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Mood Swings: Mood swings are a fundamental devastating symptom of borderline generic malegra fxt 140mg with visa. Moods can shift inappropriately from hour to hour generic malegra fxt 140mg overnight delivery, even minute to minute buy malegra fxt 140mg fast delivery. Without appropriate environmental of though-provoked justification. It can be triggered by mood swings, stress, and emotional pain. Once dysphoria begins, it tens to steadily intensify - possibly due to limbic system malfunction. Because of the psychotic episodes, borderlines are said to live at the "border" between reality and psychosis. The main psychotic symptoms are moods, physical sensations and perceptual distortions. The dominant psychotic moods center around worthlessness, badness, rage, and self-destruction. The physical sensations are remarkably similar to temporal lobe epilepsy and include unreality, derealization (familiar things become unreal). Deja-vu, out-of-body experiences, depersonalization (as though no longer yourself), unawareness spells, and feeling like body parts are numb and no longer part of oneself. Psychosis can also be brought on by drugs, especially alcohol and marijuana. This immature psychological defense persists in borderlines, resulting in "black and white thinking. When things are good, the borderline frequently feels vulnerable, and fears the black returning - often leading again to dysphoria. While intelligence is not impaired, organization and structure are - borderlines have trouble following through and completing tasks. Chronic anger, fear of abandonment (often resulting in manipulative behavior), lack of trust, impulsivity, feelings of emptiness and/or boredom, jumping to incorrect conclusions, and severe PMS are commonly experienced. Comorbidity: Borderlines frequently suffer from other psychiatric illnesses. The most common include depression, anxiety, substance abuse, alcohol abuse, other personality disorders, and eating disorder (approximately 40% of eating disorder inpatients suffer from the borderline). Borderlines have significant biological abnormalities - see Table 2. Temporal lobe dysfunction is often associated with stress. The BPD is probably a medical predisposition combined with environment insult. There are many psychological theories and concepts, with considerable disagreement among experts in the field. Both overprotective and underprotective parents have been "blamed" as the cause. There is an increased family history of alcoholism, substance abuse, other personality disorders, and depression, but not schizophrenia. If I encounter a patient who has multiple complaints, especially fatigue, headaches, stress, depression, etc. I will often review and discuss the DSM-III-R Borderline criteria to determine if he/she feels 5 or more symptoms are present. If yes, I will usually initiate treatment with fluoxetine (Prozac), evaluating the patient and diagnosis 1 week later. Prozac (fluoxetine): Prozac appears to increase serotonin. It is a breakthrough medication for borderlines - eliminating most mood swings, chronic anger, chronic emotional pain, emptiness and boredom within 3 days. For most side effects (nausea, jitteriness, agitation), reduce the frequency to every 2 or 3 days. While for a few patients the serotonin deficiency symptoms resolve permanently in 6-12 months, most need to take the medication long term. In my experience, clomipramine (Anafranil) and sertraline (Zoloft) have shown similar efficacy. Neuroleptics: Can be effectively used on a prn basis during stress or dysphoria, or prophylactically for stressful situations. Navane (thiothixene) and Mellaril (thioridazine) have been proven effective. High doses, especially in hospitalized patients, are also effective. Dosing and blood levels are comparable to treating temporal lobe epilepsy. Thyroid: Many borderlines have symptoms of hypothyroidism, with "low normal" thyroid blood tests.

Lewis: The "party line" these days for moderate to severe depression is that a combination of antidepressant medication and cognitive-behavioral psychotherapy is what works best cheap 140mg malegra fxt free shipping. Some people respond to therapy alone purchase 140 mg malegra fxt with visa, although it usually takes longer malegra fxt 140 mg cheap, some people respond very well to medication (after about 2-4weeks, depending on the drug). Bipolar Disorder (also known as Manic-Depressive Disorder) is woefully under-diagnosed in adults and children. The doctors admitted me to a hospital, because I was in pain with severe depression. They were right when they said it was all in my head! I was into self-injury for awhile and became anorexic, both to help deal with my pain. Teaching someone alternatives to negative or depressed thoughts, strategies to cope with anxiety, all seem to do much better. Hopefully, by sharing some ideas here, we can also help each other. Cirafly: Is someone more likely to commit suicide if no one is taking them seriously? They will hospitalize me to keep me "safe," but hospital abuses are the reasons behind my suicidal thoughts? Thoughts and ideas are not necessarily a reason for someone to be in a hospital. I guess it depends on how competent and trustworthy your therapist is. David: Here are a few positive ways to cope with severe depression and thoughts of suicide: Mayflower: Two things have been helpful to me. One is getting psychological help, and two is keeping busy. The busier I am, the less likely I am to think about suicide and be depressed. MKW: I found that after my serious suicide attempt, I felt better by helping others through their bad times. Lewis: You have to know that your thoughts are a reaction to pain. Relief is a feeling, and you have to be alive to feel relief. You also need to know deep down that help is possible and available. I have a nine year old daughter and it tears her apart. Lewis, about sharing your depression or emotional pain with your children? Lewis: This is something that children should be kept out of. In essence, it deprives them of their childhood, and definitely has an impact on them when they become adults. As far as I know, my family knows nothing about my depression, suicidal thoughts, or even my cutting. David: There are many teens, and even adults, who are afraid to share their feelings with their parents or other family members. However, have your therapist assist in dealing with your family. So, as Judith Asner said last night, maybe you just have to "buck up" and ask for it directly ( Surviving Bulimia Conference Transcript ). Cirafly: How do you help a suicidal person see the light at the end of the tunnel? Lewis: Usually, things that people feel are awful, forbidden, and look a lot less dangerous in "the light of day. Knowing that suicidal thoughts and depression can be helped is the first step in seeing the light at the end of the tunnel. David: Are there any special precautions people should take over the holidays, Dr. People have expectations about having "the best Christmas" or the "best presents". Lewis, for being our guest tonight and for sharing this information with us. To those in the audience, thank you for coming and participating.

If it is almost time for the next dose cheap 140mg malegra fxt overnight delivery, skip the missed dose and wait until your next regularly scheduled dose malegra fxt 140mg otc. Do not use extra medicine to make up the missed dose buy 140mg malegra fxt otc. If you use Exubera as meal-time insulin and you forget to use your dose before a meal, use the insulin when you remember and wait 10 minutes before eating. Symptoms of an Exubera overdose may be the same as signs of low blood sugar: confusion, drowsiness, weakness, fast heartbeat, sweating, tremor, and nausea. You should not use this medication if you have smoked within the past 6 months. If you start smoking while using Exubera, you will have to stop using the medication and switch to another form of insulin to control your blood sugar. Avoid letting your blood sugar get too low, causing hypoglycemia. Know the signs and symptoms of hypoglycemia, which include headache, confusion, drowsiness, weakness, dizziness, fast heartbeat, sweating, tremor, and nausea. Carry a piece of non-dietetic hard candy or glucose tablets with you in case you have low blood sugar. Hypoglycemia (low blood sugar) is the most common side effect of Exubera. Watch for signs of low blood sugar, which include headache, confusion, drowsiness, weakness, dizziness, fast heartbeat, sweating, tremor, and nausea. Carry a piece of non-dietetic hard candy or glucose tablets with you in case you have low blood sugar. Get emergency medical help if you have any of these signs of an allergic reaction: rash, hives, or itching; wheezing, gasping for breath; fast heartbeat; sweating; feeling light-headed or fainting. Other less serious side effects are more likely to occur, such as:If you use other inhaled medications, use them before using Exubera. Your pharmacist has more information about Exubera written for health professionals that you may read. Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Exubera only for the indication prescribed. Dosage Form: Extended Release TabletsGlucotrol (glipizide) is an oral blood-glucose-lowering drug of the sulfonylurea class. The Chemical Abstracts name of glipizide is 1-cyclohexyl-3-[[p-[2-(5-methylpyrazine-carboxamido)ethyl]phenyl]sulfonyl]urea. The molecular formula is C21H27N5O4S; the molecular weight is 445. It is insoluble in water and alcohols, but soluble in 0. Glucotrol XL? is a registered trademark for glipizide GITS. Glipizide GITS (Gastrointestinal Therapeutic System) is formulated as a once-a-day controlled release tablet for oral use and is designed to deliver 2. Glucotrol XL Extended Release Tablet is similar in appearance to a conventional tablet. It consists, however, of an osmotically active drug core surrounded by a semipermeable membrane. The core itself is divided into two layers: an "active" layer containing the drug, and a "push" layer containing pharmacologically inert (but osmotically active) components. The membrane surrounding the tablet is permeable to water but not to drug or osmotic excipients. As water from the gastrointestinal tract enters the tablet, pressure increases in the osmotic layer and "pushes" against the drug layer, resulting in the release of drug through a small, laser-drilled orifice in the membrane on the drug side of the tablet. The Glucotrol XL Extended Release Tablet is designed to provide a controlled rate of delivery of glipizide into the gastrointestinal lumen which is independent of pH or gastrointestinal motility. The function of the Glucotrol XL Extended Release Tablet depends upon the existence of an osmotic gradient between the contents of the bi-layer core and fluid in the GI tract. Drug delivery is essentially constant as long as the osmotic gradient remains constant, and then gradually falls to zero. The biologically inert components of the tablet remain intact during GI transit and are eliminated in the feces as an insoluble shell. Glipizide appears to lower blood glucose acutely by stimulating the release of insulin from the pancreas, an effect dependent upon functioning beta cells in the pancreatic islets. Extrapancreatic effects also may play a part in the mechanism of action of oral sulfonylurea hypoglycemic drugs. Two extrapancreatic effects shown to be important in the action of glipizide are an increase in insulin sensitivity and a decrease in hepatic glucose production. However, the mechanism by which glipizide lowers blood glucose during long-term administration has not been clearly established.