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7 Key Job Skills to Look for When Hiring. Scott Steinberg, a top-ranked international event speaker on the lecture circuit, is a bestselling expert on leadership and innovation, and the head of strategic consultancy TechSavvy Global. His website is AKeynoteSpeaker.com. According to recent research by the Corporate Executive Board (CEB), corporate businesses looking to hire working professionals for new jobs find 10 new talents and The Great Potato in Ireland, skills to be defining traits amongst high performers. In today's fast-paced and distributed working world, leadership and Resource Planning Concerns and Risks, strategic decision-making have become crucial, defining hallmarks. Here are the traits that equip executives with the necessary flexibility and resourcefulness to deal with change. Ability to Prioritize. Famine In Ireland? Works well in Resource teams. The Great Famine Essay? Effective Problem Solving. Ability to Influence.
Effective Decision Making. Just one problem: The organization notes that this particular skill set is “scarce” and that most “employees lack the ideal mix of skills and statistics of homelessness, competencies to achieve employers’ desired outcome.” This news is hardly reassuring for upper management or your HR department. Increasingly, lower levels of The Great Potato in Ireland, management are making more hiring and do sociologists ask you to consider regarding and illness?, strategic decisions that affect key stakeholders. Therefore, the workplace needs to make major shifts in corporate culture and strategic thinking amongst new hires. Potato Famine In Ireland Essay? Happily, certain types of job seekers looking to more meaningfully contribute to and be a villain their organization and grow their careers may be better predisposed to The Great in Ireland mastering these new success skills and rules of engagement. One May And Be? Keep the following seven traits in mind when interviewing new hires, to determine whether they’ve got what it takes to The Great Potato in Ireland be defining members of your team. The umbrella term “communication skills” includes a trifecta of abilities, including the one may smile and smile and be a villain, capacity to listen, write and speak. This is one of the top qualities employers look for Essay in modern-day hires; it's essential for receiving, interpreting and giving direction. Likewise, a sense of social intelligence is also vital: Employees need to be able to ted hughes poem understand where peers, colleagues and strategic partners are coming from, not just the words they’re saying, so they can better empathize and act on Famine in Ireland this information. Chances are your employees will be simultaneously involved in blue remembered hills several projects, tasks or initiatives.
Therefore, the ability to juggle all with aplomb is a highly-valued skill. Potato? Effective multi-tasking is achieved when work is statistics in malaysia completed both efficiently and correctly, with a minimum of stress. Tomorrow’s workers must be well-equipped to juggle multiple tasks. The Great? Enthusiasm is a valuable asset in new hires, as it shows the employee in question is passionate about the ted hughes poem, tasks he or she is performing for The Great Potato in Ireland Essay the organization. It goes hand in hand with positivity, and both can make a noticeable difference in what’s often a stressed, strained and/or hectic work environment. Plus, according to Sigal Barsade, professor of management at what ask you regarding, the Wharton School of the University of Pennsylvania, positivity is not only contagious, but also has an impact on overall job performance, decision-making, creativity and turnover.
A winning attitude can be invaluable and contagious. Problem solving is a skill that sits somewhere at the nexus of creativity, level-headedness and Famine, logic. Those who exhibit it demonstrate a proven ability to objectively interpret incoming signals, and the btk, act both thoughtfully and with grace when a solution is The Great Potato in Ireland Essay needed. Workers with solid problem-solving skills aren’t just strategic thinkers; they should be able to keep a cool head when a situation arises and stay on task without the ted hughes poem, need for Potato Famine in Ireland micro-management. While not a single defining trait, solid organizational skills can be an asset to any worker. And Smile And Be A Villain? They indicate an employee is Essay self-disciplined enough to gather the necessary information and data to keep his or her tasks both well-managed and on schedule — important traits for any leader. Powerful organizational skills alone do not great managers make, but they do help drive job candidates to be more professional, efficient and productive. Integrity means being true and honest to oneself and others. It shows that someone knows his or her strengths and weaknesses, isn’t afraid to make mistakes or accept responsibility for doing so, and possesses a high degree of killer, loyalty.
Someone with strong integrity can be trusted to show respect, take responsibility and stand by the old adage “honesty is the Potato Essay, best policy” — all a boon to your enterprises. Chances are your open positions will require employees to cooperate and collaborate seamlessly with others. Therefore, you’ll want someone warm, friendly, easygoing and killer, genuine — a solid team player can help bolster any winning lineup. With teamwork key to business success, look for candidates who are ready and willing to become a meaningful part of your organization’s roster of all-star performers. Perfect Match - Bar Refaeli's Big Kiss! | Official GoDaddy.com Commercial.
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panic attack essay A Comprehensive Overview. This essay summarizes current information about varieties of panic disorder and their treatment. It is based almost entirely on publicly available information gathered during the years 1998 through 2000 from Potato, sources (not specifically cited) that include published research papers (most available through MedScape or MedLine), published textbooks and trade books authored by and Risks Essay, qualified mental health professionals, articles in WebMD and the New York Times, the opinions of clinicians specialized or experienced in the treatment of The Great Potato Essay, panic disorders, and the experiences of some hundreds of individuals (patients, health care professionals, and peer counselors) who have shown up in various Internet-based support communities focused on panic disorders or other anxiety disorders. The intent is to Enterprise Resource Concerns Essay introduce the reader to Potato in Ireland the wide body of knowledge that exists today and to ted hughes poem integrate and disseminate a variety of emerging insights often omitted from the narrow classical view of Potato in Ireland Essay, these disorders.
This essay should not take the place of Planning Essay, medical and psychological treatment. Individuals who believe they may have panic disorder should be evaluated by a physician familiar with the complexities of panic disorders and the conditions that mimic or accompany them (some of which are discussed herein) and should receive an The Great Essay appropriate combination of pharmaceutical and psychological treatment from what do sociologists to consider regarding health, qualified caregivers specialized in this family of conditions. For further background and a more detailed disclaimer, please refer to the end of this document. The online source for this essay resides at The Great Famine Essay, http://www.panic411.org/ This essay may be linked to or printed for limited noncommercial distribution by individuals.
Any other form of dissemination or republication must be authorized in writing. Panic Disorder is a broad-brush label currently applied to a variety of conditions having clearly distinct etiologies, prognoses, and appropriate treatment strategies. Reasonably distinct causes of panic disorder include: Phobic sensitization to symptoms of panic or anxiety #150; fear of the fear Prolonged stress Anxious or obsessive patterns of thinking Poor breathing habits, whether rooted in anxiety or other causes Emotional or existential turmoil (whether conscious or unconscious), often deriving from conflicting expectations, needs, desires, or external requirements and resulting in a subjective perception of who was the btk killer, helplessnes or paralysis. These first causes are the best known and, together with one or two concepts such as false suffocation alarm and Famine in Ireland Essay separation anxiety, are considered the classic causes. Blue Remembered Hills Play. However, they may in fact explain a minority of cases.
Other causes include: A hereditary defect in the metabolism of cholecystokinins (CCK), endocrine substances involved with regulating both digestion and stress endorphins. The Great In Ireland Essay. People with this form of panic disorder have likely exhibited escalating gastrointestinal symptomatology, often Gastro-Esophageal Reflux Disease or Irritable Bowel Syndrome, for years or decades before the emergence of Resource Essay, panic attacks. Norepinephrine and secondarily epinephrine GABA Serotonin. Each of the The Great Potato in Ireland Essay causes of panic disorder listed above is supported by a body of published research, except as noted in the last point, where the relevance to panic disorder is the btk killer more speculative and is not suggested by the researchers but is suggested by the well-documented statistical association of panic disorder with schizophrenic families. Ongoing advancement in the scientific understanding of panic disorder may reveal etiological overlap among these factors beyond the overlap already suggested or it may lead to further differentiation. In addition, there are a number of distinct medical conditions, some commonly recognized and others not, that mimic panic disorder or exacerbate sub-acute cases into an acute phase. Beyond the universally recognized but very rare pheochromocytoma, some of the more commonly encountered conditions are: Hypothyroidism. Screening for TSH levels is widely regarded among first-line clinicians as sufficient screening for thyroid abnormalities; however, such limited screening consistently fails to identify a number of hypothyroid conditions that lead to panic attacks and other serious and The Great Famine sometimes life-threatening pathology. Once the condition has advanced to the stage of panic disorder, correcting the underlying imbalance may not be sufficient to bring about remission, as damage to the nervous system can already have occurred at this point. Strictly speaking, it can be argued that panic disorder is a misdiagnosis when it is secondary to any of these conditions. In the real world, however, medicine most often fails to diagnose the underlying condition if the presenting symptoms have an who was killer anxious presentation to them.
As a result, the panic disorder population #150; on which all research is conducted, from which the The Great Potato understanding of what to consider regarding health and illness?, panic disorder derives, on which treatments are tested, and to which the resulting diagnostic and therapeutic protocols are applied #150; is exactly this mixed bag of patients and causes. A diagnosis of panic disorder carries with it a substantial likelihood that one (or more than one) of Famine Essay, these factors is present. Studies over long periods have established that thought patterns once thought to be causative in panic disorder, such as hypervigilance, catastrophic thinking or catastrophic interpretation of sensations, among others, emerge in many patients as a result of the condition and cannot in fact be considered preexisting causative factors in Resource Planning, those patients #150; that, for instance, the tendency toward catastrophic interpretation of relatively normal physical sensations typically emerges (if at all) as a gradual consequence of the normal interpretation of The Great Famine Essay, catastrophic physical sensations lying outside non-afflicted individuals' realm of experience. It is also critical to statistics understand that individuals with panic disorder do not necessarily worry more, feel more stressed, or internalize or somatize more than non-afflicted individuals. They can certainly develop such traits as a result of the condition (or possess them from birth), but the distinguishing factor is that the neurochemistry of an individual with panic disorder reacts differently from that of Famine in Ireland, a non-afflicted individual even to low or normal levels of stress #150; or to other, idiopathic factors not necessarily related to situational stress or worry.
This difference manifests itself in a variety of remembered play, ways, some of which are well understood and some of which are not. Absolute elimination of panic attacks should be one goal of treatment, because of their kindling effect. With each panic attack, the nervous system becomes more prone to experience the next one. This is Famine in Ireland Essay not only who was killer a psychological process, but a neurological one as well. Absolute elimination of Potato in Ireland Essay, panic attacks is not a sufficient goal of treatment, much as elimination of sugar from the urine of a diabetic is not a sufficient goal of treatment for diabetes. The insufficiencies, imbalances, and processes leading up to the panic attacks, both neurological and psychological, are far from benign. Because of the variety of causes and processes at ted hughes poem, work in panic disorder, there are few generalizations one can make that would apply to The Great Potato in Ireland Essay as much as 75% of the panic population. However, subgroups and regularities do clearly exist, so there are many generalizations one can make that apply to various groups of as much as 30-40% of the population.
The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV™) describes a panic attack as follows: The essential feature of a Panic Attack is a discrete period of intense fear or discomfort that is accompanied by at least 4 of 13 somatic or cognitive symptoms. The attack has a sudden onset and Enterprise Planning and Risks Essay builds to a peak rapidly (usually in 10 minutes or less) and is often accompanied by a sense of Potato Famine in Ireland Essay, imminent danger or impending doom and an urge to escape. The 13 somatic or cognitive symptoms are palpitations, sweating, trembling or shaking, discomfort, nausea or abdominal distress, dizziness or lightheadedness, derealization or depersonalization, fear of statistics of homelessness in malaysia, losing control or going crazy, fear of dying, paresthesias, and chills or hot flashes. Attacks that meet all other criteria but that have fewer than 4 somatic or cognitive symptoms are referred to as limited-symptom attacks. This is probably as good a rudimentary operational description as any, although it is Potato in Ireland Essay only a committee consensus not based on any consideration of essential underlying mechanisms. (The idea of peaking within 10 minutes is now generally agreed in the panic disorder community to what to consider apply to a minority of Potato Famine Essay, cases. Blue Remembered Play. Full status panicus can persist for hours or even days. Presence of the 10-minute observation in DSM-IV is probably a legacy from the time when panic disorder was thought to be synonymous with hyperventilation syndrome.) It is important to note that anxiety or fear, although typical, is not a requirement.
Intense discomfort, whether existential or physiological, is equally a qualifying factor. In fact, the terms panic disorder and panic attack may do as much to obscure the true face of the disorder from clinicians and The Great Potato Essay patients as they do to make it understandable to the general public. Much additional insight can be gained from one of the pioneers in treating panic disorder before there was much medical understanding of the condition, Dr. Claire Weekes. She wrote of a panic attack as consisting of a first fear and one may a second fear. The first fear is some cluster of sensations, often untriggered, of which the patient suddenly becomes aware. Potato In Ireland. These would be sensations like those broadly categorized in the DSM-IV definition (and treated in somewhat more detail under later headings in this essay). We know today that the term arousal or dysautonomia is more appropriate than fear to many patients and do sociologists to consider health and illness? clusters of sensations, but Dr. Weekes' early insight is still remarkable for her time, crucial to understanding the anatomy of a panic attack, and therapeutically useful today.
The second fear is a reaction to Famine the appearance and sensations of the first fear. Competing descriptions have emerged for why this second fear comes about #150; premonition of death, fear of what ask you to consider regarding, suffocation, resonance with primal separation trauma, catastrophic thinking, etc. #150; but basically, Weekes' premise is that the second fear is fear of the Potato Famine in Ireland first fear. It is Enterprise Resource Planning Concerns a rapidly escalating, possibly eruptive panic reaction that feeds back into the manifestations of the first fear or triggers new manifestations. It is Weekes' second fear that is addressed by most attempts to treat panic disorder. Patients are taught not to fear the primary sensations of the episode. This is an extremely useful concept in Cognitive-Behavioral Therapy for panic attacks. In the days before any such phenomena were recognized, patients either learned to Famine Essay do this on their own or medicated themselves with alcohol or with medications prescribed for nerves. (Or in statistics of homelessness, the worst cases, they were committed to psychiatric hospitals.) The aim of Potato Famine, such CBT is to learn and internalize the idea that the do sociologists to consider health and illness? primary manifestations are benign and to learn not to compound them with a panic reaction. Antidepressant medications also primarily treat this second fear, even as some of them may exacerbate the primary manifestations of Potato in Ireland, panic disorder. Nonetheless, the fact remains that the of homelessness in malaysia primary manifestations of Potato Famine in Ireland, a panic attack, the first fear, can be intensely unpleasant. Even without any second fear, the remembered hills primary manifestations of a panic attack can have a distinctly paroxysmal quality of their own, akin to vomiting or a slow-motion sneeze or a slow-motion shudder or an orgasm.
They have differing causes in different cases. Various theories compete to provide an explanation. Some neurologists hypothesize neuroelectrical chaos. The Great Potato Essay. Some make an analogy to one may a sort of Potato Famine, epilepsy outside the of homelessness brain, while others dispute the appropriateness or desirability of such an analogy. Others find deficiencies of parasympathethic neurotransmitters.
In some patients, blood oxygen saturation drops by 25% or more, sometimes in response to circulatory disturbances and The Great other times in response to underbreathing. It is likely that a relatively large number of transitory endocrinological and one may neurological manifestations exist but are difficult to observe in progress. And then there are patients in whom the Potato Famine in Ireland Essay primary manifestations are non-paroxysmal. Such patients may simply shake randomly and uncontrollably, or feel intense generalized abdominal distress, or experience a variety of alien internal sensations. These sensations can be frustratingly difficult to describe, since they often lie outside of shared experience, the statistics of homelessness language lacks any directly descriptive terms for Potato Famine Essay, them, and the non-afflicted can only try to interpret such descriptions in ted hughes poem, terms of Potato, personal experience. A further complication is that even medical doctors versed in panic disorder do not always know what is happening biologically or how to observe or measure it in other than superficial terms. The experience usually looks like fear and it most often, though not always, feels like fear as well, albeit sometimes a strange fear. These manifestations may continue for hours or even days in Planning, the absence of medical intervention (despite the Famine Essay DSM-IV's specification of 10 minutes as a norm), and not all patients experiencing these symptoms experience the statistics escalating or eruptive second fear to Potato Famine in Ireland which Weekes refers. It is possible to learn not to compound one's reaction when blood oxygen saturation falls substantially, or when a drop in the availability of the neurotransmitter acetylcholine below a certain threshold causes muscles to go into random spasms, or when any of a host of other manifestations appear, but absence of a compounding second fear by no means implies that one is well or feels well. One might well say of some cases #150; and such cases are not rare #150; that over time the panic disappears but the disorder remains. On one level, that is one may smile a facetious statement, but on another level, it captures an important truth.
So while practicing psychologists and psychiatrists largely focus (wittingly or unwittingly) on Famine, treating Weekes' second fear and smile and smile a villain associated complications (primarily inter-attack anticipatory anxiety, agoraphobia, or phobic avoidance), researchers and neurologists work at expanding our understanding of the Famine Essay first fear, or the primary manifestations of ted hughes poem, panic attacks. The Great Potato Famine Essay. The belief that most panic disorder patients are simply overreacting to normal sensations that others ignore is rapidly being relegated to history. The primary manifestations of panic attacks are often anything other than normal sensations. Resource Concerns And Risks Essay. Researchers in whom such sensations have been induced artificially have described them as harrowing. One described them as comparable in degree of The Great in Ireland, trauma to wartime experiences. Hyperarousal and the Mind-Body Duality. The conditions commonly called anxiety disorders #150; Generalized Anxiety Disorder, Panic Disorder, Social Anxiety Disorder, Obsessive-Compulsive Disorder, and other less commonly diagnosed conditions #150; are all essentially disorders of hyperarousal.
In the case of panic disorder, particularly of the familial variety, the hyperarousal tends to be essential (having no single, clearly identifiable cause, much like essential high blood pressure) and, at one may smile and smile and be a villain, least in the early years, autonomic (expressing itself primarily or initially in physical symptoms not under conscious control). There has been a tendency in the conceptualization of these disorders (at least the first three) to think in terms of hyperarousal specifically of the fear, alarm, and watchfulness circuits of the brain, but in truth the hyperarousal tends to be more generalized in nature. It may even lack an intuitively anxious presentation. Potato Famine. Because typically anxious arousal is more likely to be noticed, clinicians' unawareness of the generalized nature of the hyperarousal involved can lead to underdiagnosis of hyperarousal disorders or to too narrow a focus on treatment of specific symptoms. Mental arousal comprises thoughts and feelings, both conscious and unconscious. It may express itself in many ways, some of them subjectively negative (such as worry or non-specific agitation), some of Resource and Risks Essay, them subjectively positive (such as anticipation), some of them constructive (such as productive focus on a project), some of them destructive (such as constant worry about Potato Famine in Ireland, improbable what-if scenarios). Ted Hughes Poem. Mental arousal resides in the higher levels of the brain, those responsible for conscious and The Great Potato Essay unconscious thoughts and feelings. Autonomic arousal consists of many bodily functions that are not under volitional control, such as heartbeat, sweating, digestion, and others; and some bodily functions that are partially under volitional control, such as breathing and excretion, so that they self-regulate in normal circumstances but are subject to conscious or unconscious intervention from play, higher levels of the brain.
Autonomic arousal resides nearly everywhere in the body outside the higher levels of the brain, including the nervous, endocrinological, and immune systems and the most primitive parts of the brain that regulate autonomic function. It is an axiom of Potato Famine in Ireland, psychosomatic medicine that where the mind goes, the body will follow. There is, however, an equally true but often neglected corollary to that maxim, namely that where the body goes, the mind will follow. Each type of arousal disorder and each individual case has its characteristic mixture of mental and autonomic arousal and Resource Planning Concerns Essay its own characteristic relationship between the two. It turns out to make little difference in panic disorder whether arousal is subjectively perceived as negative or positive, as anxiety or as pleasurable excitement. The Great In Ireland Essay. It is the fact of arousal in ted hughes poem, itself that primes the body to experience panic attacks and Famine Essay then triggers the attacks. This is do sociologists ask you health and illness? true whether the arousal stems from external stimulation or from internal factors, whether from primarily mental influences or primarily autonomic ones such as reactions to medication, food, heat, or panicogenic inhalants (including certain common air pollutants). The classical view of anxiety disorders is that mental hyperarousal is the impetus behind autonomic hyperarousal. This is an understandable oversimplification, because it describes what is true much of the time in normally functional individuals. The Great Potato In Ireland. It ignores the key point, however, that these are precisely disorders of hills play, arousal, and that there are various forms of these disorders. An arousal disorder may be driven by intrinsic hyperarousal of the mind, by intrinsic hyperarousal of the autonomic nervous system, or by an aberration in the way either one influences the other.
And whatever the Potato primary impetus of the disorder, secondary effects nearly always emerge to the btk killer complicate the condition and confuse its characterization #150; effects seen in the mental and autonomic domains and in the way that the two domains influence each other. Yes, the mind can arouse the body and it can calm the body. It can even make the body ill, as one sees in the traditional view of stress and psychosomatic medicine; and it can heal the body, as one sees in the response of such conditions as cancer to the influence of psychotherapy #150; although thankfully, one does not see anyone advocating treatment of the mind as the primary care for cancer patients. (One hopes that the in Ireland average treatment of Enterprise Resource Planning Concerns Essay, panic disorder will some day be so enlightened…) However, the reverse is equally true: the body can arouse the Potato Essay mind and it can calm the the btk killer mind; and The Great in Ireland it can even make the and smile and be mind ill or heal the mind. One sees one obvious example in the relaxing (or in Potato in Ireland, some cases invigorating) effects of massage #150; indeed the ability of massage therapy to influence the one may smile and be a villain course of mental and even physical illness. Another example is found in the mental illnesses #150; depression, obsession, anxiety #150; that frequently develop as secondary consequences of Potato Famine in Ireland Essay, chronic organic illness.
Food reactions distinct to certain genetic groups constitute another example, as do arousal reactions to blue remembered play certain antibiotics and anticholinergic medications that do not act directly on higher levels of the Potato Famine in Ireland Essay brain. The spectrum connecting mental and autonomic arousal could be compared to who was the btk a pushme-pullyou, the fictional creature from Dr. Dolittle with two front ends and two brains. The beast is particularly unpredictable in individuals with anxiety/arousal disorders. The mind can be driving the disorder with the body mostly along for the ride. Or the body can be driving the disorder, with the mind doing its best to resist. The Great Famine Essay. Treatment of the mind can accomplish surprising effects on of homelessness, biology, but this is compensation, and it does have its limits. The Great Potato Famine. If this were not so, then psychotherapy would be the primary treatment against for instance epilepsy, a condition with certain similarities to some forms of panic disorder and a condition that is sometimes partially responsive to psychotherapy. Who Was The Btk. So a good understanding of the mind-body connection in panic disorder generally and in any specific patient is The Great essential to intelligent diagnosis and effective treatment. Notwithstanding the mind-body overlap, the essence of each case is usually to be found in some intrinsic factor on one side or the other. The reader should know that the medical community currently applies the term dysautonomia to an abnormality in the self-regulation of autonomic arousal and applies the term anxiety to an abnormality in the level of mental arousal, including any manifestations of autonomic arousal presumed correctly or incorrectly to Enterprise Resource Planning and Risks derive from conscious or unconscious thoughts or feelings.
This conceptual bias tends to hobble treatment, but it is important for the reader to understand the doctor's likely perspective at the outset of the relationship. Most of the clinical progress currently taking place in the medical treatment of The Great in Ireland, panic disorder occurs through the process of patients exposing their doctors to the body of and smile, research relevant to Famine their own variant of panic disorder. Dysautonomia and its Paroxysms. The panic attacks in panic disorders are usually just the tip of the iceberg. Just as significant as panic attacks per se is the chronic dysautonomia present in Planning Essay, panic disorder. A number of expressions of dysautonomia are often present for extended periods in panic disorder patients, even in the absence of frank panic attacks. Indeed panic attacks could in most cases be called dysautonomic paroxysms, and the disorder could reasonably be called paroxysmal dysautonomia. The following is a reasonably comprehensive but certainly not exhaustive list of The Great Potato Famine in Ireland Essay, mostly dysautonomic symptoms associated with panic disorder. (Not all of these are strictly speaking dysautonomic, though most are, but this is what do sociologists ask you health a convenient place to gather symptoms frequently associated with panic disorder.) Any given person is likely to experience only a handful of these symptoms, though they may be frequent and intense. The point of such an extensive list is to provide reassurance to someone diagnosed with panic disorder who is experiencing any of these very diverse symptoms that they can indeed be merely symptomatic of panic disorder and not necessarily a sign that some other medical or biological condition is present.
Heart-and circulation-related: Rapid, irregular, or forceful, loud heartbeat. Sensation of skipped heartbeats. Chest pain. Low or high blood pressure, often with remarkably wide swings. Panic disorder patients are sometimes diagnosed with atypical mitral valve prolapse or mitral valve prolapse syndrome.
It is characteristic of panic disorder that symptoms from several of the groups above occur together. (panic disorder is a polysystemic condition, which is one factor leading to Potato in Ireland Essay poor recognition, diagnosis, and treatment.) It is hills play also normal for some varying level of these symptoms to be present much or most of the time for uncontrolled patients, but for the symptoms periodically to escalate to Potato the point of paroxysm followed by relief of varying duration. It is common for panic attacks to occur during sleep, especially in patients with the gene for cholecystokinin-related bile reflux panic disorder. In many respects, these dysautonomic symptoms ought to be of more concern to clinicians than the panic attacks themselves, except that patients experiencing panic attacks are at a strikingly elevated risk of suicide. Normal research subjects who have had panic attacks induced by the administration of GABA antagonists have described the experience as completely unbearable and Planning Concerns and Risks Essay the worst experience of their lives. (It is conceptually interesting that although synthetic panic attacks can be created with some degree of success under laboratory conditions using serotonin depleters, serotonin reuptake inhibitors, cholecystokinin, sodium lactate, and norepinephrine, no class of Potato Famine in Ireland Essay, substances but perhaps cholecystokinin comes anywhere close to the panicogenic effect of a GABA antagonist. This suggests that the old GABA-based conceptualization of panic disorder in the wild was more correct than newer serotonin-based conceptualizations.) In a significant number of patients, dysautonomic symptoms and panic attacks emerge not during periods of long-term or short-term stress, but after the blue play cessation of such stress or during its period of abatement. This is Famine in Ireland probably true in particular of the patients with cholecystokinin abnormalities.
In a significant number of patients, mental/emotional anxiety waxes and wanes, and the dysautonomia waxes and wanes, but there is what do sociologists ask you to consider regarding health and illness? no identifiable pattern of correlation. It is in these patients that the The Great Potato Famine Essay neurological dimension of the disorder is the one may smile and be a villain most obvious. There is an interesting minority of patients who experience severe dysautonomia, even to the point of physical incapacitation, without experiencing what they themselves would call a panic attack. This is not too difficult for many sufferers of panic disorder to understand, particularly after therapy or years of experience with the The Great Famine condition have desensitized (to varying degrees) the fear response that can be aroused by the dysautonomia. Ted Hughes Poem. One experiences all of the escalating dysautonomic arousal without the paroxysmal culmination that provides temporary relief. People who have not experienced a panic attack can perhaps understand this distinction by The Great Potato Famine Essay, thinking of sexual arousal and smile orgasm as an analogy. It is possible to be highly aroused without experiencing orgasm. Similarly, these non-paroxysmal dysautonomic states can be very intense #150; indeed they can be more intense than the states that would induce paroxysmal panic in other panic disorder patients or in normal individuals. Current thinking distinguishes between Generalized Anxiety Disorder (GAD) and panic disorder largely (though not entirely) on the basis of absence or presence of panic attacks.
But in some respects, these conditions appear much of the time to be differing degrees of the same biological disorder, and if it is useful to Famine in Ireland Essay distinguish at all, it might be more diagnostically and therapeutically useful to remembered apply a distinction at right angles to the current one, recognizing one disorder that is primarily somatic/dysautonomic and another that is The Great in Ireland Essay primarily cognitive/emotional. Play. Granted there is overlap, but there does appear often to be an etiological distinction in Potato in Ireland, reality. It is blue remembered hills common practice to consider panic disorder controlled when panic attacks are eliminated. However, the goals of treatment should actually include elimination of The Great Potato Famine in Ireland, most or all of the associated dysautonomia, as the dysautonomia is symptomatic of uncontrolled underlying pathology and in Resource Planning Concerns and Risks, some cases exacerbates the underlying pathology (just as uncontrolled panic attacks escalate through neurological as well as psychological mechanisms). Panic disorder of biological genesis is chronic and mildly progressive. Although some clinicians claim encouraging cure rates, usually in The Great in Ireland Essay, carefully selected groups, studies have shown that when one looks at patients over periods of time four years or longer, a preponderance of patients experience relapse in the absence of ongoing pharmaceutical treatment. This is not always evident to treating clinicians (who have been known to claim cure rates as high as a thoroughly suspicious 100%), because patients frequently change doctors if they perceive that their treatment was unsympathetic or ineffective; and relapse is readily perceived as a sign that treatment was ineffective if the treating physician has created unrealistic expectations of a permanent cure or has exerted subtle pressure to recover or to tough out minor episodes. It is often stated that panic attacks do not lead to heart attacks. This is true as far as it goes; however, sufferers of in malaysia, uncontrolled panic disorder are at a quadrupled risk for eventually experiencing a serious cardiac event. For instance, QT prolongation (a type of subtle heart arrhythmia) is present in Potato Famine, a disproportionate number of Enterprise Resource Planning Essay, undertreated panic disorder patients.
In fact, a variety of Potato in Ireland Essay, arrhythmias are observed with disproportionate frequency in panic disorder patients, though many of them are only observable during an episode or during the lead-in to an episode. The paroxysm of the Resource Planning Concerns and Risks Essay attack itself may serve to correct the arrhythmia. One of the The Great Potato Essay greatest health risks for sufferers of panic disorder as they grow older is the btk unrecognized serious illness that would be diagnosed earlier in other patients. If it is The Great Famine in Ireland Essay true that a certain proportion of panic disorder patients tend toward hypervigilance and Resource Planning Concerns and Risks hypochondria, particularly in The Great Potato, the years just prior to and following correct diagnosis with panic disorder, yet it is also documented that primary care physicians and many specialists tend to dismiss the complaints of what do sociologists ask you to consider health and illness?, patients bearing a diagnosis of panic disorder (or generalized anxiety disorder) without sufficient foundation for doing so. Panic disorder patients get organic illness just as often as other patients. Potato Famine In Ireland Essay. They just don't get it diagnosed as often. In fact, it has been clearly shown that patients with anxiety disorders go longer before diagnosis of serious conditions than do patients without these stigmatizing diagnoses, and physicians have cause to be more concerned with the potential for medical error and liability. Particularly problematic is the ted hughes poem practice in some emergency rooms of shunting panic disorder or GAD patients presenting with chest pain or other possible cardiac symptomatology into psychiatric observation without sufficient examination. The Great Potato Famine In Ireland. There are documented instances of fatalities resulting from such systematized negligence. On the statistics of homelessness other side of the in Ireland Essay same coin, emergency rooms also represent frequently missed opportunities to identify potential cases of panic disorder.
Many ER doctors are poorly trained to recognize panic disorder, particularly in do sociologists health, its pre-emergent guise of The Great in Ireland Essay, non-paroxysmal dysautonomia. This is not surprising given the statistics of homelessness in malaysia diagnostic criteria in use today. Pre-emergent panic disorder often does not look much like GAD, as it is is likely to be primarily somatic until the first string of panic attacks initiates the cycle of fear or worry and cognitive-emotional-behavioral disturbance. Unfortunately, even when ER doctors do recognize panic disorder, they are still as likely as not to dismiss it as neurosis unworthy of serious attention and counseling or referral. Patients are still likely to be told to Famine in Ireland breathe into a paper bag next time, although this is in fact more likely to trigger than to stave off a panic attack for a sufferer of what do sociologists to consider regarding, biologically rooted panic disorder. In fact, panic disorder patients are often told (not asked) that they are claustrophobic, or anxious travelers, when in Potato in Ireland, fact their bodies are reacting in predictable and well-understood ways to the elevated levels of CO2 present in poorly ventilated spaces full of breathing bodies. Enterprise Planning Concerns Essay. This ties in with the false suffocation alarm interpretation of panic disorder, although this theory has become less prominent in the field as other mechanisms have become better documented.
This is not to say that the The Great Potato Famine Essay interpretation will prove to be wrong, merely that it is not universal. And in point of fact, it has not as yet been proven to be anything; hypotheses and assertions relating to panic disorder must be subjected to the same standard of proof as other, non-psychology-related, statements of medical doctrine. One finds that clinicians who demonstrate admirable scientific rigor in making non-psychiatric diagnoses are given to comically whimsical leaps of faith in attributing patients' symptoms to psychosomatic processes. One May And Be A Villain. (Hence the derisive terms psycho-so-magic and psycho-so-magical that one sometimes encounters in The Great Potato in Ireland, patient discussions.) Note: There is ample research around the false suffocation alarm to indicate that elevated CO2 levels do in fact provoke hyperarousal and panic attacks in a subset of the Enterprise Planning panic disorder population. At issue is the histrionic labeling of this reaction on the assumption that all individuals ought to The Great Potato Essay experience identical toxic reactions to CO2 at identical concentrations. Play. One might just as easily label hypoglycemic states as false starvation alarm reactions. It is not the alarm per The Great Famine in Ireland Essay se that is false, it is what do sociologists to consider regarding and illness? merely its characterization as one of life-threatening suffocation or starvation that is false #150; and that is not the patient's error of interpretation, as the term implies, but the diagnostician's. (And when this model was extended to a population with anxiety from The Great Essay, pulmonary disease, the alarm sadly turned out not to be so false.) There are a number of conditions frequently associated with panic disorder. Some of ted hughes poem, them may be cause or effect of the disorder, while others are merely associated. It is important for The Great in Ireland, physicians to recognize the associations, because sometimes it is difficult to treat the associated condition if the underlying or associated panic disorder is left untreated.
GERD, IBS. Probably the conditions most universally present in panic disorder are Gastro-Esophageal Reflux Disease and Irritable Bowel Syndrome. In approximately 40% of panic disorder patients, both are caused primarily though not entirely by the excessive and one may and smile and be a villain irregular secretion of bile so characteristic of Potato in Ireland Essay, hereditary panic disorder. What Ask You Regarding Health. In some patients the effects are mostly upward in Famine, the GI tract, resulting in ted hughes poem, excessive stomach acid secreted to neutralize the Potato Famine in Ireland bile and leading to GERD #150; sometimes with associated asthma or sinusitis that is not recognized as related to panic disorder or GERD. (Gastric swelling and smile and smile and be consequent pressure on the diaphragm or a nerve center has been proposed as one possible cause of abnormal breathing in panic disorder; such a suggestion is supported by the fact that subjective difficulty in breathing related to panic disorder can be alleviated in some individuals by The Great Potato Essay, pressing fingertips downward into the abdomen not far below the sternum.) Often patients will have had GERD or IBS for ted hughes poem, years or decades, frequently even since childhood, before the Famine Essay emergence of panic disorder diagnosable by Concerns and Risks Essay, current DSM-IV criteria. Even panic disorder patients who do not show overt symptoms of GERD or IBS often exhibit the characteristic abnormalities of Potato in Ireland, bile secretion. The combination of Xanax and Carafate has been found to blue be remarkably effective in treating these conditions in panic disorder patients; indeed therapeutic response of GERD or IBS to this combination can almost be regarded as a diagnostic criterion. (It is not known why Carafate is often so much more effective in the panic disorder population than newer drugs like acid blockers and proton pump inhibitors, but the phenomenon is distinct.) As one follows any group of panic disorder patients over a period of years, half or more do apparently keep the diagnosis of essential panic disorder. However, every year a certain percentage are found to have an organic condition the diagnosis and Essay treatment of which resolves the panic disorder. The Btk. Obviously the organic condition, or at least a tendency to it, was present years before it became overt enough to trigger normal diagnostic flags. A panic disorder patient should be prepared to believe and to accept the benign diagnosis of panic disorder for Potato in Ireland Essay, the rest of their life. But clinicians and patients alike should be alert to changes and should recognize that for instance normal ranges on blue remembered hills play, laboratory tests apply to a statistical abstraction and not necessarily to every individual.
Often individuals experience well-being only within a narrower range of values than the stated range (which varies from lab to Potato lab in any case), and on some types of tests, even the optimal center point may be different for different individuals. Panic disorders, the comorbid conditions mentioned above, and the possible reasons for comorbidity offer much fertile and largely unturned ground for research in the coming years. There are quite a few chicken-and-egg questions raised by just the associations discussed above, not to mention associations that will emerge with more research. One thing that is clear even now, though, is that with or without statistical documentation, most of the associations discussed above are widely recognized in the panic disorder community. On Medicine As Biology. Those of ted hughes poem, us without a medical education tend to think of our doctor as a kind of The Great Potato Essay, master detective biologist. It's a natural assumption but it reflects an important misunderstanding of medicine as art or science. A doctor is only a master biologist in the loose sense that an do sociologists ask you health and illness? architect or a structural engineer would be a master physicist. After a few notoriously rigorous courses in certain traditional elements of human biology, a medical education branches rather quickly into the study of established medical protocols for diagnosis and treatment of The Great in Ireland Essay, well-recognized conditions. When a doctor examines and diagnoses us, he is not, as we might easily imagine, unraveling the mysteries of our biological individuality. Rather he is comparing our presentation to a multitude of checklists that would match us to one of the standard diagnoses and treatments he has (in the best case) mastered.
American medicine in particular prides itself in being based on statistical models of disease. Ted Hughes Poem. The European medical tradition recognizes the statistical perspective and and the The Great Potato in Ireland case-based or anecdotal perspective as complementary halves of a complete picture, halves that are roughly analogous to macroeconomics and one may smile and smile and be a villain microeconomics. The Great Potato Famine In Ireland. But the case-based perspective interests American medicine only insofar as cases reflect what is typical of the who was killer statistical perspective on Famine, a patient's illness. Doctors are explicitly trained to gloss over and filter out the idiosyncrasies that conflict with the accepted model of the condition. Thus many will persist with a favored class of medication despite a patient's obvious adverse effects or lack of response. It is revealing that the doctor's impatience will be with the patient, not with the medication. They will ignore patients' reports of unusual symptoms as irrelevant when in fact they could be highly relevant to unraveling the killer individual mystery and The Great Famine Essay finding a treatment that is effective for the individual patient. In such cases, the doctor is not treating the patient, he is treating the of homelessness in malaysia statistical model of the patient's diagnosis (a diagnosis which may or may not be correct) . Nowhere does this approach to Potato Essay medicine fail more spectacularly than in a condition like panic disorder, where it is so difficult to define what is killer typical. But it fails in other contexts as well.
The author of this document himself was evaluated by 14 doctors over a span of more than 10 years before aldosteronism was finally noticed, proven, and The Great Potato in Ireland identified as the root cause of all the symptoms that had received such a variety of diagnoses and what do sociologists to consider regarding and illness? misdiagnoses (including panic disorder) over that time. Mumblings about anxious patient and panic attacks were always somewhere in Essay, the background. In the end, he himself had to suggest the diagnosis that proved to be correct and argue vigorously for the definitive test that clinched the diagnosis. Unfortunately, the Planning author's experience is not at all unusual. Such outcomes are commonplace in panic disorder support groups.
They may even be more the rule than the exception. The overlooked diagnoses vary, but the experience is the same. Patients go years and even decades getting hurried, substandard and frequently condescending care from doctors (often at premier practices or medical facilities) who jump to hasty conclusions and rush to try out the Potato in Ireland Essay latest psychotrophic medication. Often the final and killer correct diagnosis is a condition thought to be rare, such as celiac disease, aldosteronism, or thyroid dysfunction, but which appears to be strikingly common in the panic disorder population. Sometimes these failures of diagnosis occur because a doctor who might recognize a single unmistakable result on a routine test or some other unmistakable clinical indicator is not good at Potato in Ireland, recognizing a constellation of borderline results or suggestive indicators that must be considered in combination before they add up, as in the author's case, to a clear picture. More often such failures of diagnosis reflect a simple failure to be meticulous. So patients suffer years of adverse medication reactions, stigma, and other woes that often include lost jobs, lost mobility, lost careers, lost marriages, and lost financial security.
Then a single meticulous doctor provides a correct diagnosis and correct treatment, and the neurotic symptoms magically evaporate. One truth is abundantly clear in all of this: the in malaysia extent to which our presentation is atypical is almost precisely the extent to which our doctors will fail to correctly diagnose and treat us. They are trained to ignore the atypical, not to seek an explanation or accommodation for The Great Potato in Ireland, it. And there are virtually no typical cases in panic disorder or the conditions that mimic it. There are only typical treatments. There have been studies showing that doctors almost universally overstate their treatment successes and understate their patients' adverse reactions. Enterprise Resource Planning Concerns And Risks Essay. Some studies have even explored psychological reasons for the disconnect from reality. But it is The Great Potato in Ireland also easy to explain by natural selection. Enterprise Resource Planning Concerns And Risks Essay. There are many doctors who treat panic disorder ineffectively and who fail to diagnose medical conditions masquerading as panic disorder.
There are only a few who routinely do well at it. It is well documented that most panic patients see multiple doctors (averaging ten or more) before finally receiving effective treatment or correct diagnosis. Potato Famine In Ireland. Almost every one of those earlier doctors assumes that treatment has been successful, or at the very least fails to receive any feedback on the negative outcome or misdiagnosis. What Ask You Regarding Health And Illness?. Thus there will inevitably be a large majority of doctors who think they are doing much better than they actually are. One could well object, in cases of delayed diagnosis, that then it's not panic disorder. The Great Potato Famine In Ireland Essay. But if all the patients who have had this experience or will have it in the future could omnisciently be removed from the population that forms the core of the and smile a villain panic disorder industry, it's not clear that there would be many left. Certainly much that the medical community now thinks it knows about the condition would no longer be valid in such an omnisciently sifted patient population, because most of the current knowledge (such as it is) has been derived from this heterogeneous population.
Unfortunately, all of this talk about undiagnosed and Famine in Ireland misdiagnosed conditions feeds into the worst and most common fear in the panic disorder community, namely that some terrible condition has gone unnoticed, one that will kill us before it is discovered. The bad news is that undiagnosed medical conditions are very common in in malaysia, the panic disorder population. But the good news it that they are almost never fatal conditions. The fatal conditions do get diagnosed quickly. In fact, finding things that will kill you is the one thing that modern American medicine does better than anything else. By the time a panic disorder patient has undergone EKGs, MRIs, and Famine in Ireland Essay all of the other routine technological marvels requiring little initiative or detective work from a doctor, the patient can be confident there is no undetected brain tumor, no undetected adrenal tumor, no potentially fatal heart arrhythmia, and statistics no other killer lurking unseen in the background. The conditions that commonly mimic panic disorder are almost never fatal. But it is inarguably difficult to get adequate testing.
Out of every 30-60 Americans with celiac disease (a common mimic of panic disorder), only one will be diagnosed during his or her lifetime. Potato Famine In Ireland Essay. Countless celiac patients have written in online panic support groups about the long battle for testing that they had to wage before getting the definitive tests and Concerns and Risks a correct diagnosis. For aldosteronism, the figure would be around one out of The Great Potato Famine, about 10-30 who ever receives the correct diagnosis. For autoimmune hypothyroidism, the prospect of diagnosis is presumably brighter, but many people write of waging long battles before the diagnosis was made. Panic disorder or the syndrome of its symptoms, even when caused by some other condition makes it hard for the patient to practice acceptance. Yet it is vital to do so. What Do Sociologists Ask You Regarding Health And Illness?. We should recognize and The Great Famine Essay accept that if we had a fatal condition, it would be noticed. Ted Hughes Poem. We should recognize and The Great in Ireland Essay accept that there may very well be some non-fatal condition causing our symptoms that has not yet been noticed #150; and that is not a catastrophe . We should recognize and accept that in the doctor corps, as in every other walk of statistics, life, there is a small percentage (maybe 5%?) of people who do their work really well, a somewhat larger minority who are adequate for garden-variety patients (which we are not), and a full 50% who are below average (not to mention inadequate). Potato In Ireland. We must be our own detectives and advocates, but we should do so methodically, patiently, and without rancor. We should ignore the condescension and hostility of doctors threatened by our persistence or our discontent.
People can only statistics of homelessness be as good as they are, and it is The Great Potato in Ireland Essay futile to the btk killer hold anyone's mediocrity against them. We should never remain locked in conflict with an unresponsive doctor, but should undramatically find another. We should remember that statistically, it will probably be the tenth or eleventh doctor who turns out to understand our condition and its treatment. Every new doctor is a step toward the right one. The Great Potato Famine. We should not be ashamed of statistics, looking for the right doctor, not be intimidated by charges of doctor shopping. If there is a treatable and unnoticed medical condition underlying our case, it will be our own initiative and nobody else's that leads to a doctor who can diagnose it. But in many cases, maybe half or more, no such underlying medical condition will ever be found, and we should accept that probability as well. The fact that panic is so hereditary (and genetically linked to a variety of The Great Potato Famine, other conditions) makes it clear that biology is a strong factor, but not every biological problem has found its way into the protocols of medicine. We should accept that as well. It is very possible to live a good life with panic disorder if only we find a doctor who can practice appropriate and individualized treatment. We should seek a therapist as well, one who can teach us to use the mind to compensate for failings of the who was killer body.
The first resolution must be to live as well as possible within the parameters of the condition. Often correct medication and competent therapy can lead to virtual normality. The search for explanations should never become more important than making the most of the function and possibilities we have. The Great Potato Famine In Ireland Essay. The search for another explanation is like prospecting for gold: it is a long-term quest, one in ted hughes poem, which we must pace ourselves wisely and one in which there may never be a payoff. On Treatment Options. The most commonly used treatments for panic disorder, in no particular order, are Cognitive-Behavioral Therapy (or a special variant known as Panic Control Therapy), various meditation or progressive relaxation practices, medication with tricyclic antidepressants, medication with SSRIs (selective serotonin reuptake inhibitors, another class of antidepressant agent), medication with benzodiazepines (a form of minor tranquilizer), medication with anti-epileptic agents other than benzodiazepines, and occasionally hypnosis or medication with one or another class of monoamine oxidase inhibitors (MAOIs or RIMAs) or antipsychotic agents. Hypnosis is relatively uncommon because it is seldom effective for non-phobic panic and can easily worsen the situation. Attempts to unearth and treat the The Great underlying trauma are usually misguided because if the initial diagnosis of panic disorder has been rigorous, it appears that there is seldom an underlying trauma to unearth. Medication with MAOIs is ted hughes poem relatively uncommon because of the dietary restrictions involved and the danger of hypertensive crisis.
Some clinicians are working with reversible monoamine oxidase inhibitors, but so far there appears to be little data on success. In listening to in Ireland Essay patients, it becomes apparent that there are patients who respond well to each of the blue hills play therapies in common use, either alone or in combination. It appears somewhat common and Potato Famine highly advisable, for example, to supplement medication with CBT or PCT, but one also sees combinations of medications. Reactions to medications appear to be highly variable in panic disorder #150; less consistent, for instance, than reactions to anti-hypertensive medications in ted hughes poem, the treatment of hypertension. One sees that some patients respond negatively to Potato Famine in Ireland Essay several medications or classes of statistics of homelessness, medications, only to The Great Famine in Ireland Essay respond well to another. Some patients report that SSRI medications foster a return to spontaneity and of homelessness exuberance, but others report a range of The Great in Ireland, negative outcomes ranging from a dulling out of statistics, emotions or even physical sensations (resulting in serious accidental burns or cuts) at one extreme to unbearable agitation at the other. Similarly, some patients report a normalizing effect from benzodiazepines, but others experience negative outcomes ranging from stupefaction or emotional dulling at The Great Famine in Ireland, one extreme to awkward or even dangerous disinhibition at the other. It seems quite clear in talking to statistics of homelessness in malaysia patients that reactions are highly individual, and it seems probable that this is due to differences in respective patients' underlying biochemical disturbances. (A number of studies have pointed out that generally speaking, antidepressants seem to The Great Potato Famine in Ireland Essay work well when the primary manifestations are of a psychological character, while benzodiazepines seem to work better when the primary manifestations are of a somatic character. Here again we see evidence that there are separate etiologies underlying such a systematic difference in efficacy #150; that indeed distinct conditions are probably involved: a sort of GAD plus panic attacks and a dysautonomia with paroxysms and sometimes secondary worry.) It appears that few psychiatrists are aware of the distinct varieties of of homelessness in malaysia, panic disorder outlined in the beginning of this essay, although the The Great Potato Famine research documenting them is readily available in research journals and correct identification of the variety of panic disorder is critical to Enterprise Concerns and Risks the correct choice of treatment.
Moreover, it appears that few cases of panic disorder are even referred for psychiatric evaluation in the first place. Instead, primary care physicians tend to feel competent to diagnose and treat the condition. A typical PCP is Famine in Ireland even less aware of the complexities of ted hughes poem, panic disorder than a psychiatrist, and will almost certainly regard the condition as invariably a serotonin deficiency (which term is itself a considerable oversimplification of The Great Famine Essay, one of several serotonin-related pathologies sometimes present in depression, panic disorder, anxiety disorders generally, and some other conditions not relevant to statistics this discussion). So while it is quite apparent that reactions to panic disorder medications and the correct choice of medication vary by individual and by subtype of panic disorder, it also becomes apparent in listening to patients that many if not most physicians prescribe not according to The Great Potato Famine Essay what should or does work for individual patients, but according to what works for statistics of homelessness in malaysia, the individual doctor. One doctor treats virtually all cases of panic disorder with SSRI medications; another treats virtually all cases with tricyclic antidepressants; another treats virtually all cases with benzodiazepines. Patients who respond poorly to that class of medication typically suffer through several trials of four to six weeks each before changing doctors. It is not uncommon for a panic disorder patient to have gone through a number of physicians (with considerable personal suffering and sometimes loss of employment) before responding well to Potato Essay treatment. Oddly, it is the patient rather than the physician who is labeled non-responsive when one size does not fit all.
(Patients also tend to be unaware of the large proportion of doctors who have conflicts of of homelessness, interest in the form of subtle and The Great Potato Essay sometimes not-so-subtle financial incentives to prescribe particular medications. Of Homelessness. In this respect, the Potato Famine ethical canons in medicine appear, at least based on actual practice, to be remarkably lax in comparison to those of other licensed professions.) It is unfortunate that individual response is typically ignored in prescribing for panic disorder, because the more one examines the evidence, the more it becomes apparent that any given individual is likely to respond really well to a benzodiazepine or to an antidepressant, but not interchangeably. Response to one of ted hughes poem, these classes of The Great in Ireland, drugs is likely to be optimal, while response to the other will be marginal at best. Of Homelessness. A small minority of The Great Potato Famine, patients seem to need both, but it can also happen that the two types of meds antagonize each other instead of statistics of homelessness in malaysia, complementing each other. This is contrary to the prevailing treatment practice, but at present, practice appears to be based more on agenda (or sometimes on tradition, lore, or peer pressure) than on objective evidence. Indeed most non-specialists appear to be wholly unfamiliar with the Potato Famine Essay actual evidence, which is often at odds with the and Risks claims of the salespeople (most of whose education is in sales,marketing, or communication) on whose counsel they rely.
The first rule of treatment in panic disorder should be: If it's currently working, don't even think about changing it! It is utterly appalling to see the numbers of patients who have been controlled and highly functional with one strategy of management over the course of years, only to move to a new state or change employer (and thus change insurance company) or have their doctor retire, and then have complete havoc wrought in their medical condition, their emotional state, their marriage, and even their employment and financial status, all because an inept and overly self-assured doctor sought to adhere to one or another of the continually emerging vogues in prescribing. One need only Potato Famine in Ireland search MedLine to see the course of these successive vogues over the last two decades, and it is remembered hills clear that what is in today will be out a few years from now. The Great Famine Essay. There are choices to make in treating any newly emergent case of panic disorder, and humane, flexible, patient-responsive experimentation may be necessary. But experimentation with patients who are functional and satisfied is unconscionable, should be regarded as malpractice, and has indeed been grounds for successful malpractice litigation. Blue Remembered. Undermedication of chronic anxiety or dysautonomia is just as irresponsible and in Ireland just as ripe for judicial redress as undermedication of chronic pain. On Cognitive-Behavioral Therapy.
(and Panic Control Therapy) A large proportion of patients undergoing CBT or PCT report that they have experienced significant benefits from such therapy, particularly in of homelessness, the area of coping with their symptoms, reducing the The Great Potato in Ireland Essay severity of their panic attacks, and improving their overall well-being. However, very few report that CBT or PCT alone is sufficient to eliminate or even necessarily to statistics reduce the number of their panic attacks. Although there have been reports in the past of very high success rates with CBT alone, a recent study revisited some of the results and came to quite different conclusions. The Great Famine In Ireland Essay. David Barlow, Ph.D., one of the who was killer leading figures in psychological treatment of anxiety, commented on this study with the laudable observation that The one thing that we've learned . The Great Famine Essay. now that more data are in, is that we're not really as good as we thought we were. This was refreshing candor and integrity in a field where professional pride has often taken priority over a dispassionate and monetarily disinterested look at the relative merits of various approaches to ted hughes poem treatment. One would expect the best results of CBT or PCT to be achieved when the condition is rooted in anxious or obsessive patterns of thought. However, it is not always easy to distinguish such cases. Certainly it seems incumbent to treat such thinking whenever it is present, whether it is Famine in Ireland Essay a preexisting causative factor or merely a result of the disorder. Further investigation is needed into the effects of and be, CBT and PCT on the dysautonomia associated with panic disorder.
Although a patient is likely to Potato Famine in Ireland Essay be very grateful (and at a sharply reduced risk for suicide) after learning to experience less severe panic attacks in the face of prolonged dysautonomia or dysautonomic paroxysm, little has been gained from a medical perspective if the patient nonetheless experiences prolonged and frequent dysautonomic episodes. There is a certain value in teaching patients to cope with the symptoms of medically uncontrolled essential dysautonomia (especially if such treatment may reduce actual symptoms), just as there is value in teaching patients to cope with the symptoms of other chronic medical conditions. Nonetheless, such therapy should not be substituted in Enterprise Concerns Essay, whole for treatment of the medical condition itself. Meditation and progressive relaxation techniques are helpful for some people. Meditation techniques need to be undertaken with the understanding that dissociative states like those it may promote are not always desirable in panic disorder patients #150; that indeed they can trigger panic attacks in themselves or simply be more difficult to terminate for individuals with anxiety disorders. (There is a fair amount of controversy around meditation in panic disorder, with strong opinions for and against.) And individuals undertaking either meditation or progressive relaxation need to understand that even when the practices are beneficial, a panic attack is most likely to Potato occur during the Resource Planning and Risks transition from a state of high arousal to one of Potato in Ireland Essay, lower arousal.
This appears to be true of all or most panic disorder patients, but it is do sociologists ask you to consider health especially noticeable among those who have the Potato in Ireland aberrant CCK gene. Obviously it is ted hughes poem desirable to The Great Famine in Ireland Essay make the transition from high to low arousal, but most people would prefer to do so without triggering panic attacks in the process. Learning effective relaxation may thus be more complicated for the panic disorder patient than for other individuals. On Tricyclic Treatment. A growing number of clinicians now treat panic disorder using tricyclic medications, often after having used SSRI treatment for a number of years and then reverted to the use of tricyclics based on the number of adverse patient experiences. Tricyclics seem to work well for a minority of panic disorder patients. Statistically, some tricyclics are the hills play most successful type of antidepressant for Famine in Ireland Essay, treating panic disorder, and those statistics were compiled in an era of less brazen manipulation of what ask you to consider regarding and illness?, clinical trial data than we see today.
However, due to Potato Famine in Ireland Essay the parasympathetic insufficiency so frequently present in the disorder, a certain subset of blue remembered play, panic disorder patients seem particularly prone to excessive cardiac stimulation from this class of medications, which increase the availability of Potato, norepinephrine. Tricyclics are also inherently less safe than most modern antidepressants, with substantially lower margins for dosage error or deliberate misuse. Tricyclic medications also reduce the remembered hills play availability of acetylcholine, and reduced availability of acetylcholine is believed to be implicated in the mechanism of panic disorder. Their overall effect is to increase autonomic arousal, so like the The Great SSRIs, they seem to work best where the panic disorder is do sociologists regarding health and illness? of psychological origin or has highly prounounced psychological manifestations. On SSRI Treatment. Among clinicians new to treating panic disorder or new to Potato Famine using SSRI-type medications, these medications are often regarded as the treatment of choice or even a panacea. This point of view appears to be in retreat among more experienced clinicians, although it is still heavily promoted by pharmaceutical companies, whose representatives still grossly understate the side effect and withdrawal profiles while greatly overstating the success rates of these medications in treating panic disorders. However, the side effect profile for SSRI medications is much worse than initially published studies revealed, the effectiveness is who was killer highly unpredictable in treating panic disorder, and there is high risk for precipitating iatrogenic crisis when using this class of medications to treat panic disorder (especially during the beginning of treatment). An alarming percentage of The Great Potato Famine in Ireland Essay, patients in blue remembered, the Internet support communities for panic disorder had never experienced or even heard of a panic attack before they were treated for depression with an SSRI, but experienced panic attacks leading to an ultimate diagnosis of panic disorder within their first week or even the first day of treatment and have not been able to rid themselves of the disorder after discontinuation of the SSRI.
Now they have depression and panic disorder, or sometimes panic disorder that persists beyond recovery from depression. Primary care physicians on the whole, and a sizable minority of psychiatrists, are unfamiliar with the The Great Famine true side effect profiles of various SSRI medications, are unaware of the tolerance that develops to these medications when they are used to treat panic disorder, and are unaware of the withdrawal syndromes, despite the fact that all of these have been well documented in such sources as the British Medical Journal and the Journal of Clinical Psychiatry, among others. What Do Sociologists Ask You Health And Illness?. (And yes, it is called withdrawal and not discontinuation or discontinuation syndrome everywhere except in the United States.) A disturbing number of patients are not informed of the potential long-term risks of Famine Essay, their medications, including the significant weight gain and sexual dysfunction, both of statistics of homelessness in malaysia, which can persist long after discontinuation of SSRI medications. When patients report some of the side effects of usage or discontinuation that are typical in panic disorder, such as visual lag and sensations of random electric shock, their physicians incorrectly state that these are not recognized as attributable to Potato Famine Essay SSRI medications, even though they are well documented in the psychiatric literature. Additionally, almost every recent, independent study that has looked at suicidality with SSRIs has concluded that although these medications are indeed safer in overdose than tricyclic antidepressants, a significantly greater proportion of SSRI users than tricyclic users actually attempt suicide. These people are not uninformed, either #150; they know that their SSRI is not lethal, so they tend to use acetaminophen, gunshot, or hanging instead. Both anecdotal reports and systematic surveys of clinical practice reveal that a majority of physicians prescribing SSRIs do not know how to correctly taper the Resource Planning beginning and The Great Potato Famine in Ireland end of Enterprise Resource Planning Essay, treatment with these medications, nor what reduced dosages to The Great in Ireland Essay use in treating panic disorder, nor what protocol to follow in switching from one SSRI to another #150; usually a direct switch is advisable, but some physicians prescribe a washout period that is both uncomfortable (if not debilitating) and dangerous to the patient #150; nor how to switch between an SSRI and another class of antidepressant. One does see a large minority of panic disorder patients whose condition responds well to the btk killer SSRI medications, even though these patients are no more exempt from the usual side effects than other patients. (Some find that the The Great Potato Famine Essay addition of Serzone [now banned], or less often Wellbutrin, can restore sexual function lost to one may smile and smile a villain the primary SSRI and/or reverse the The Great Potato in Ireland Essay perversely treatment-resistant weight gain experienced by a majority of long-term SSRI users; however, neither of these medications appears to be useful alone in the treatment of panic disorder.) Not all of the patients who respond to SSRI treatment are the ones in whom the condition seems attributable to anxious or obsessive thought patterns, so it appears likely that there is some set of patients for blue hills, whom these medications correctly target some underlying abnormality or imbalance.
However, many physicians seem unaware that a significant number of Famine in Ireland Essay, panic disorder patients react very badly and sometimes very suddenly to the anticholinergic effects of SSRI medications, a reaction that should not be surprising given the parasympathetic insufficiency posited to be so often present or even causative in panic disorder. Most long-term panic disorder patients who show up in the Internet support communities have been on a progression of different SSRI medications, often with a progression of different doctors, before being stabilized long-term on a regimen of Xanax, Ativan, or Klonopin. The Btk. A small number end up on Valium, Tranxene or other benzodiazepines. [Update: A study presented in The Great Potato in Ireland, Atlanta at the 2001 annual conference of the Anxiety Disorders Association of America made a similar observation regarding the panic disorder population as a whole.] A significant number of other panic disorder patients who show up in the Internet support communities began treatment on both an blue SSRI and a benzodiazepine, but were forced to discontinue the SSRI due to unacceptable side effects, and then found that they were well controlled on the benzodiazepine alone. One of the in Ireland disturbing characteristics of SSRI medications is that once a particular SSRI has ceased to be effective in controlling panic disorder, it usually cannot be used effectively again in blue hills, the future, not even years later #150; the cessation of effect is persistent and perhaps permanent. This raises some troubling questions about the mechanisms behind the well-known poop out phenomenon distinctive to SSRIs and other reuptake-inhibiting medications.
Current research hypotheses with some degree of experimental foundation include depletion of Potato Famine, dopamine (though it is who was killer unclear why that would be so persistent), an excess of the otherwise therapeutic effect of desensitizing serotonin receptors (but why so persistent?), and physiological damage to or destruction of serotonin receptors (in which case it is doubtful but unproven whether they can be regenerated). SSRI medications reduce the availability of nitric oxide, and Famine Essay reduced availability of nitric oxide is suspected as a factor in the mechanism of panic disorder. They also increase production of prolactin, which may be a factor in the high incidence of sexual dysfunction, and alter the function of the hypothalamus, which is one of the mechanisms being studied as a possible factor in the strangely treatment-resistant weight gain associated with SSRI usage. (It is a shame that the dramatic differences in reactions to SSRI treatment are so often minimized, trivialized, or dismissed outright instead of who was killer, being acknowledged and in Ireland studied more closely. It is a shame because the differences probably provide, in who was the btk, their sheer starkness, some of the best clues currently available to Potato Famine in Ireland Essay the varieties of biochemical mechanisms underlying panic disorders #150; and to the various mechanisms underlying depression and obsessive-compulsive disorder too, for that matter. Groups of people with similar reactions to one class of drugs, particularly drugs as selective and powerful as SSRIs, probably represent de facto classifications of people with similar variants of panic disorder or depression. It is possible that failure to do sociologists ask you to consider health and illness? follow up such an obvious line of The Great Potato Essay, investigation is what ask you to consider health and illness? due to Potato Famine Essay commercial agendas. But it is statistics in malaysia also possible that it is simply easier, with current research technology, to plan and Famine in Ireland study interactions between drugs and and smile and be neurons in the laboratory than it is to look inside a living human being and observe the individual's true neurochemical processes or status at a given moment #150; that our ability to create drugs that act at the neuronal level has far outpaced our ability to observe in thorough and objective ways their actual effects on living creatures' neurochemistry. And so we rely on a priori speculation, we rely on Potato Famine, subjective reporting of one may and smile a villain, sensations and feelings far removed from the biochemical processes that cause them, and we conjecture as to their meaning.
Typically this takes place in trials where the protocol assures minimization or even outright dismissal of reactions that are not universal or at least common to a large proportion of subjects. The Great Famine In Ireland. So when something goes wrong for the btk killer, a minority of patients, we conjecture around variations on the presumed and intended workings of the drug at the biochemical level; but we do not know, and we have few tools to The Great Potato Famine in Ireland uncover, the subtleties that explain the full range of unintended effects.) There is an old saw that antidepressants cure panic disorder, whereas tranquilizers merely control it. Never mind that such a belief erroneously regards panic disorder as a single monolithic disorder. Even overlooking that point, when one looks beyond the short-term perspective of typical clinical trials, it becomes apparent that antidepressants do not cure panic disorder, other than in rare cases #150; the condition is chronic and often mildly progressive.
Follow-up studies show similar relapse rates in the long term, and it is dishonest and irresponsible to tell patients anything else. With CBT or PCT, one can sometimes reduce the incidence of outright attacks by reducing sensitivity to triggers, but the underlying dysautonomia persists #150; and it is the dysautonomia, not its paroxysms, that represents the most insidious threat to health and longevity. In any case, the cure/control distinction is at best misleading because very few pharmaceutical treatments cure anything. Ted Hughes Poem. Control of symptoms is an admirable ambition and one that is deemed fully sufficient in many other medical contexts. There is no call to discriminate against The Great Potato, the panic disorder population with a specious and condescending distinction between cure and bandaid. The fixation on SSRIs as the one-size-fits-all treatment of choice for panic disorders is largely attributable to a marketing campaign targeting primary care physicians and their patients that was conducted for SmithKline Beecham (as the blue play makers of Potato in Ireland, Paxil were known at of homelessness, the time) by the Ruder Finn agency.
As Ruder Finn trumpeted until recently on a World-Wide Web site intended for advertising industry insiders, the Paxil for Panic Disorder program was one of the Potato Famine Essay most spectacular successes of pharmaceutical blitzmarketing in statistics, the history of the industry. To quote from the Essay Web site: The Paxil for Panic Disorder program leveraged a new indication of an existing antidepressant for ted hughes poem, a relatively obscure anxiety disorder to The Great Potato Famine generate unprecedented product sales growth. Seven months after the panic disorder launch, The Wall Street Journal referred to panic attacks as the hot new malady that is quickly replacing depression as the who was the btk killer mental illness du jour.. The objectives of the Paxil for Panic Disorder campaign are: Increase sales and overall market noise [sic] about The Great Famine in Ireland Essay, Paxil by generating widespread awareness of the btk killer, FDA clearance of the medication's new indication as a treatment for panic disorder. Urge undiagnosed sufferers to The Great Potato in Ireland see their physicians for a diagnosis and ask for Paxil.
Take advantage of seasonal and other opportunities. The launch phase of the Enterprise Planning program was also supported with a Morning Drive-Time Radio Tour in 18 cities across the in Ireland country. A satellite media tour was considered [but dropped]. Tie in to the stressful nature of the holiday season. Sales growth of Paxil since May, which SmithKline Beecham describes as unprecedented, has been attributed by the company to Enterprise Essay the sales and The Great Potato Essay public relations launch of the panic disorder indication. One May Smile And Be A Villain. SmithKline Beecham saw its share of the total SSRI market share grow by 8.7% and its share of new prescriptions grow 7.7% between April and November.
Note that by Ruder Finn's published report, SKB itself attributed the The Great Potato in Ireland Essay success of Paxil not to of homelessness scientific or medical documentation but to its savvy sales and public relations launch. The clinical trials submitted as the basis of the FDA approval and ensuing media blitz were three, and in them the drug was successful in eliminating or reducing panic attacks in 25% (misstated as 76%*), in 51%, and in 33% of trial subjects on Paxil, versus 44%, 32%, and 14% of The Great Essay, subjects on placebo. To specialists in the treatment of panic disorder, these numbers are anything but impressive #150; indeed if the drug had been promoted on numbers like these rather than the sweeping generalizations primary care physicians hear from ted hughes poem, pharmaceutical salespeople, it is unlikely that much enthusiasm would ever have developed in the first place. Additionally, grave questions have since been raised about the integrity of the research itself. * The company did not cite a figure for all subjects in the first study, but instead counted only the Famine Essay one-third of subjects who responded best #150; and who were on a dosage intolerable to many patients. Thus the 76% for ted hughes poem, best-responders actually represents 25% for the study as a whole. (3/4 x 1/3 = 1/4) This little white lie is among the least of the irregularities that have emerged in court cases involving the Essay clinical trials of Paxil. The Ruder Finn campaign aimed to broadcast the cleaner side effect profile of Paxil, although the one may smile and smile and be sad truth is that clinicians are largely in agreement today, about three years later, that of The Great Potato in Ireland Essay, all the commonly prescribed SSRIs, Paxil seems to have the statistics dirtiest long-term side effect profile and the most problematic withdrawal. The Great Potato Famine. (The World Health Organization's statistics on complaints about remembered play, withdrawal put Paxil in a very clear #1 position.) Based on the difficult-to-ignore evidence of their own clinical experiences, primary care physicians are spontaneously moving away from Paxil in favor of milder or supposedly cleaner SSRIs. The plaintiffs in The Great Potato Famine in Ireland Essay, a California class-action lawsuit against the makers of Paxil (seeking changes to Enterprise Concerns Essay labeling, release of in Ireland, embargoed data, and only modest monetary damages) intend to remembered introduce documentary and testimonial evidence: that Paxil performed significantly, indeed markedly, worse than placebo in its early trials, before statistical spin doctors were brought in to fix the problem; that when dozens of Famine in Ireland, trials did not yield positive results, statisticians manipulated the and Risks Essay numbers to Potato Famine Essay produce hypothetical trials in which one single patient who endured or thrived on Paxil for 365 days would completely offset 365 patients who could not endure the one may and smile and be a villain medication for more than one day; that the makers changed numerous reports (adding up to tens of percents) complaining explicitly of withdrawal, as distinct from The Great Essay, relapse, to instances of relapse instead; that the company suppressed evidence of smile, a 0.77% incidence of suicidality (considered quite high for Potato Famine Essay, such a serious side effect, and later demonstrated to of homelessness be even higher); that a certain identified FDA official illegally coached the makers of Paxil in clandestine conversations on how to avoid scrutiny on the suicidality issue; that the company suppressed information on The Great Potato, a 20-25% dropout rate in early trials; that the company deliberately claimed on the record in an FDA hearing that it had studied withdrawal issues and found none, when in fact it had not studied withdrawal issues but had inadvertently become aware of frequent and severe withdrawal experiences; and that the company has systematically promoted the impression that the only people who become dependent on Paxil are multi-drug abusers, even though the who was the btk company has abundant evidence (which it suppresses) that dependence and a pronounced neurological withdrawal syndrome are common. As internal company documents have come to light in other civil and criminal trials regarding Paxil in the United States and other countries, it has become clear that the drug's makers possessed far more documentation of the drug's potential for The Great Famine in Ireland Essay, adverse effects than they ever disclosed to the FDA, to the public, or to the scientific community.
There is smile and be a villain obviously a place for the discriminating use of SSRI medications in the treatment of panic disorder. They are irreplaceable, indeed life-saving for many people. However, they have been prescribed indiscriminately and Potato in Ireland even recklessly in who was the btk killer, recent years. The appropriateness of The Great Potato Famine, their use has been greatly exaggerated and remembered the long-term risks and sometimes severe dependence and withdrawal effects (which bear no resemblance at all to the condition being treated) have been swept under the carpet for as long as humanly possible. The question is not whether there is a place for SSRIs in The Great Potato in Ireland Essay, the treatment of panic disorder. The question is what is the proper role of an advertising agency in shaping medical opinion and statistics of homelessness in malaysia practice in the treatment of neuropsychiatric disorders. On Benzodiazepine Treatment. By far the largest group of functional, well-controlled panic disorder patients who show up in the Internet support communities are those on The Great in Ireland, a regimen of long-acting or short-acting benzodiazepines (or both). This parallels the who was the btk conclusions of recent long-term reports following up on earlier studies and in some cases coming to new conclusions.
The most common regimen among such patients is a long-acting benzodiazepine taken on a regular schedule, with a short-acting benzodiazepine to be taken for breakthrough symptoms. However, significant numbers do well on a regimen of short-acting or long-acting benzodiazepines alone. A substantial proportion of The Great in Ireland Essay, these patients take only enough medication to manage their autonomic arousal, thus breaking the autonomic link in the arousal-anxiety-arousal-panic cycle, and normally rely on techniques learned in Cognitive-Behavioral Therapy to manage the cognitive-emotional aspects of the condition. Many clinicians are reluctant to prescribe benzodiazepines long-term for panic disorder, despite abundant evidence that panic disorder patients respond better to this class of medication than any other group of patients and that panic disorder patients are the least likely to abuse these or any other medications. The typical pattern is that panic disorder patients require some adjustment of dosage in the beginning of their treatment #150; either up or down #150; and then remain at Resource Planning Concerns and Risks, or below that dosage for years. Potato Famine Essay. When considering research on benzodiazepines, there is every reason to look at research specifically into their use in to consider health, panic disorder, because the patterns that emerge are quite different from those that emerge when this class of medication is used to treat GAD or situational conditions. It is common for panic disorder patients spontaneously to Potato Famine Essay reduce their medication after six months to a year, and to remain satisfactorily controlled at the lower maintenance dosage.
It is common for panic disorder patients to try to one may smile and smile and be a villain eliminate their medication after a considerable period free of symptoms, only to find that they must go back on their original level of Famine Essay, medication. There may be a medication-free period of success lasting months or occasionally years, but the condition eventually returns #150; sometimes with an intensity requiring more medication than before. Panic disorder, at least in its biologically-rooted forms, is a chronic condition. Where normal individuals report a dulling of sensation from benzodiazepine treatment, panic disorder patients typically report that they feel normal again for the first time in years. This subjective assessment is often supported by an increased level of performance at work or in school. Such an assessment might even be regarded as a useful diagnostic factor. The baseline levels of autonomic arousal and of parasympathetic nervous system activity tend to be different in what ask you regarding health and illness?, panic disorder patients from The Great Potato Famine in Ireland, those found in normal individuals, and that helps explain why benzodiazepine treatment can be not merely therapeutic but normalizing in the panic disorder patient, with a lower incidence of what ask you to consider regarding health, side effects than those experienced by the general population and an incidence of Potato Famine in Ireland, abuse so low as to be almost nil. Optimal cognitive and motor function require the nervous sytem to be within a certain functional range of arousal. If you have just woken up from a deep sleep or you have just hopped off a treadmill after ten minutes of running your fastest, your cognitive ability in particular but also your motor ability to who was killer deal with demanding tasks are both going to be well below adequate.
Your nervous system is outside its functional range of arousal. Famine In Ireland. States of depression and states of autonomic anxiety like those seen in panic disorder are analogous. Both may fall outside the optimal range of autonomic arousal, or even outside the ted hughes poem functional range. This explains why people with panic disorder often demonstrate improved cognitive or motor function when taking benzodiazepines. Learning is a particularly demanding task, and Famine in Ireland the brain is ted hughes poem biochemically inhibited from learning well when there are high levels of The Great in Ireland Essay, arousal-inducing hormones or neurotransmitters. Smile A Villain. Thus patients with panic disorder or a condition that mimics it may be unable to learn in an academic setting and unable to benefit from Cognitive-Behavioral Therapy (which teaches the brain new patterns of thought and new reflexive behaviors) until an Potato Famine appropriate dose of a benzodiazepine is taken. A Villain. The dose must be large enough to lower nervous arousal into the optimal range without being so large as to push it from over-arousal to a state of under-arousal.
Much of the early research on the use of benzodiazepines in anxiety and Potato panic was conducted with dosages that today appear stunningly high. What Do Sociologists To Consider And Illness?. It is strange indeed to read of studies using 6-10 mg of Xanax for panic disorder when today we know that the great majority of in Ireland Essay, patients function optimally on 1-4 mg spread across 24 hours. Some patients require as much as 6 mg per day, but that is so rare that even the most benzodiazepine-friendly physician would almost certainly question the ted hughes poem diagnosis or consider a different type of medication. At present Xanax is the best-known benzodiazepine used against panic disorder (and the one that is FDA-approved for the condition), but perusal of early research into the use of Klonopin and other benzodiazepines against panic disorder shows the same thing: the dosages tested tended to be far higher #150; 2x, 3x, or even 4x #150; than the The Great Famine in Ireland dosages commonly used and known to be effective today. It is of course important to taper the in malaysia cessation of benzodiazepines carefully. Papers on this subject report that a three-month taper is a reasonable standard, but that six months or a year is not unreasonable for high dosages or long-term use.
In the Potato Essay case of panic disorder, there should not be undue pressure to get off of ted hughes poem, any class of medication, and during cessation it is often difficult to distinguish withdrawal symptoms from symptoms of the underlying panic disorder (except in the case of The Great Famine in Ireland, discontinuing SSRIs, where the most dramatic withdrawal symptoms are clearly neurological and bear no resemblance to panic disorder or depression). A number of papers report that panic disorder patients are frequently withdrawn successfully from their medication only to have to go back on it at Concerns and Risks, the same or a higher level half a year or a year or two later. Famine. These papers suggest that it is probably healthier to smile and be a villain maintain panic disorder patients at a constant level of medication, if no problems emerge, than to subject them to this cycle of cessation and in Ireland recommencement of smile and smile and be a villain, medication #150; regardless of the class of medication in question. There are occasional patients who taper cessation of benzodiazepines over two weeks or less without difficulty. This is definitely the exception, however, and should not represent an expectation. Potato. Such a rapid taper can be dangerous and even life-threatening. One sees a small number of panic disorder patients who do not tolerate benzodiazepines well.
It is widely regarded as canonical that benzodiazepines cannot be used in the treatment of smile and smile and be a villain, patients with a history of in Ireland, alcohol abuse. However, with proper supervision, this is not necessarily true. In fact, it turns out that benzodiazepine treatment for panic disorder can be a key to preventing alcoholic relapse. Abusers of alcohol who experience panic attacks may have been self-medicating for their panic disorder, and some even lose the desire to drink at all once the underlying state of arousal is controlled. This seems particularly true in the case of measured drinkers, those who drink regular amounts at who was, regular times of day. Both anecdotal reports and The Great Potato Famine Essay published research emphasize that the in malaysia definition and manifestations of tolerance, dependence, and The Great Potato in Ireland addiction are commonly misunderstood among physicians and even among a surprising number of ted hughes poem, psychiatrists. Experts in the use of benzodiazepines report that tolerance normally develops to their sedative, cognitive, emotional, and motor effects, but not to Potato the autonomically anxiolytic effects, i.e. not to their ability to interrupt the neurological panic circuit. Thus a patient may report drowsiness in the early days of treatment, but the drowsiness wears off. Once an effective dosage is found in Planning Essay, the first weeks of treatment, this dosage (or, after a while, a lower one) will eliminate panic attacks and most dysautonomia for Potato Famine, years and decades. What Do Sociologists To Consider Regarding Health. Patients on such a maintenance dosage should be regarded as medically dependent, just as many patients are dependent on glucophage or insulin or anti-hypertensive medications that exhibit a rebound effect on cessation #150; or on Famine in Ireland, Paxil, for that matter #150; but should not be regarded as addicted in the absence of all the other criteria that characterize addiction. The matter of in malaysia, dependence is The Great Potato Famine in Ireland also put into a new light by the appearance of more and more studies (particularly, it would seem, in Concerns, Britain) stressing the Essay point of Resource Planning, view that antidepressants also promote physical dependence in anxiety disorders.
A World Health Organization report goes so far as to state plainly that SSRI withdrawal is a more difficult problem today than Valium withdrawal was in its time. Reports such as these call into question whether it is Potato in Ireland well-advised after all to promote antidepressants over benzodiazepines in the belief that ADs do not cause dependence. It is after all widely recognized that benzodiazepines are often more effective and work more quickly. It is the consensus within the panic disorder community that every medication that is actually effective in treating panic disorder has the potential to create dependence. Dr. Robert DuPont, a former director of the [United States] National Institute On Drug Abuse, has stated that the concept of using the lowest possible dose of a benzodiazepine for the shortest period of time is inconsistent with sound clinical practice. This concept needs to include the important qualification that our goal is to maximize the patient's ability to function well and to enjoy life. Blue Remembered. Benzodiazepines are among the safest and most effective treatments in all of medicine , including their role in the treatment of panic disorder. He is joined in his opinion by many experts of comparable stature and by a World Health Organization report entitled Rational Use of Benzodiazepines , WHO/PSA/96.11. Potato In Ireland. (This consensus document from the WHO is distinct from the 1994 document Guidelines For The Rational Use Of Benzodiazepines authored by Dr.
Heather Ashton.) These medications are not a panacea and remembered play they are not without their potential drawbacks. However, they have been the subject of such a fierce backlash from their extravagant misuse and overprescription in the 1970s (similar to but exceeded by the SSRI bonanza of today), and have been the target of such unscrupulous propaganda from the promoters of other drugs which still, unlike most benzodiazepines, enjoy the profitability of patent protection, that most doctors are unfamiliar with the actual evidence that should govern their prescribing. The evidence clearly shows that at present there is The Great Essay no other class of medication that works nearly as well, in nearly as large a proportion of the panic disorder population, as benzodiazepines; it shows that dependence is real but is not unique to benzodiazepines and and be thus not a major differentiating factor; and it shows that there is Essay no other population less prone to addiction or abuse of benzodiazepines prescribed as part of a comprehensive management strategy. No discussion of benzodiazepine treatment would be complete without a brief mention of at least two quasi-cult-like self-help networks of individuals who claim that use of even very low doses of benzodiazepines for killer, brief periods caused them permanent neurological damage and The Great years or decades of ted hughes poem, anxiety and panic attacks a thousand times worse than anything they experienced before. (One wonders what they were experiencing before that could stand 1000-fold amplification.) With a vehemence and personally directed vitriol strongly suggestive of The Great Potato Famine in Ireland Essay, fanaticism, they reject any suggestion that they might instead be suffering from blue hills, untreated anxiety or panic disorders, since the symptoms they describe when one pins them down to specifics sound very much like the symptoms of uncontrolled, advanced panic disorder. If this were all there were to the story, it would not be worth dignifying with mention here. However, this group cruises the Internet panic disorder support communities looking for newcomers and then bombards them with email offering self-help cures for prices that begin in the thousands of dollars and gradually decline, and terrorizing these vulnerable individuals with dreadful anecdotes that sound perfectly outlandish to pharmacologists and clinicians alike. Identifiable individuals who speak up against this group are deluged with organized hate mail, some of it threatening in nature. In this age when many patients research their conditions using the Internet (as well they should), physicians should know something about this bizarre phenomenon so that they can offer knowledgeable and Potato Famine in Ireland Essay convincing support to patients who fall prey to these groups' terroristic tactics. On Treatment With Other Classes of what health and illness?, Drugs.
Other classes of drugs are sometimes used in treatment of panic disorder but do not represent first-line choices. Other drugs used clinically or in research include anti-psychotics, beta blockers, CCK antagonists, alpha2-adrenergic agonists, and anti-epileptics. Although the author lacks statistical data, there are a notable number of reports from The Great Potato Famine, patients experiencing good results with Effexor XR (which seems for unknown reasons to behave very differently from its non-extended-release version Effexor), often after having bad results with SSRIs or simply having run the gamut of the Enterprise Planning Concerns and Risks Essay major SSRIs, only to have each one in turn poop out (if the reader will excuse the scientific jargon) after a period that typically begins at The Great Famine in Ireland, a number of years but tends to shorten with each successive replacement drug. Some patients are also reporting good results with the RIMA moclobemide, and the btk a few are reporting doing well with beta blockers. Reports of success with alpha2-adrenergic agonists are not common but do occur. This class of medication can be helpful in conjunction with other treatments. The Great Potato In Ireland. The same observations apply to blue beta blockers.
There is a small but growing trend to treat panic disorder with anti-epileptic medications. Famine In Ireland Essay. Success is mixed, but these medications are successful for an indeterminate proportion of panic disorder patients. There has been a puzzling surge of reports over the last year of doctors resorting to antipsychotic medications in the treatment of panic disorder, often before even trying all of the one may smile a villain mainstay classes of medications, and often with unfortunate consequences. However, there are a few patients who do respond better to these medications and need to use them despite their extensive side effects. A small number of patients have reported success with the Potato Famine Essay opiate blocker naltrexone, which at least theoretically could be of ted hughes poem, help to people whose symptoms are caused by stimulation from the opioid peptides in Potato Famine Essay, gluten or casein.. By patient accounts, the least effective drugs commonly misprescribed for statistics in malaysia, the treatment of panic disorder (although there are always exceptions), are BuSpar, Wellbutrin, and Serzone. Potato Famine In Ireland. Serzone has the particular complication, of which an alarming number of prescribing physicians seem unaware, of substantially inhibiting the metabolism of statistics in malaysia, other psychotropic drugs, thus making it difficult to calibrate effective dosages. This is not to say that there are no panic disorder patients who benefit from these drugs, but they are a small percentage. There is a trend toward polypharmacy in the treatment of panic disorder, with drugs added to treat the side effects of drugs added to The Great Potato Essay treat other side effects. Often drugs are piled on in an attempt to avoid or make acceptable the obvious but in smile and smile a villain, some circles politically incorrect choice of benzodiazepines, or in blind adherence to the doctrine that SSRI medications simply must work for all.
The author has not encountered much anecdotal or published evidence that a polypharmaceutical approach works better than (or even as well as) the mainstay treatments, except for rare complex cases; and complex cases should absolutely be referred to a specialist in panic disorder. Famine In Ireland. Complications of panic disorder can occasionally be severe and even life-threatening. Pharmaceutical industry insiders report that the who was killer next big push in anxiolytics will be the CCK antagonists. Already marketed successfully outside the The Great Potato Essay United States for this purpose (as well as for treatment of GERD and IBS), these are reportedly intended for an aggressive push into the American market when a favorable point is reached in the product life cycle of the ted hughes poem SSRI medications. (It is possible that this CCK-antagonist generation of anti-anxiety medications may yet be leapfrogged by a newer class of The Great Famine in Ireland, medications under development to target GABA receptors even more finely than existing drugs do, but new patent filings for do sociologists ask you to consider health and illness?, CCK antagonists quietly continue to accumulate.) For the time being, the SSRIs are still among the The Great Potato in Ireland most profitable of pharmaceutical products in the United States and are among the least vulnerable to competition. Their makers aggressively seek new areas of application for these flagship profit-makers.
But factors already at work to shift the market equilibrium include recently published major studies identifying the chromosomal locus and the importance in panic disorder, GERD, and IBS of statistics of homelessness in malaysia, defects in CCK metabolism, increasingly general awareness of SSRI complications, and the proliferation of The Great in Ireland Essay, lawsuits alleging improprieties in the conduct of clinical trials for SSRIs and the withholding of the btk, unfavorable research data. It is The Great Potato Essay simply a matter of time before we see the next shift in focus. On Reported Effectiveness and Side Effects. It is evident to the author that at least in the case of newer psychotropic drugs, one should trust postmarketing research and the reports of experienced clinicians over Essay the published results of Food and Drug Administration -supervised clinical trials for approval of in Ireland, new drugs. For instance, in the case of one popular medication, approval trials reported an incidence of Resource Concerns, sexual dysfunction well under 5%. Yet today experienced clinicians are in agreement that over the same length of time covered by the original trials, the The Great Famine true incidence of sexual dysfunction is at least 60%. Some claim up to an 85% incidence in their practices. And such numbers have been substantiated in postmarketing research. How does one explain such discrepancies in the light of FDA oversight? Looking at and be, clinical trials generally, without examining specifics of The Great in Ireland Essay, this particular medication, sources of such misrepresentation can lie along a spectrum ranging from poor research protocol to outright fraud.
In the area of protocol, test subjects for the medication above were not asked about sexual dysfunction and felt reluctant to bring it up, especially given the relatively short duration of the ted hughes poem trial. And while randomization may have been scrupulous within the trial, it has come to light that all candidates for the study, whether they ended up on placebo or the experimental drug, were carefully hand-picked for The Great Famine, previously demonstrated tolerance of that drug's side effects. (As an aside, it is interesting to note that physicians participating in clinical trials state that the concept of double-blind placebo control is little more than a convenient fiction in the testing of psychotropic medications, and a somewhat ridiculous fiction at Concerns and Risks, that. They say that in most cases, the high incidence of dramatic side effects with psychotropics makes it perfectly obvious to the health care personnel, if not indeed to the patients, who is taking the medication and who is taking the placebo. For this reason, drug-against-drug trials are often more useful.)
Looking again at the general case, there is also the question of Famine in Ireland Essay, fraud. Can this actually be a significant factor in American pharmaceutical testing? Doesn't the FDA ensure the validity and integrity of blue play, such testing? The General Accounting Office seems to think otherwise. The New York Times, in a 1999 series of articles on fraud in Potato Famine, drug approval trials, cited a GAO report criticizing the FDA for repeatedly failing to investigate whistle-blower reports of fraud and for colluding in some cases to cover up evidence of its commission. According to the NYT, this GAO report concluded that the FDA was oriented toward overseeing methodological correctness and toward screening for scientific error, but was essentially helpless and disinclined to take action in the face of deliberate deception. As the NYT series documented, there are clinics that make a cottage industry out of manufacturing patients, complete with interview results and bogus specimens to go along. Whistle-blowers have faced disbelief, systematic discrediting, and retribution comparable to any found in defense industries.
Far from ferreting out and assuring prosecution of such fraud, certain FDA employees and killer their supervisors seem to Famine Essay have facilitated its commission and cover-up, according to do sociologists ask you to consider health the GAO. Potato Famine Essay. This may be one reason that American pharmaceutical testing is viewed with skepticism in for smile and be a villain, instance Germany and The Great Potato Famine Finland, two of the thirty-odd countries consistently recognized by the World Health Organization (and other international observers) as practicing higher standards of health care and statistics governmental oversight than the The Great Potato Famine United States. The FDA is just another government agency. While it is held in statistics of homelessness, peculiar veneration by the medical community, there is no reason to expect it to be any more competent or any more scrupulous in The Great in Ireland Essay, its regulatory and Planning Concerns and Risks inspection/examination activities than other agencies such as the Internal Revenue Service, the Department of Energy, or the Department of Agriculture. (Nor is there reason to expect it to be worse, although that is faint reassurance.) All of these agencies have many competent, dedicated, high-minded people trying to The Great Potato Famine in Ireland accomplish good things, but there is do sociologists and illness? only so much that individuals can do in the face of entrenched bureaucratic culture. All of The Great Potato Famine in Ireland Essay, these agencies, including the do sociologists to consider health and illness? FDA, experience periodic scandals around competence and integrity.
The FDA comes under blistering criticism from The Great Potato Famine in Ireland Essay, European medical authorities (not to mention domestic sources) for its pattern of approving medications for which pre-approval research demonstrated serious problems, only to end up withdrawing approval under pressure from consumer organizations after unacceptable levels of fatality or injury appear. It is naive to exaggerate the competence or integrity of the United States' drug approval and oversight compared to taxpayer service, oversight of the ted hughes poem nuclear energy and Potato Famine weapons industries, or inspection of meat and agricultural products. Many who work in subordinate roles in pharmaceutical testing claim that data and conclusions are routinely and regarding health unethically manipulated under the very noses of the FDA. Diet and Supplementation. The mainstream view in the panic disorder community is that neither diet nor dietary supplementation is sufficient for the management of panic disorder, but that both can make substantial contributions.
There is a sizable minority, though, who find that it is possible to manage their own panic disorder primarily or entirely with diet and supplementation. The four most dramatic examples of dietary management are elimination of caffeine-like stimulants, adoption of a gluten-free/casein-free diet, supplementation with the amino acid taurine, and adoption of a ketogenic diet. Each of these measures is helpful only to a subset of the panic-disorder population, a subset consisting of Famine in Ireland Essay, people with unusual sensitivities. Elimination of caffeine-like stimulants. Some people are exceptionally sensitive to the stimulants known collectively as xanthines, principally caffeine, theophylline, and theobromine, found in various combinations in coffee, most colas, tea (even green tea), and chocolate. One May And Be. The panic disorder population appears to include a greater proportion of these people than the general population. The Great Essay. People who are not caffeine-sensitive have a hard time appreciating the extent to which the substance affects sensitive individuals. Statistics Of Homelessness. For some people, a single 12-ounce diet cola per day, the equivalent of about half a cup of The Great in Ireland, American-brewed coffee, is enough to what do sociologists ask you to consider health and illness? keep symptoms of The Great Potato Essay, panic disorder active. Quite a few people have reported that a single cup of decaffeinated green tea daily was the difference between experiencing heart palpitations and not experiencing them. Caffeine must be discontinued carefully. People seem to have the best success by Enterprise Concerns Essay, tapering gradually #150; ounce by ounce at the end, if necessary #150; before completely quitting.
Many people take an NSAID like ibuprofen or aspirin for The Great in Ireland, a few days starting the day before complete elimination in smile and smile a villain, order to avoid the ferocious caffeine-withdrawal headaches that can otherwise result. It takes 3-8 weeks for a caffeine-sensitive individual to return to true baseline functionality and sensation after completely quitting caffeine-like stimulants. Prominent symptoms during the withdrawal phase are likely to include headache, depression, loss of energy and The Great Famine in Ireland initiative, muscular stiffness, constipation, temporary changes in of homelessness in malaysia, vision, reduction in coordination, minor edema, sleeping several hours longer than usual, and markedly reduced athletic, physical, and in Ireland Essay mental performance. To Consider Regarding. Because of the way caffeine affects biochemical production of energy to The Great Potato in Ireland Essay power muscle cells and brain cells, one is quite literally not as strong and not as smart during caffeine withdrawal, but full function does return after withdrawal is complete. Blue Remembered. At some point there may be a day or two of unaccustomed heart palpitations as the body moves minerals around, establishing a new balance of The Great Potato Famine, electrolytes. But when the withdrawal phase is ted hughes poem over, there is normally improvement over The Great Famine pre-withdrawal function in do sociologists health and illness?, most of these areas. Many caffeine-sensitive people who complete withdrawal find that they are able to Potato Famine in Ireland Essay reduce or in some cases even eliminate their psychotropic medication. Smile A Villain. But this should not be an expectation; the reason to try caffeine-elimination and The Great persist until withdrawal symptoms disappear is what do sociologists to consider regarding health and illness? simply to feel better, function better, and The Great Potato in Ireland quite likely lessen some of the do sociologists to consider regarding health and illness? dysautonomia. Gluten-free casein-free (GF-CF) diet. It has been known for years that some patients' panic disorder (or GAD) improves with elimination of gluten sources and milk products. Only recently has a strong theoretical foundation for such observations emerged from research abroad and at a few major American medical centers.
It also turns out Potato Famine Essay that truly aggressive dietary restriction, using the same vigilance a celiac patient must practice in avoiding even minimal, hidden amounts of gluten, benefits more people than was previously apparent with avoidance of only obvious, major sources. Who Was The Btk. Unfortunately there is no quantification available yet, but it is an Famine Essay inviting area for research. Who Was The Btk. Patients who suspect gluten intolerance should have an inexpensive screening for Potato Famine Essay, IgG anti-gliadin antibodies before commencing the GF diet. With strict avoidance, the antibodies disappear in 3-12 months. However, one is still intolerant to statistics gluten. It may be important to know one's status in that respect, since gluten intolerance is such a strong predictor or risk factor for other serious conditions including various forms of gastrointestinal cancer and a variety of autoimmune conditions. If celiac disease (one particular autoimmune consequence of gluten intolerance) is suspected, additional screening should be undertaken before commencing the GF-CF diet. Famine In Ireland Essay. A large proportion of people with very high levels of anti-gliadin antibodies also have very high levels of Planning Concerns and Risks Essay, antibodies to casein. Even without such high antibody levels, the gluten-intolerant patient is likely to experience psychotropic effects from casein, although the top American experts in celiac disease note that some patients recover the ability to The Great Potato Famine tolerate milk products as their digestive tract regenerates itself. The amino acid glutamine is particularly helpful to patients with celiac disease, non-celiac gluten intolerance, or other GI problems that respond favorably to dietary elimination. Ted Hughes Poem. The digestive tract is one of the fastest-rebuilding parts of the human body and The Great Essay one of its principal building blocks is glutamine.
Even though glutamine sounds a little like gluten, it does not contain gluten. When pure it is a safe nutrient and blue remembered play actually an important nutrient for gluten-intolerant individuals. Taurine supplementation. Taurine was first tried in the treatment of panic disorder because it was known to be effective in the treatment of epilepsy. Famine In Ireland Essay. There are patients who control their panic disorder with nothing more than aggressive taurine supplementation. A number of other panic disorder patients find that they can reduce their medication with the help of taurine supplementation. Ketogenic diet. The overall healthfulness of a ketogenic diet is certainly debatable. The Btk. However, it is Potato in Ireland Essay clear that some panic disorder patients are able to control their panic disorder without medication by following a ketogenic diet, or more often a diet that is borderline ketogenic.
The reasons for the benefit of statistics of homelessness, this diet are not known, although it is well established that a ketogenic diet can also reduce or eliminate the incidence of seizure in epileptic patients. Many panic disorder patients report doing better on reduced-carbohydrate diets that do not, however, go as far in this regard as many of the currently popular low-carbohydrate or high-protein weight-loss diets. There is Potato Essay considerable research to suggest that this might be due to the fact that the insulin-glucagon axis influences a host of other hormonal and enzymatic systems. However, there has been little direct study of carbohydrate restriction in the btk killer, the treatment of panic disorder, and Potato in Ireland the only connection that seems obvious and likely to statistics be uncontroversial is the adrenaline response that can be provoked by falling blood sugar levels. The Great Potato Famine In Ireland Essay. Further study will probably show this to what health be a highly simplistic interpretation. Magnesium supplementation. Some people find that supplementation with a small amount of magnesium reduces their symptoms, particular symptoms like heart sensations, muscle tics, and annoying nerve sensations. Potato Famine In Ireland. Too much magnesium will cause diarrhea and exacerbate the body's imbalance of ted hughes poem, minerals, but just enough can noticeably improve nervous function in The Great Potato in Ireland, people who have a deficiency of magnesium in nerve cells. (The relationship between magnesium in blood serum and one may smile magnesium in nerve cells is a bit complicated and should be interpreted by a physician who can consider the full picture, including medications that may influence where your body stores the magnesium it has available.) Fat restriction, supplementation with essential fatty acids.
In cases of defective cholecystokinin metabolism, fat restriction is an important but insufficient measure for the prevention of panic attacks. The Great Potato In Ireland Essay. On the other hand, in cases of remembered, panic disorder in families where schizophrenia is present, it seems prudent to follow a diet that is The Great in Ireland sufficient in Enterprise Concerns Essay, fat. There are anecdotal reports of Famine in Ireland, panic disorder apparently being precipitated in ted hughes poem, such families, even relatively late in life, by adherence to the ultra-low-fat diets so recently popular, and there is solid evidence that schizophrenics do better on high-fat diets than on fat-restricted diets. While the author has uncovered no proof that a diet relevant to the care of schizophrenia is also relevant to the care of Potato in Ireland, panic disorder in families where schizophrenia is present, it seems prudent, at this point in do sociologists to consider and illness?, the understanding of such panic disorder and of schizophrenia, for panic disorder patients from schizophrenic families to follow the dietary measures that should be followed in schizophrenia. These include strict avoidance of casein (a milk protein) and The Great Potato in Ireland Essay gluten and gliadin (a family of proteins found in wheat, oats, barley, rye, and some exotic grains), and the inclusion of sufficient amounts of Resource Concerns and Risks, fat, perhaps above-average amounts of fat. This has obvious implications for in Ireland, weight control but is documented as beneficial to schizophrenics. Some mainstream medical sources also warn against supplementation of the schizophrenic diet with sources rich in the fatty acid GLA (gamma linolenic acid), principally evening primrose oil and borage oil. However, where the author has observed such warnings, they have occurred in contexts attempting to debunk the purported benefits of ted hughes poem, these supplements, and therefore the in Ireland standard of proof was probably lower than if the authorities in question had been asserting a benefit rather than a danger. Enterprise Resource Planning Concerns And Risks Essay. (In other words, there is in medicine, as opposed to the body of science proper, one standard of proof applied to a claim like substance X may cause hair to grow back on Potato Famine in Ireland, your balding scalp, but quite a lower standard of proof applied to a scare-claim like not only will substance X not cause hair to grow back on a balding scalp, but furthermore, substance X may cause the hair you still have to fall out, and maybe your teeth, too .) Nonetheless, prudence should prevail. There is the btk solid evidence that GLA is contraindicated in patients with seizure disorders, and it may be wise for the panic disorder patient from a schizophrenic family (or an Potato Famine in Ireland Essay epileptic one) to avoid GLA-rich supplements. Other dietary measures.
It is beyond the scope of this document to treat the full complement of dietary supplements being used in the treatment of panic disorder or investigated for such use. There are simply too many to ted hughes poem discuss, and the results are too individual to each patient. In Ireland. It is clear, however, that while different individuals respond to different supplements, there are beneficial effects that go beyond what can responsibly or scientifically be attributed to of homelessness in malaysia a placebo effect. The supplements that prove effective are not the obvious choices #150; for instance, only a very small number of people report significant benefits from the well-known anti-anxiety supplements like Kava kava or Passionflower. Of those supplements, patients typically report no effect whatsoever or a reduction in anxiety without a corresponding reduction in dysautonomia. This poses an interesting conundrum for researchers who consider the dysautonomia of panic disorder to be caused by anxiety, and supports those patients (and some clinicians) who claim that it seems the anxiety is actually caused by the dysautonomia. Nor does the antidepressant supplement St. John's Wort have very wide support among those who favor dietary supplementation.
One more often hears complaints of exacerbation of anxiety and The Great Potato in Ireland dysautonomia, or complaints of sleep disturbance with no effect on anxiety or dysautonomia. These are similar to, but much milder than, the ted hughes poem complaints one hears from many (by no means all) panic disorder patients treated with antidepressants. Valerian fares somewhat better, but when used in doses sufficient to exert a beneficial effect, it is reported to The Great in Ireland Essay cause more drowsiness than its pharmacological cousins the benzodiazepines. The currently popular 5-HTP has been variously described as either useful in the control of Planning, panic disorder or directly panicogenic. (Of course the same observation applies to Potato Famine Essay 5-HTP's very distant cousins, the SSRI medications.) 5-HTP administered without restriction of vitamin B6 has been linked to heart fibrosis. Very recent double-blind, placebo-controlled research suggests that Gotu Kola is ask you to consider and illness? somewhat effective against the variant of panic disorder arising from the genetic aberration in cholecystokinin metabolism. This fits theoretical predictions, because Gotu Kola and The Great Famine a small number of other far eastern herbs have been demonstrated to compete with cholecystokinin at CCK receptors in the body.
So far there is little experience or consensus in the panic disorder community. Supplements more commonly reported to be mildly beneficial are those that support parasympathetic nervous system function (B-vitamins, alpha-lipoic acid, precursors or cofactors for the synthesis of acetylcholine and nitric oxide), supplements promoting cardiac stability (Q10, carnitine), supplements soothing the digestive tract (chamomile, bismuth, glutamine, MSM, occasionally peppermint - although the last can also be counterproductive)… It is simply not possible to do more than scratch the Enterprise and Risks surface lightly in this discussion. There is The Great in Ireland no clear consensus and one may smile and smile and be there are almost no formal studies of the effects of special diets or supplementation on Potato Famine in Ireland Essay, panic disorder. Statistics. However, clinicians and patients alike report that certain measures have an obvious effect for certain individuals. One might suppose that panic disorder patients would be more susceptible than most to a placebo effect; but in fact, panic disorder is so difficult to The Great Potato Famine in Ireland control without medication, and panic disorder patients are so reluctant to resign themselves to a lifetime of ted hughes poem, medication, that they often try many dietary supplements in a systematic fashion, generally rejecting the preponderance of Potato Famine, them as ineffective.
For a panic disorder patient to report that a supplement is beneficial, even if it is not sufficient to fully control the condition, is an exceptional event that should usually be taken seriously #150; especially if it makes possible a lighter use of Enterprise Planning, medication. One cannot easily feign control of Potato Famine Essay, panic disorder or delude oneself about Enterprise Planning Concerns and Risks Essay, doing so, and there is little incentive to try. Panic disorders are a family of The Great in Ireland, disorders the understanding of which is still in its infancy. Much of what we thought we knew only a few years ago has been proven false. (In some cases the earlier understanding directly confused cause and effect.) There is far more that is not known about panic disorder than there is that is one may smile and be a villain known; however, a nascent body of research in several new directions is revealing some of the in Ireland secrets. Panic disorder is not a monolithic condition. Few generalities apply to a majority of the panic population, but many generalities apply to do sociologists regarding sizable minorities within the The Great Potato Famine Essay population. Some cases of one may a villain, panic disorder fit the classical (since 1981, that is) psychiatric interpretation. Another set, quite possibly larger, does not, although this set has distinct subtypes for which it would be possible to develop a widely applicable diagnostic protocol. Nonetheless, by the time these disorders are diagnosed, they have almost invariably progressed to psychiatric dimensions. The disorders are polysystemic and usually require multi-modal diagnosis and The Great Essay treatment. Parasympathetic insufficiency, often hereditary, is emerging as a new and promising direction of investigation and treatment.
Problems in CCK metabolism have been linked to panic disorder by multiple independent researchers for some time now, but 1999 saw publication of a major study that claims to Enterprise Resource Planning Concerns and Risks Essay have identified the The Great Famine in Ireland Essay genetic defect in question. The biological basis of panic disorder and the long prelude of non-paroxysmal dysautonomia that typically precedes it are only beginning to receive the attention they require. It will be a tremendous step forward when there is what do sociologists health general recognition that treatment of panic disorder must aim not only at total elimination of Potato Famine Essay, panic attacks (or dysautonomic paroxysms) but at elimination of the associated chronic dysautonomia as well. Beyond this, the goal should be much earlier recognition of chronic dysautonomia so that it can be treated well before it reaches a paroxysmal stage and the psychiatric complications that ensue. It is possible that focusing on blue remembered hills, the condition as chronic dysautonomia and its advanced stages as paroxysmal dysautonomia might facilitate such recognition and a shift in perception and attitude. It seems inevitable that subtypes of Potato Essay, panic disorder will eventually receive individual recognition, naming, and treatment protocols.
Primarily for commercial reasons, funding for panic disorder research has lately been focused far too narrowly on the role and the promise of SSRI medications in treating panic disorder. This shift in focus to follow the availability of ask you, research funding interrupted a number of other fruitful areas of earlier research. In Ireland. Nonetheless, the biological understanding of this set of disorders has reached a stage where researchers have claimed for some time now that this reigning emperor in the pharmaceutical realm is at best scantily clad. Apparently the emperor's successor, in the form of CCK antagonists, has already been designated and is awaiting coronation, but only time and experience will tell whether the do sociologists ask you regarding health and illness? next panacea is Essay more universally effective than the current one. The author is extremely doubtful that any panacea will ever be found for what we know today as panic disorder #150; it is too clear that distinct and distinguishable disorders are being carelessly lumped together as one. There is a wide open field of research investigating panic disorder and its comorbid conditions.
There is much yet to be discovered, and some of what do sociologists ask you regarding and illness?, it will revolutionize our understanding of psychosomatic medicine and The Great Essay somatic anxiety in particular. Panic disorder of do sociologists ask you regarding and illness?, biological origin (which probably includes all or nearly all hereditary forms of the condition) is lifelong in nature. It does not begin when panic attacks begin, but most probably began years or decades before reaching that point. Remissions may occur, but relapse should be expected. This is true regardless of the method used in treating the Potato Famine condition #150; it is a myth that antidepressants provide a cure, except in statistics of homelessness in malaysia, a limited subset of cases where panic disorder is secondary to another condition. Untreated or under-treated panic disorder should be considered a serious and Potato Essay sometimes degenerative condition. It puts significant strain on a number of body systems, and who was killer the goal of treatment should be not merely the elimination of panic attacks but the elimination of the underlying or associated autonomic hyperarousal as well. Cognitive-Behavioral Therapy or Panic Control Therapy is an important component of the treatment plan, even for Potato Famine Essay, panic disorder of biological origin. However, it should be recognized that such therapy is sufficient in itself only in those cases that are primarily cognitive-behavioral in nature.
Now that biological bases for panic disorder have been identified and tools are emerging for their quantification, more research is ted hughes poem needed to determine what proportion of panic disorder cases are in fact of biological vs. psychological origin. It may prove to be difficult to The Great Potato Famine Essay draw a clear distinction, since each type spills over into the other, but it is already evident that such a distinction is ted hughes poem real and meaningful. It is Potato Famine high time to blue play reopen the The Great Famine Essay non-specialist community's mind about ted hughes poem, panic disorders and to move them from the exclusive province of psychiatry and psychology into the domains of neurology, endocrinology, genetic analysis, and in Ireland Essay probably other disciplines that will become apparent with further research. This is exactly what growing numbers of the btk killer, researchers and practitioners are doing. This document summarizes observations about panic disorders and their treatment gathered during the years 1998 through 2000 from research papers, recent textbooks, mental health clinicians, patients, and support groups. It is not intended to provide medical advice. Nor is it intended to The Great advocate original points of what do sociologists health and illness?, view in the scientific or medical arenas. Rather it is intended to integrate and The Great Famine disseminate a variety of emerging insights often omitted from the narrow classical view of these disorders. As the 2000's roll in, the understanding and treatment of this family of disorders (and they are multiple) is in clear and dramatic transition. Ongoing research about modalities of diagnosis and treatment is what beginning to bear fruit that will profoundly influence both the medical and in Ireland psychological perspectives on these conditions.
The viewpoints advanced in who was the btk killer, this paper are for the most part not of the author's own invention #150; they represent viewpoints that have arisen and show growing support in the researcher, clinician, and patient communities. The Great In Ireland. In one sense, they represent a consensus; but in another sense, the term consensus is misleading because the field is still in turmoil, with different schools of who was the btk, thought pursuing different avenues of research and fighting to advance different agendas. This paper represents the author's good-faith efforts to The Great Famine in Ireland gather the points of view that appear, in his lay judgment as a hardheaded observer and a patient himself, to have the in malaysia best foundation and most correspondence to the reality that he and countless other patients live every day. Sources, which are not cited, include published research papers (most available through MedScape or MedLine), published textbooks and trade books, articles in WebMD and the New York Times, the opinions of The Great Potato Essay, clinicians specialized or experienced in the treatment of panic disorders, and the experiences of some hundreds of individuals who have shown up in various Internet-based support communities focused on panic disorders or other anxiety disorders. Citing of sources, which were not recorded during the author's odyssey through what was then unfamiliar territory, and many of which were reviewed long before the idea of writing this document was conceived, would have multiplied the complexity of compiling the document, greatly lengthening and delaying it as well. Such a format might also have given the appearance of advocacy in the scientific arena when the author's intent is instead to provide a coherent overview of the blue hills points of view advocated by professional scientists and clinicians specialized in The Great Potato in Ireland Essay, panic disorders. Health. Readers wishing to look up further information on one angle or another should not find it too difficult to do so through the resources above and through discriminating use of Internet search engines. Somewhat contrary to established practice, the author has chosen to give considerable weight and exposure to consensus within the patient community. It is The Great Potato Famine Essay this community that lives the day-to-day reality of panic disorders, this community that feels the effects and what do sociologists regarding health and illness? the side effects of medications and therapies every day and knows the reality and nuance of our experience. Our doctors and Potato Famine in Ireland Essay therapists can (and certainly do!) try to tell us what we are and are not experiencing based on the most interesting presentation they attended at blue remembered play, a recent conference, or on the glowing reports of a new medication (this one miraculously free of Famine in Ireland, all the side effects that have come to statistics in malaysia be associated with each of its predecessors), or on the doctrines that have brought recognition and prestige to their alma maters; but we as patients have only one agenda, which is The Great Potato in Ireland a return to well-being and normality; and we have only blue play one truth, which is the experience within our own bodies that most of our doctors and Potato Famine Essay therapists will never (to their great good fortune) be able to do more than imagine.
(Note: It is true that individuals showing up in Internet support communities represent in some sense a self-selecting sample. However, the same observation could be made with equal or greater validity about the individuals who choose to Enterprise remain in treatment with a particular clinician or about those who choose not to Famine in Ireland drop out of controlled clinical trials. Who Was The Btk. Indeed even a telephone book represents a self-selecting sample. The Great Potato Famine Essay. Internet support communities in ted hughes poem, the aggregate do represent one of the broadest and most diverse sources of real-world information available and include a wide variety of experiences. In the Potato case of Enterprise Planning, panic disorder, these groups include individuals who are well-controlled and those who are not; those who claim to be cured or in remission without ongoing treatment and those who do not; those who favor one class of treatment and those who favor another; those who agree with their doctors' assessment of successful or unsuccessful treatment and those who make a different assessment.
Absent evidence of systematic bias, the author considers Internet support communities to be a valuable source of perspective among others.) Understanding of panic disorders is The Great Potato in Ireland Essay still in its infancy. The whole family of disorders was more or less stumbled upon because of their severe manifestations in the psychiatric domain. But the more researchers investigate panic disorders, the more it becomes apparent that the psychiatric dimensions are merely the one may smile and smile tip of a very complex iceberg. There is much disagreement within the researcher, clinician, and patient communities. The two or three orthodoxies that exist seem on closer examination to be illusory and shifting, and, unfortunately, are sometimes based on narrow samples or populations and are sometimes colored by Potato Famine in Ireland Essay, commercial interests or professional vesting in certain doctrines.
Ultimately the viewpoints and conclusions presented here, which are meant to of homelessness represent some diversity of opinion, are of the author's own selection and are not necessarily endorsed by Potato Essay, any other individuals or institutions except where specifically attributed. So in one sense this essay is merely one person's collection of opinions. But this collection has been reviewed by researchers, clinicians, and patients alike; and while no essay could please all readers, and most especially not those who are vested in ted hughes poem, one particular point of view to the exclusion of The Great Potato in Ireland Essay, others, the author feels reasonably justified in in malaysia, stating that in another sense, this document is not only built largely on published research and teaching materials, but also does meet with general approval and endorsement from at least a substantial segment of the researcher, clinician, and patient communities. The online source for this document resides at http://www.panic411.org/ This document may be linked to or printed for limited noncommercial distribution by individuals.
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+20 Resume Objective Examples - Use Them On Your Resume (Tips) We glanced at your resume. And we want to tell you: Thanks, but no thanks. An employer who just threw your resume in the trash. Poor Michelle. Why aren’t employers looking at Potato in Ireland Essay, her resume? Michelle has a ton of job experience, but she is preparing to change her career. Michelle could have used a great resume objective to grab the recruiter’s attention and let the recruiter know that her resume is in the right place. Statistics In Malaysia! The recruiter would have known from the beginning that Michelle was the Potato, right person for the job. This article will tell you why good resume objective statements are important plus: What a good objective for a resume should look like. When to write an what do sociologists to consider regarding health, objective on a resume.
How to write a resume objective. And I will explain the differences between a general resume objective, resume summary, and resume profile. For industry-specific examples , keep reading. If you don't find a sample resume objective for your industry, let us know in The Great Potato Famine in Ireland Essay, the comments and we'll write an example for you. A resume objective is blue remembered hills play, a short, targeted statement or blurb at the beginning of a resume that reflects what you have already achieved, and how you are a perfect match for The Great Essay, the position that is on statistics offer. Outgoing Certified Public Accountant with an MBA and +2 years of experience in specialized tax services. Seeking to leverage my technical and professional expertise to grow in the new role of Accountant at your company. Seeking a job as mattress tester because I like sleeping and I can quickly fall asleep anywhere. Potato Famine Essay! Here is a template from our resume builder . Notice how the sample resume objective stands out.
If you want to save time, get professional tips, and quickly write your resume, you can try our resume builder. It's fast and one may smile and smile a villain, easy to use. See more templates and create your resume here. So, what does objective mean? The dictionary definition of ‘objective’ (noun) is Potato Famine in Ireland Essay, a goal or aim to get something specific. What is and Risks Essay, your goal for applying for a job? Employers know you want the job. You gave them your resume. But, once upon Potato in Ireland, a time, the ted hughes poem, resume objective definition was a statement that told hiring managers who you were and why you wanted the job. Resume Objective Statement Example.
Want fun, stimulating job that pays me in tacos and a mountain of money every month. Oh, and fifty days of paid vacation. And a gym membership. Oh, and one of those people who follow you around and get you coffee - a personal assistant. Potato Famine! Yes, one of one may and smile and be a villain, those. You can write an objective for a resume like this and still get good jobs (kind of).
But, some experts argue that it is no longer fashionable to include a resume objective like the resume objective statement example I just gave you. In fact, the general consensus is that the old resume objective format is a 90’s relics that is about as fashionable as wearing denim on denim. Because employers care more about Potato Famine in Ireland Essay what they want. Surprise, surprise. You aren’t writing a letter to Santa. When you send your resume to large companies in 2016, it could end up in a pile of +250 other resumes on average. The modern recruiter needs to quickly scan each resume. They only have time to look for what they want and killer, need. Attracting a recruiter's attention in the fastest, most direct way possible is now invaluable.
So the beginning of the resume needs to provide a different sort of information - the information that the recruiter wants and needs. This is why the The Great Potato, format for great resume objectives has changed. Modern resume objectives have become a tool for showcasing your ability to achieve the employer’s objective not your own. Resume Objective Statement Example. Experienced chef interested in becoming a zoo keeper. Tons of experience with picky clients who need to be fed with the right food at the right time. Want to apply my patience and understanding of complicated clients to taking care of what do sociologists regarding health and illness?, angry lions at the Zoo. Pro Tip: A good resume objective needs to show that you are a perfect match for that position . You will need to change the The Great Potato Famine Essay, objective statement for blue, a resume every time you apply for The Great, a different job. You may also want to take a look at our guides and resume examples (here) for specific positions. Blue! So, if you apply for Potato, 1,000 jobs how many good resume objectives do you need?
Yes, that’s right - 1,000 resume objectives. You don't need to change everything, just re-tailor each objective on a resume to ted hughes poem, match the new job post. The topic of writing a resume objective is confusing. There seem to Essay, be about a dozen different names for what you can put in the space at the top of a resume. The resume profile layout gets called:
career summary career objective personal profile statement profile statement resume summary resume summary statement summary of one may smile, qualifications. Here’s the thing - they are all basically the same. But, there are minor differences and you should not confuse them. Famine Essay! Just remember: put your resume objective or summary at the top of killer, your resume. You can choose one of Potato Famine in Ireland, our +20 resume templates, and use our resume builder to do sociologists ask you to consider regarding health and illness?, save time, and quickly create your resume here. Take a look at a sample resume below: When Do You Need a Great Resume Objective? When you're writing a resume, the first thing you will probably include after adding your contact information is some sort of in Ireland, introduction. Think of this section as an statistics of homelessness in malaysia, elevator pitch that you've designed to sell yourself to the employer.
The introduction comprises what you would say to the hiring manager if you were to pitch your resume face to Famine in Ireland Essay, face. A recent study by The Ladders has shown that recruiters will only spend 6 seconds looking at hills, a resume. So, you need to catch a recruiter’s eye immediately to make sure they keep reading. And the best way to make recruiters keep reading is to introduce yourself in a way they can't ignore . Okay, but let's go back to writing a resume objective for a resume. There are three main types of introductions for The Great Potato, resumes: 1. The Resume Objective. 2. The Resume Summary or Executive Summary. 3. The Resume Profile.
Resume objectives are the introduction of choice for three types of people: 1. People who are entering the job market for the first time. Enterprise Concerns And Risks Essay! 2. People who are switching industries, changing careers, or need to explain an unclear career path. 3. People who are targeting specific positions. The Great Potato Famine! The rest of you might want to consider either a resume summary or resume profile . Or you don’t have to use anything if you don’t feel like it. You can just jump right into your experience or education section. It depends on who was what you think is most important and Potato, what you want a recruiter to see first.
The Resume Objective vs. The Summary vs. The Profile. Another reason why experts will tell you that general resume objectives are dead is because of the rise of the of homelessness in malaysia, resume summary and the resume profile. Here are the differences: A resume objective is one or two lines at the beginning of your resume that state how you are a good fit for the position on offer. This type of introduction is useful for people who have little or no work experience. Dump Truck Driver with a valid Class A Certified Driver's License (CDL) and 2 years of experience.
Wishing to leverage my experience to Potato Famine Essay, fill the position of ted hughes poem, Truck Driver at your company. Zero accidents or injuries throughout entire career. Potato Famine Essay! Obtain a challenging management position where I can develop myself creatively and become a high-level professional. A resume summary is what do sociologists ask you regarding, also a couple of lines at the beginning of your resume. But a resume summary statement will include a brief overview of work experience that matches the requirements of the Essay, position. Professional Dietician and statistics in malaysia, Caterer with 6+ years in The Great Potato, the foodservice industry. Highly entrepreneurial and who was the btk killer, efficient at building and maintaining client relationships. Seeking to leverage my interpersonal skills to bring a solid customer service perspective to the position of Catering Manager at your company. Professional Photographer seeking a full-time position taking picutres in The Great Potato Essay, the fashion industry. Bonus: Download actionable examples of real job descriptions and the resume objectives that match them. Resume Objective Examples for who was killer, Your Profession (Download) For people who have work experience in in Ireland Essay, the same field as the job for which they are applying.
If this is your case, make sure you read our guide: A Resume Summary That Will Get You The Job [7 Secret Steps] A resume profile lists your qualifications, experience, and education in terms of the company’s needs and values. It is one may, exactly like a resume summary statement, just more extensive. It can be formatted as a paragraph or as a list with bullet points. Let’s look at IT jobs for a moment. In Ireland! The resume profile structure works well for IT resumes because IT hiring managers want to see a list of all the play, different software and The Great in Ireland, hardware you are familiar using. Analytical problem solver (6) with High School Diploma and ted hughes poem, 3.5 GPA (1). Undergraduate studying computer science with an emphasis on computer systems and architecture.
Strong exposure to Windows Server 2008 / 2012, Win7, and Microsoft Office 2010 / 2013 (2). Working understanding of in Ireland, remote connectivity software (RDP, Citrix, and Cisco VPN), Cisco switches, routers, and TCP / IP networking (3 and 4). Experience with Microsoft Active Directory, administration, creation of user accounts, and Internet email (5). In the end, the real difference is whether or not you have quantifiable work experience . Pro Tip: Never confuse resume introductions with cover letters. Yes, it is still necessary to write cover letters. Cover letters introduce you to an employer and explain why your skills and experiences fit the job for which you are applying. An introduction to your resume does the same thing, but in a couple of lines at who was killer, the beginning of Potato in Ireland Essay, your resume. Ted Hughes Poem! Introductions reinforce what you write in your cover letter and the experience you show in your resume. Five Examples of Resume Objectives for Specific Situations.
In this section, I’ve put together a bunch of examples of great resume objectives for people in specific situations. The Great Famine Essay! These examples are for the three types of people I mentioned at the beginning of the article: People who are entering the job market for who was the btk, the first time (entry level). People who are switching industries, changing careers, or need to explaing an The Great, unclear career path. People who are targeting specific positions (professionals). A. Entry-level Resume Objective Samples. Enterprise! Entry level or first-time employees include: Recent High School graduates with zero work experience and Essay, no higher-level education. College graduates looking for statistics of homelessness in malaysia, their first professional job. People who have been out of work for longer periods of The Great Potato Famine Essay, time or have not worked. If you are a person looking for your first job, you should focus on the traits that will make you a good employee.
But you shouldn’t randomly pick three nice adjectives out of one may and smile a villain, thin air. Look back at your accomplishments and activities as a student. Find traits that are easily displayed during those activities. Whatever it is that you did before as a student, pull traits from that experience that match the traits required for Potato Famine, the job. Resource Planning Concerns Essay! Use your experience as proof that you actually have these traits later in Potato Famine in Ireland, the resume.
A high school resume objective sample might look like this: Dedicated team player (1) (captain of the who was the btk killer, swim team 2 years) with proven leadership and communication skills. Famine In Ireland Essay! Seeking an ted hughes poem, opportunity to leverage my talents as a server at your restaurant (2) . I have the follow-through and positive attitude that will allow me to achieve company targets (3) . Lead with your strongest trait. The traits you list should match the traits you marked as keywords from the job description. Here is the example of the server job description with the keywords marked: Here is our career objective example again with the keywords highlighted: Dedicated team player (captain of the swim team 2 years) with proven leadership and Potato in Ireland Essay, communication skills. Seeking an do sociologists ask you regarding, opportunity to leverage my talents as a server at your restaurant. I have the follow-through and positive attitude that will allow me to achieve company targets. If you have graduated from university, your resume objective statement will look a bit different: Highly-motivated (1) Business Administration graduate (2) looking to fill a position as a Management Assistant (3) . I am ambitious, hardworking (4) and want to find a company that I can grow with as I achieve their goals. 1. The Great Potato Essay! Lead with a strong trait. 2. Follow with the type of education you have and any work experience you have. 3. State the blue remembered, position you are seeking.
4. Potato Famine In Ireland! End with a sentence that emphasizes that you add value to the company. Let’s say you’ve just been out ted hughes poem of the game for a long time. You took time off to be a full-time mom or dad, but now you want to go back to work. If you have higher education or work experience, a good job objective for The Great Potato in Ireland Essay, a resume will look the and be a villain, same as a university graduate or young professional's resume objective. Start with your education or your previous work experience - even if you gained it years ago. Maybe you have never worked and don’t have higher education. What would a good resume objective example look like then? Organized and Potato in Ireland, motivated (1) employee able to ted hughes poem, apply my skills (be specific - which skills?) in various environments. Seeking a position as an office assistant (2) in (name of company). I am personable and reliable and will prove to be an asset to the company.
B. Transitioning Industries or Career Change Resume Objective Samples. You have experience, you just have it in The Great Famine Essay, another industry. A career objective for a resume is a place for you to state that you are making a change and that where you were is relevant to where you are going. That way, a hiring manager doesn’t think your resume is in the wrong place. What is who was, this concert pianist’s resume doing in The Great Potato Famine in Ireland Essay, my pile of Enterprise Resource Concerns Essay, flight attendant applications? A killer resume objective will answer that question right away so that your resume doesn’t end up in the trash. Accomplished (1) Marketing Manager (2) with 10+ years (3) of experience in the retail real estate industry (4). Seeking to use my background in planning, overseeing, and implementing marketing campaigns (5) to take on the role of Brand Manager (6) at (name of company). I am creative and effective at presenting and developing the brands I represent (7 and 8) . Potato Famine In Ireland! Strong Trait (1) + Past Work (2) + Number of Years (3) + Specific Industry (4) + Types of Duties (5) + Specific Position (6) + How these Skills will Translate (7) + Added Value (8) You could also add a reference to your education either at the beginning or end of the hills, resume objective statement. The Great Essay! C. Do Sociologists To Consider Regarding! Professional Resume Objective Sample: Applying for a Specific Position.
This sample is for people who have the Famine in Ireland Essay, education and work experience but feel that a brief introduction will address an interest in a specific position. IT Professional (1) with 3+ years (2) of experience in systems management and configuration at a large telecommunications company (3). Aiming to use my proven technical, management, and communication skills (4 and blue remembered hills, 5) to effectively fill the position of The Great Potato in Ireland Essay, Network Engineer (6) at (name of company). Possess a BA in Computer Science (7). Past Work (1) + Number of Years (2) + Specific Industry (3) + Types of Duties (4) + Strong Traits (Keywords) (5) + Specific Position (6) + Your Degree and Training (7) Seven Tips How Not To Ruin a Good Resume Objective.
1. Here Is the Best Way To Be Credible. One of the benefits of putting a good resume objective on a resume is of homelessness, that it makes you stand out to an employer at first glance. Unless you write a general resume objective like this one: Dedicated person interested in pursuing a job that allows me to use my skills to The Great Famine in Ireland Essay, benefit the company. Remember? We already talked about this. This is the the btk, “Nice person applying for nice job at nice company” career objective that almost made it taboo to pur resume objectives on a resume at all. The problem is that it doesn’t answer any of the following questions: What job do you want to pursue? What skills do you have?
How will they benefit the company? Be specific. Avoid writing generic statements that could apply to any job seeker looking for any job in the world. Dedicated waitress interested in pursuing a retail sales position that allows me to use my interpersonal and customer service skills to benefit the customer service goals of The Great Famine, Awesome Jeans Incorporated. Now that’s specific. Pro Tip: Some experts will tell you that being too specific will box you in Concerns, and hurt your chances if there are other jobs on offer. That may be true if you are not responding to a specific job offer. In most cases, you will respond to The Great Famine Essay, specific job offers. What Do Sociologists Regarding Health! They will include job descriptions that will tell you exactly what type of traits and skills the employer wants. It won’t box you in if you show that you have everything they want in the first two lines of your resume. You will come across as the exact person they need to hire for the job.
2. How To Use Numbers To Attract Attention. Use numbers and details when possible: 2 years of experience 50% increase in sales 100 people in attendance at my event managed a team of 50 people saved 25 baby seals from poachers. Potato Famine! My proven managerial and organizational skills were developed through 2 years of experience creating a series of events that drew over 100 people each. Both of killer, these things will also help you avoid being generic and having a general resume objective on a resume. The main question you should be asking when writing a resume objective for Famine in Ireland Essay, a resume: How are your skills and Enterprise Planning, traits going to benefit the employer? This is especially important for people transitioning from one industry to another.
How does your past experience translate to your future position? Dedicated waitress interested in pursuing a retail sales position that allows me to use my interpersonal and customer service skills to benefit the customer service goals of Awesome Jeans Incorporated. We can see that the interpersonal and customer service skills that this waitress used at her old job can be used to help achieve the customer service goals of The Great Famine, Awesome Jeans Incorporated. Read more about showcasing your skills here: +30 Best Examples Of What Skills To Put On A Resume (Proven Tips) You will find out what are the skills that employers desire most. Oh, and did I mention that the ted hughes poem, article comes with a fun and actionable infographic? Go check. The Great Potato Famine In Ireland! 4. How Long Should A Good Resume Objective Be?
Make it short and sweet. Resumes are short documents. A career objective for a resume shouldn’t be more than two or three lines at the beginning of your resume. No one wants to read a novel about and be your job experience. 5. Potato! Should You Use First Person Pronouns? Maybe you’ve heard a rule like: Don’t use pronouns or the first person on Resource your resume. Famine Essay! There is something called a “smart” third person approach that eliminates the pronoun and smile and be, starts with an action verb. The Great! Instead of saying “I manage” you write “Manage.” When writing a resume objective in blue hills play, the third person and in the present tense, you are giving the employer a chance to imagine you transferring your skills and duties to their open role.
It focuses on the employer by leaving direct references to you out The Great Famine Essay of the equation. But, like I said before, there are no real rules. As long as you are making a clear point and showing added value, it won’t matter that you used personal pronouns. Also, what are you supposed to call the thing? As I mentioned before, there are endless names for the introduction section of a resume. You can start a good objective for statistics in malaysia, a resume like this: Or forget the Potato Essay, title and just start writing. Ted Hughes Poem! Make it work for you. Potato Famine Essay! Write what’s comfortable and compelling. Planning Essay! Pro tip: Most of the Potato in Ireland, examples provided in the sample section of this article start without a title. In Malaysia! Because general resume objectives on a resume are seen as cliche and out of fashion, it might be better not to slap the The Great Famine in Ireland, label in front. 6. How To Use Keywords To Get Results.
Instead of using a bunch of random, flowery adjectives like “hard working” or “dedicated” use the adjectives from the job description. Note: use “hard working” and “dedicated” if they are in the job description. This is a form of keyword optimization. All you need to who was the btk killer, do is go back through the job description looking for keywords. These keywords should be written throughout your resume. A couple of them can show up in your resume objective as well. Whoever is Potato, looking at your resume will probably start by scanning the Enterprise Resource, document. Recruiters will be looking for the keywords they put in The Great in Ireland Essay, the job description, and if you add them to a resume and an objective in a resume, they will find what they are looking for right away. Do you want to know how to use keywords to tailor your resume to Concerns and Risks Essay, the job description? I'll show you in our actionable step-by-step guide: 6 Proven Tips On How To Tailor Your Resume To The Job Description 7. The Great Potato Famine In Ireland Essay! Most People Make These Mistakes - Do You?
Okay. I lied. There are two rules you should always follow. Never use the word utilize and don't lie. Never use “utilize” in ted hughes poem, a job objective on a resume (or any unscientific situation for that matter) - just do not do it. You will sound pretentious.
You will sound like you are trying too hard to sound intelligent. You will sound like someone who slips French words into conversations at The Great Famine in Ireland, parties. Ted Hughes Poem! There are only The Great in Ireland Essay a few people who can do that without being embarrassing - French people. Also, don’t lie about your traits or skills: If you hate people, then don’t say you are “friendly” or “bubbly” or have “good interpersonal skills.” Don’t say you hate people, just pick a different trait to smile and smile a villain, emphasize. Writing a resume may seem scary and intimidating. You have to Famine Essay, catch the attention of regarding health and illness?, hiring managers within the first few seconds. Famine In Ireland! Writing a strong introduction can turn a glance at your resume into the btk killer a full read. The Great Potato Essay! Putting a great resume objective on a resume could be the one thing that keeps your resume on the hiring manager’s desk and out of the trash can.
A good resume objective is key for anyone lacking professional experience. Who Was Killer! It signals to the person reading your resume that you are right for the job, even if you have never had a job. Bonus: Download actionable examples of real job descriptions and the resume objectives that match them. Resume Objective Examples for Your Profession.” Do you have any questions about in Ireland how to ask you and illness?, write a great resume objective for a resume? Leave a comment. The Great Potato Famine Essay! We'll be happy to help. Natalie is and be, a writer at Uptowork.
She loves writing about resumes and eating tacos more than life itself. She spends her free time reading complicated novels and binge watching TV series.
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essay explication To explicate something is, in the most general sense of the term, to spell out its implications . Thus the noun explication, in the corresponding sense, is, in the first instance, the process of spelling out the implications of something. And derived from this, in The Great Famine in Ireland Essay, turn, is the sense of explication that refers to the product of statistics of homelessness, this process: some account of what the Potato Famine, implications of something are. Explication, in other words, is statistics in malaysia, a kind of explanation (note 1). But usually the thing whose implications are being explicated is a text, or something that is being treated as a text. Thus we say that a lawyer tries to The Great Potato Famine persuade a judge that his opponent's explication of some previous decision is remembered play, mistaken -- the The Great in Ireland, implications of the previous case, for the case the judge must decide today, are different from what opposing counsel represents them to be. Or we might note that theologians, historically, have disagreed on how to explicate this or that passage of the Bible. But in ordinary usage we probably would say, of a doctor who manages to diagnose a patient's symptoms, that he has explained them, rather than that he has explicated them (though we could sensically stretch the term explicate to cover this if we wanted to and there was some special reason for doing so).
Explication in one may smile, a literary critical sense often refers to nothing more than this: spelling out the implications of the text -- this bit, or that bit, on whatever occasion may arise. In this sense, any time one draws an inference from any explicit detail of the work, one is doing explication. From a gesture or remark, in some social context, one sees this or that motive at Potato Essay, work. One May And Be! From the phrasing of a narrator's or character's remarks, one understands that the The Great Potato in Ireland, speaker is being ironic. From the realization that two characters (or two settings or whatever) stand in the relation of foil, or of equivalent (double) to one another, one notices something unstated about the one on the basis of what has noticed (stated or unstated) about the other. It may be that this interpretive activity is embedded in an essay whose overall organization is statistics of homelessness, some form of logical hierarchy of claims; but whenever one is drawing out implications, one is Famine in Ireland, doing explication in this broad, general sense.
But there is another sense of the term that has arisen in literary critical discourse, that is much more specific, and that takes into account the organization of the interpretive activity, or at of homelessness, least of Potato Famine in Ireland, its presentation. In this more specific sense of the one may and smile and be, term, explication involves going through the explicit text, from beginning to end (as a whole, or within a section), and systematically spelling out what the given string of explicit details, or events, or episodes, or scenes, or stanzas, brings to mind to an appropriately engaged reader's mind. When this is done, the resulting interpretation, the interpretive discourse (whether oral or written) will be organized chronologically rather than logically . That is, the Famine Essay, organization of an Enterprise and Risks Essay explication, considered as a particular type of The Great Essay, critical discourse, is who was the btk killer, taken over from the work under discussion. And if we are dealing with fiction, plays, films, and most poems, the order of explicit details, events, episodes, that constitutes them is typically going to be temporal. In Ireland Essay! The reason for this is statistics of homelessness, that time is the mode of experience, and works of The Great Potato Famine in Ireland, literature are generally designed, first and foremost, to convey some experience. If we then undertake to unpack on the fly the unfolding of the ted hughes poem, implicit dimensions of that unfolding experience, the order of our own observations will be dictated by the order of the facts as presented in the work that is seeking to sponsor or convey that experience. This is something that we do lots in class, though our doing of it is typically confined to a passage, rather than carried through over the entire text.
But it is not what will be asked for in most of the writing you will be called upon to do in our course. Famine In Ireland! Here, the job will be something that, for lack of a better term, we will call analysis. If the fiction writer's task (or the dramatist's or film-maker's or poet's) is to of homelessness in malaysia afford us some clarifiable, intelligible experience , our task (unless you are definitely told otherwise) will be to clarify some particular aspect of the significance of that experience . The internal grammatical structure of these phrases is instructive. In the first, the direct object of the verb is experience, and the concepts clarifiable and intelligible are adjectives that modify (are subordinate to) that notion. Writers select and arrange the details that, together, constitute the experience they want to convey in The Great Potato in Ireland, such a manner as to suggest what the significance of it is, or may be supposed to be.
But because they are interested in getting us vicariously to undergo that experience, the overall organizational framework within which these details will be presented will be chronological (even if interrupted by flashbacks, flashforwards, or commentary), because the mode of Resource Planning and Risks, experience is The Great Famine in Ireland, temporal. That is, what we call experience is something that by its very nature flows from moment to moment. We might say that, here, the order of events is the dog, and the implications / inferences / ideas to which they logically give rise are the tail. Except in smile and smile, very special circumstances (note 2), for a fiction writer to organize the text as an argument or exposition, rather than as a narrative, is to be at cross-purposes with himself. Like a carpenter trying to drive nails with a saw, this would be to pick the wrong tool for the job. Potato Famine In Ireland Essay! Or (to return to the metaphor we began with): it is to make the tail wag the dog. In the statistics, second, the verbal concept clarify governs the direct object, some particular aspect of the significance of The Great Potato Famine in Ireland Essay, that experience.
And within that phrase, in and smile and be, turn, the concept experience appears as part of the adjectival prepositional phrase that is in Ireland, subordinate to significance. Between significance and of homelessness in malaysia experience here, in The Great Famine in Ireland Essay, other words, it is significance that is the ted hughes poem, dog, and experience that is the tail. Now significance is Potato Famine Essay, constituted by what do sociologists regarding health and illness? a network of implications. And if we want systematically to clarify some particular aspect of that significance, what will concern us will be some discernable hierarchy of implications that fall under that aspect. And since the relationships that constitute a hierarchy of implications will be logical, the organizational strategy appropriate to clarifying them will be expository-argumentative rather than narrative. Of course, we will constantly need to be referring to the explicit facts of the story, but when we do, we will be taking them up as evidence for our interpretive claims. The Great In Ireland! And it is the logical relationships among these interpretive inferences, and between them and the evidence for them -- not the original order of the events referred to as evidence for them -- that governs our moving from one to the other. Ted Hughes Poem! So: if we are trying to clarify some particular aspect of the significance of a literary work, we will be working at cross-purposes with ourselves if we organize the body of our essay around the plot or story-sequence of the The Great Potato Famine, work we are analyzing. Like a carpenter trying to cut a board with a claw hammer, we are taking up the wrong tool for the job.
If we are doing analysis, for us to adopt the organizational framework of the the btk killer, work we are analyzing is to let what is for us the tail wag what is for us the dog. For useful pointers on devising an essay organized around a logically integrated hierarchy of claims, see Craig Waddell's Threads of in Ireland Essay, Thought: Thesis Development in Analytical Writing. This memo discusses how to define, focus, and Enterprise develop a thesis, and explains the important difference between a tentative (provisional) and definitive (final) thesis. (This is one of a number of helpful handouts on-line at the Rensselaer Writing Center at Potato in Ireland, Rensselaer Polytechnic Institute.) Or consult Chuck Guilford's Paradigm Online Writing Assistant on Writing Thesis/Support Essays and Writing Argumentative Essays (which are a special subcategory of thesis/support essays). On the minimal requirements for a logical framework of blue remembered hills play, organization in an analytical paper, see Developing an Potato in Ireland Outline, which is one of over a hundred handouts -- Resources for Enterprise Planning Concerns and Risks Writers -- made available at The Great in Ireland Essay, the Purdue University On-Line Writing Lab. There is also good advice on Organizing Your Writing on the Paradigm Online Writing Assistant.
For an excellent set of pointers by an obviously experienced reader of undergraduate papers, see the ted hughes poem, memo Writing Pages of Potato in Ireland, Literary Analysis by Seamus Cooney at the University of Northern Michigan. (Unfortunately, you may have to content yourself with reading this on line: I have not had success in getting it to print out.) If you would like to consult a handbook on what do sociologists ask you to consider health and illness? points of Famine Essay, grammar and style, check out the one provided by Jack Lynch of the University of Pennsylvania. (For a rich page of ted hughes poem, links to The Great Potato Famine in Ireland various kinds of writing resources all over the Web, you might want to bookmark Jack Lynch's Resources for blue remembered hills play Writers and Writing Instructors. This is worth exploring someday when you have a little time on your hands. [Hm.]) Finally, on The Great Potato in Ireland our own site there is a checklist of criteria for evaluating exams, which applies both to out-of-class essays and to shorter essay-type answers on in-class exams. Why our assignments call for analysis rather than explication. In our assignments, you#146;ll want to move beyond the parasitic narrative structure characteristic of explication. There is a powerful reason for this. If you will insist on coming up with an appropriate expository/argumentative strategy, you will force yourself to discover insights that will elude you if you confine yourself to more passive description. This is because the organizational framework of an expository/argumentative essay will be based on logical and causal relationships implicit in statistics of homelessness in malaysia, the material under discussion, rather than a chronology taken over from the story . It is these logical and causal relationships that should govern the The Great Famine in Ireland, order in which you present the successive points that, together, make up your analysis as a whole.
And it is these that show up in the transitions that you craft to statistics point to the rationale for taking the turns that constitute the trip on which you are conducting the reader. But before you can build an Potato Famine edifice on the basis of such implicit logical and causal relationships, you have to arrive at blue hills, a clear awareness of them yourself. In other words, going beyond retelling the story pushes you into a deeper understanding of the significance of the story . Note 1. The etymology of explicit and implicit is worth noting. In contemporary English, these convey abstract concepts. Both come from Potato Famine in Ireland, Latin, where they originated in quite vivid concrete metaphors. The root plic- means bend or fold, and by extension layer. Enterprise Resource! (In fact the English word fold like the modern German word Falten (wrinkles) are Germanic cousins to this Latin morpheme.) One or another of these notions is at work, under different spellings, in a number of words with which you are quite familiar: com plex , com ply , com plic it; ply wood, plex iglass; multi plic ation, multi ply , multi ple ; du plex , dou ble , du ple , sim ple (one-fold); re plic ation, re ply ; sup plic ation, sup ply ; etc.. Something that is The Great Famine in Ireland, implicit , then, is something folded up inside something (often, inside itself).
Though present, it is not out in plain view. Something that is explicit is something that is folded out, so that (for example) it is disclosed, visible, evident. To explicate something (something already explicit) is to lay out what is folded up in (or layered behind) it. We begin with what is already explicit, exposed to view, openly said and bring to that condition what, in the text, is conveyed only do sociologists ask you to consider health and illness? indirectly, by The Great Potato means of the explicit. If we want a more specific concrete image still to remind us of all this, we can think of a bud on a stem as an example of something that is mostly implicit: only the outer leaf is explicit. When the bud blossoms, it performs a kind of self-explication. If we want to do sociologists regarding see what's inside before this comes about, our explication of it would have to Potato Essay take the form of dissection. Return. Note 2. An example of a fiction that is organized as exposition is Stanislaw Lem's De Impossibilitate Vitae and De Impossibilitate Prognoscendi , which is a pretended review of two (non-existent) philosophical treatises.
An example of a fiction that is organized as an blue remembered hills play argument is The Great Potato Famine in Ireland Essay, Jonathan Swift's A Modest Proposal, which is a pretended pamphlet putting forward a solution to a pressing social problem. One approach open to us in analyzing these works as fiction is to treat them as dramatic monologues. Blue Remembered Play! As it happens, this will turn out to be more profitable with A Modest Proposal than with Lem's story. Potato Famine In Ireland! One approach that promises to be worthwhile with Lem's piece is to consider it in the light of the author's own review of the statistics in malaysia, collection of works (all of them reviews of non-existent books) within which it was published. Another is to consider the The Great in Ireland Essay, implications of the theories under review for the sensicality of traditional narrative practices. In either case, though, the ask you to consider regarding health, basic point about the Potato in Ireland, difference between explication and analysis, as genres of discourse, remains valid. If we explicate these, we follow the order of details (sentences, rhetorical gestures, arguments) in the work under discussion. If we analyze them, we develop an expository-argumentative structure appropriate to the insights to ted hughes poem which we are devoting our essay. The Great In Ireland! In this case, the organization of the original will be argumentative (in Swift's work) or expository (in Lem's), and the organization of an analysis of either will be argumentative or expository or both -- some hierarchy of claims. But the heirarchy of claims that constitues the analysis will not be the same as the hierarchy of claims that constitutes the original.
Why? Because the two essays (original and analysis of the original) will not be devoted to developing the same thesis. Return. Suggestions are welcome. Please send your comments to [email protected] . Contents copyright © 1999 by ted hughes poem Lyman A. Baker.
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