitously found to be effective in stabilizing mood. In addition, several drugs used to treat epilepsy have been found to be effective in controlling mood swings.

The following interview is of a young woman diagnosed with bipolar disorder who describes the symptoms she was experiencing during an acute manic episode. VIDEO

DEPRESSION

Major Depressive disorder (MDD) is a very common mood disturbance with a lifetime prevalence in the general population of about 17 percent. Women are twice as likely as men to suffer from a major depressive episode.

Major depression is a chronic and recurrent illness. The classic symptoms of depression are a deflated mood and a loss of interest and pleasure in things that normally would be interesting and pleasurable. Patients feel hopeless, worthless, guilty, have difficulty concentrating, decreased sexual interest, low energy levels, and become withdrawn from family and friends. About 80 percent of people have changes in sleeping patterns, appetite, and weight. Approximately 90 percent of patients also have significant generalized anxiety. Two thirds of patients with depression contemplate suicide and between 10 to 15 percent succeed in killing themselves.

Sometimes depression can become so severe that psychotic symptoms like delusions develop. In addition, some patients can have a deterioration in cognitive functions like memory and concentration, to the point that depression can mimic a dementia.

In the following video we will see an elderly man with a severe depression that had to be treated with electroconvulsive shock treatment. In cases that do not respond to psychotherapy or drug therapy, electroconvulsive treatment can be very effective. However, shock therapy is often reserved for severe cases of depression, as is shown in this video. VIDEO

SCHIZOPHRENIA

The term "schizophrenia" was first used in the 1800's to describe a condition which was initially conceptualized as a schism among thought, emotion, and behavior in affected patients.

Schizophrenia affects 1 percent of the population worldwide. Both men and women are equally at risk for getting the disorder. However, men tend to show symptoms earlier than women. The onset of symptoms typically starts in the early twenties for men as compared to late twenties in females.

The classic course of schizophrenia is one of exacerbation and remissions of symptoms. Unfortunately, with each exacerbation the patient fails to return to the previous level of functioning. The majority of lives are characterized by aimlessness, social isolation, poverty, homelessness, and frequent hospitalizations.

During an exacerbation, patients experience psychotic symptoms, namely hallucinations and delusions. Hallucinations are usually auditory with patients often hearing voices, sometimes telling them to do things to hurt themselves. Bizarre delusions often take on a grandiose, paranoid, persecutory, or somatic theme. For example, patients may believe that there is a government conspiracy or that they are a messenger from god. Loosening of associations is a disturbance in thought processes that can lead to illogical and incoherent speech.

Patients with schizophrenia also are socially isolated, exhibit an amotivational state, and have a blunted emotional response. These symptoms must be differentiated from depression in order for the depression to be treated appropriately. Approximately 50 percent of schizophrenics attempt suicide and about one out of ten succeed.

While there is much optimism for the treatment of schizophrenia with new drug therapies, about half of patients still lead severely devastated lives. This condition tears apart the fabric of the individual, his family, and the society in which he lives.

The following video shows us how the effects of schizophrenia reach far beyond the patient. In the video we will see two patients in remission of their symptoms, struggling to come to terms with their affliction. VIDEO

ALCOHOL ABUSE

Almost 9 out of 10 people in the United states have had an alcohol containing beverage at least once in their lives, and about half of all US adults are current alcohol drinkers. One out of 10 women and two out of five men can be diagnosed as alcohol abusers. One out of 20 women and one out of 10 men have the more serious diagnosis of alcohol dependence.

The personal and societal costs of alcohol abuse are enormous. Abusing alcohol lowers life expectancy by ten years. The most common causes of death among people with alcohol abuse are suicide, cancer, and heart and lung disease. Half of all motor vehicle accidents involve a drunk driver and alcohol is associated with about half of all homicides and a quarter of all suicides.

Alcohol is a drug which acts as a central nervous system depressant. With continued use, a person develops both tolerance and dependence. With time, a person must continue to use greater amounts of alcohol to achieve the desired effects. Dependence is both physical and psychological. After prolonged use, the body experiences withdrawal symptoms when alcohol intake is abruptly stopped. This withdrawal process can be life threatening. Many people develop a psychological dependence on alcohol to help them cope with life's stresses and avoid dealing with painful emotions.

Denial of the problem is a hallmark of alcohol abuse and abusers often respond angrily when confronted by family and friends. The most familiar mode of treatment is Alcoholics Anonymous, a self-help program started in 1935 by two recovering alcoholics. Today there are over 70,000 AA centers worldwide. They use the model of a twelve step program that begins with an admission of the problem, total abstinence from alcohol and other drugs, and living life "one day at a time" in battling against a lifelong disease.

The following video will help illustrate some of these points. VIDEO

TOURETTES DISORDER

Tourettes Disorder is a rare type of tic disorder that afflicts about 4 or 5 people per 10,000. Tourettes is a disease that begins in childhood and afflicts boys three times more commonly than girls. The child usually develops both motor and vocal tics by 11 years of age.

Tics are sudden, involuntary, recurrent motor movements or vocalizations. Common motor tics include eye blinking, coughing, grunting, sniffing, snorting, barking, smelling things, and making obscene gestures. Vocal tics may include repeating one's own or other's words and phrases or using obscene language.

Tics are made worse by stress and anxiety. They occur many times a day, nearly every day, and cause a great deal of impairment in school and the social life of the child or adult with Tourettes.

Up to 80 percent of patients with Tourettes can get some relief of their symptoms. A combination of behavioral treatment to reduce anxiety and the use of anti-psychotic medication, like haloperidol, can be helpful.

Many patients with Tourettes also have obsessive-compulsive disorder.

The following video shows a patient suffering from a severe case of Tourettes disorder who has received only partial relief from medication. He visibly struggles to keep his vocal tics in check. VIDEO

BORDERLINE PERSONALITY ("SELF-DESTRUCTIVE SUZY")

There is an entire group of conditions categorized as personality disorders, defined by personality traits that are beyond the range of what is found in most people. In a personality disorder the aberrant trait is inflexible, maladaptive, and causes a significant amount of distress and functional impairment to the affected individual or to those close to him.

One of the most serious of the personality disorders is borderline personality. Such people have emotions that go all over the place -- one moment they can be happy, the next, angry and irritable. In one second they are praising another person, even idolizing her, and in the next moment, they see their friend as the devil incarnate (this is called splitting). Patients with Borderline Disorder are quick to take offense, exceedingly sensitive to even a hint of rejection or disapproval, impulsive and sometimes sexually promiscuous. They are usually self-destructive, cutting or burning themselves and sometimes making genuine suicide attempts. Depression is widespread among those with borderline personality. Substance abuse is also common, perhaps as an effort to self-medicate, to bring their stormy emotions under control. The prevalence of borderline personality is from 1 to 2 percent and is more common in women than men.

The cause of borderline personality is unclear but much attention has been paid to the psychological factors underlying the condition. Early childhood experience marked by unstable, unreliable relationships with caregivers is believed to contribute to the development of this lifelong pattern of interpersonal relationships. Often there is a history of sexual abuse in there patients. Treatment is typically a combination of pharmacology to treat the mood swings and erratic behavior, along with psychotherapy. A promising approach is to combine the acceptance notions of Rogerian therapy -- the patient is fully accepted as he or she is -- while at the same time making available behavioral change techniques to help the person achieve his or her goals in a less self-destructive way. This technique consists of teaching the patient how to control anxiety and anger, how to deal with others, how to handle criticism, and how to cope with life's inevitable stressors without feeling as if all is so hopeless that suicide is the only option.

The following video is of a woman diagnosed with borderline personality who also has anorexia nervosa. VIDEO

ATTENTION DEFICIT-HYPERACTIVITY DISORDER

Attention Deficit-Hyperactivity Disorder (ADHD), is a disorder of childhood. In the United States, about 3 to 4 percent of children meet the criteria for this condition. The principle signs of ADHD are hyperactivity, impulsivity, and easy distractibility. Children with ADHD are often irritable, unpredictable, fidgety, emotionally labile, and have difficulty delaying gratification. Because of these traits these children often have trouble socializing with peers and adults. In addition, they often do poorly in school and about 20 percent of them also have a learning disorder. Approximately one out of five children with the disorder continues to have symptoms into adulthood.

The following video shows one such patient who has failed to achieve a higher level of functioning because of this disorder. VIDEO

ALZHEIMER'S DEMENTIA

Dementia is a syndrome characterized by a decline in a person's cognitive capacity and changes in personality. The risk of developing dementia increases with age. Among Americans over 65 years old, one out of 20 has severe dementia. After age 80, the risk increases dramatically to one out of five.

There are many causes of dementia, some reversible and some not. Alzheimer's type of dementia accounts for more than half of all cases.

The symptoms of Alzheimer's dementia come on gradually and are irreversible. There is a slow but progressive deterioration in cognitive functioning which includes memory loss and the inability to name and recognize objects. People often become disoriented and can often wander to unfamiliar places unknowingly. Alzheimer's dementia also affects the motor system and patients can have difficulty initiating movement and develop trouble walking. There are also personality and behavior changes.

No one knows what causes Alzheimer's type dementia but research has shown that there is a loss of neurons in the brain that make the neurotransmitters acetylcholine and norepinephrine. On average, people live for about 8 years after being diagnosed with Alzheimer's dementia.

As you will see in the following video, our patient exhibits several of these symptoms and is painfully unable to recognize her own daughter. VIDEO