PeruPsychDoc.com

  Hello Friend,

One of the biggest challenges facing newcomers to any country is in caring for their health needs. It is essential, particularly with cognitive or emotional issues, that communication is clear between patient and therapist and not hampered by language-related concerns. I was raised and trained in the U.S.A. and have specialized in treating English-speaking clients for many years.  

I have always taken pride in providing a highly individualized approach to treatment. Each person is different and their  treatment needs are unique.

The science and art of psychological therapy are based on the ability to identify particular aspects of a person who needs adjustment or repair, to help these to be seen and take appropriate action.

The measures taken may be in the realm of understanding of self, lifestyle changes, relationship changes, and/or adjustments and applications of psychopharmacology.

Through experience I have found that a thoughtful combination of psychotherapy and
drug therapy combined with clear communication between doctor and patient can be a significant pathway for therapeutic success.

Thank you for visiting the website, and feel free to ask any questions you may have on the contact page.                                                                


DID YOU KNOW?  
You can apply for S.S. Disability in the USA directly from Peru. Dr. Calderon Marttini routinely assists with these matters through the U.S Embassy. 

DID YOU KNOW?  In Peru, only a licensed Psychiatrist can prescribe medication for depression and other similar maladies.

>>>>In addition to his work with the U.S. Embassy and at the Hermilio Valdizán Hospital in Santa Anita, Dr. Calderon Marttini also has a private practice at Javier Prado Este #4921 Block B Oficina 10MAP He is available to see patients in either location. Contact the doctor to determine which location will be most convenient for you.  

Call for appointment:  99-927-5813 

SKYPE:  jorge.calderon2001  (please call for skype hours)


Send email to jrcalderonmarttini@gmail.com

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Areas of Expertise include:

  • Depression
  • Anxiety / Fears
  • Addiction / abuse of psychoactive substances
  • Attention Deficit and Hyperactivity
  • Obsessive Compulsive Disorder
  • Trauma / Post Traumatic Stress
  • Dissociative Disorders
  • Thinking Disorders
  • Impulsivity disorders
  • Divorce
  • Loss of a loved one
  • Stress at Work
  • Marital Problems
  • Sexual Problems
  • Domestic Violence and Abuse
  • Eating Disorders
  • Personality Disorder
  • Psychosis
  • Schizophrenia
  • Bipolar Disorder
  • Insomnia / Fatigue
  • Memory / Concentration
  • Psychotherapy / Pharmacotherapy
  • Sports Psychiatry
  • Issues faced by gifted children or teens
This is the website of Dr. Jorge Calderon-Marttini, a Lima, Peru-based psychiatrist who specializes in treating English-speaking visitors and residents.
jrcalderonmarttini@gmail.com
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What is Anxiety? 



 Anxiety Symptoms and Causes

Anxiety is a general term for several disorders that cause nervousness, fear, apprehension, and worrying. These disorders affect how we feel and behave, and they can manifest real physical symptoms. Mild anxiety is vague and unsettling, while severe anxiety can be extremely debilitating, having a serious impact on daily life.
People often experience a general state of worry or fear before confronting something challenging such as a test, examination, recital, or interview. These feelings are easily justified and considered normal. Anxiety is considered a problem when symptoms interfere with a person's ability to sleep or otherwise function. Generally speaking, anxiety occurs when a reaction is out of proportion with what might be normally expected in a situation.

Anxiety disorders can be classified into several more specific types. The most common are briefly described below. 

What is Generalized Anxiety Disorder (GAD)?

Generalized Anxiety Disorder (GAD) is a chronic disorder characterized by excessive, long-lasting anxiety and worry about nonspecific life events, objects, and situations. GAD sufferers often feel afraid and worry about health, money, family, work, or school, but they have trouble both identifying the specific fear and controlling the worries. Their fear is usually unrealistic or out of proportion with what may be expected in their situation. Sufferers expect failure and disaster to the point that it interferes with daily functions like work, school, social activities, and relationships.

What is Panic Disorder?

Panic Disorder is a type of anxiety characterized by brief or sudden attacks of intense terror and apprehension that leads to shaking, confusion, dizziness, nausea, and difficulty breathing. Panic attacks tend to arise abruptly and peak after 10 minutes, but they then may last for hours. Panic disorders usually occur after frightening experiences or prolonged stress, but they can be spontaneous as well. A panic attack may lead an individual to be acutely aware of any change in normal body function, interpreting it as a life threatening illness - hypervigiliance followed by hypochondriasis. In addition, panic attacks lead a sufferer to expect future attacks, which may cause drastic behavioral changes in order to avoid these attacks
 

What is a Phobia?

A Phobia is an irrational fear and avoidance of an object or situation. Phobias are different from generalized anxiety disorders because a phobia has a fear response identified with a specific cause. The fear may be acknowledged as irrational or unnecessary, but the person is still unable to control the anxiety that results. Stimuli for phobia may be as varied as situations, animals, or everyday objects. For example, agoraphobia occurs when one avoids a place or situation to avoid an anxiety or panic attack. Agoraphobics will situate themselves so that escape will not be difficult or embarrassing, and they will change their behavior to reduce anxiety about being able to escape. 

What is Social Anxiety Disorder?

Social Anxiety Disorder is a type of social phobia characterized by a fear of being negatively judged by others or a fear of public embarrassment due to impulsive actions. This includes feelings such as stage fright, a fear of intimacy, and a fear of humiliation. This disorder can cause people to avoid public situations and human contact to the point that normal life is rendered impossible

What is Obsessive-Compulsive Disorder (OCD)?

Obsessive-Compulsive Disorder (OCD) is an anxiety disorder characterized by thoughts or actions that are repetitive, distressing, and intrusive. OCD suffers usually know that their compulsions are unreasonable or irrational, but they serve to alleviate their anxiety. Often, the logic of someone with OCD will appear superstitious, such as an insistence in walking in a certain pattern. OCD sufferers may obsessively clean personal items or hands or constantly check locks, stoves, or light switches

What is Post-Traumatic Stress Disorder (PTSD)?

Post-traumatic Stress Disorder (PTSD) is anxiety that results from previous trauma such as military combat, rape, hostage situations, or a serious accident. PTSD often leads to flashbacks and behavioral changes in order to avoid certain stimuli

What is Separation Anxiety Disorder?

Separation Anxiety Disorder is characterized by high levels of anxiety when separated from a person or place that provides feelings of security or safety. Sometimes separation results in panic, and it is considered a disorder when the response is excessive or inappropriate

What are common symptoms of anxiety?

People with anxiety disorders present a variety of physical symptoms in addition to non-physical symptoms that characterize the disorders such as excessive, unrealistic worrying.  Many of these symptoms are similar to those exhibited by a person suffering general illness, heart attack, or stroke, and this tends to further increase anxiety. The following is a list of physical symptoms associated with GAD:
· Trembling 
· Churning stomach 
· Nausea 
· Diarrhea 
· Headache 
· Backache 
· Heart palpitations 
· Numbness or "pins and needles" in arms, hands or legs 
· Sweating/flushing 
· Restlessness 
· Easily tired 
· Trouble concentrating 
· Irritability 
· Muscle tension 
· Frequent urination 
· Trouble falling or staying asleep 
· Being easily startled 

Those suffering from panic disorders may experience similar physical symptoms to those with GAD. They also may experience chest pains, a sense of choking, shortness of breath, and dizziness.

Post-traumatic stress disorders have a range of symptoms that are unique to this form of anxiety. Frequent symptomatic behaviors include:

· Flashbacks or nightmares of re-experiencing the trauma 
· Avoidance of people, places, and things that are associated with the original event 
· Difficulty concentrating or sleeping 
· Closely watching surroundings (hypervigilance) 
· Irritability and diminished feelings or aspirations for the future 


What Causes Anxiety?

Anxiety disorders may be caused by environmental factors, medical factors, genetics, brain chemistry, substance abuse, or a combination of these. It is most commonly triggered by the stress in our lives. Usually anxiety is a response to outside forces, but it is possible that we make ourselves anxious with "negative self-talk" - a habit of always telling ourselves the worst will happen.

Environmental and external factors

Environmental factors that are known to cause several types of anxiety include:
· Trauma from events such as abuse, victimization, or the death of a loved one 
· Stress in a personal relationship, marriage, friendship, and divorce 
· Stress at work 
· Stress from school 
· Stress about finances and money 
· Stress from a natural disaster 
· Lack of oxygen in high altitude areas 


Medical factors

Anxiety is associated with medical factors such as anemia, asthma, infections, and several heart conditions. Some medically-related causes of anxiety include:
· Stress from a serious medical illness 
· Side effects of medication 
· Symptoms of a medical illness 
· Lack of oxygen from emphysema, or pulmonary embolism (a blood clot in the lung) 


Substance use and abuse

It is estimated that about half of patients who utilize mental health services for anxiety disorders such as GAD, panic disorder, or social phobia are doing so because of alcohol or benzodiazepine dependence. More generally, anxiety is also know to result from:
· Intoxication from an illicit drug, such as cocaine or amphetamines 
· Withdrawal from an illicit drug, such as heroin, or from prescription drugs like Vicodin, benzodiazepines, or barbiturates 


                                  Call Dr. Calderon now for an appointment: 99-927-5813            BACK


Genetics                                                                                                 

It has been suggested by some researchers that a family history of anxiety increases the likelihood that a person will develop it. That is, some people may have a genetic predisposition that gives them a greater chance of suffering from anxiety disorders.

Brain chemistry

Research has shown that people with abnormal levels of certain neurotransmitters in the brain are more likely to suffer from generalized anxiety disorder. When neurotransmitters are not working properly, the brain's internal communication network breaks down, and the brain may react in an inappropriate way in some situations. This can lead to anxiety. 


How is anxiety diagnosed?

A psychiatrist, clinical psychologist, or other mental-health professional is usually enlisted to diagnose anxiety and identify the causes of it. The physician will take a careful medical and personal history, perform a physical examination, and order laboratory tests as needed. There is no one laboratory test that can be used to diagnose anxiety, but tests may provide useful information about a medical condition that may be causing physical illness or other anxiety symptoms.


To be diagnosed with generalized anxiety disorder (GAD), a person must:

· Excessively worry and be anxious about several different events or activities on more days than not for at least six months 
· Find it difficult to control the worrying 
· Have at least three of the following six symptoms associated with the anxiety on more days than not in the last six months: restlessness, fatigue, irritability, muscle tension, difficulty sleeping, difficulty concentrating 

Generally, to be diagnosed with GAD, symptoms must be present more often than not for six months and they must interfere with daily living, causing the sufferer to miss work or school. 

If the focus of the anxiety and worry is confined to a particular anxiety disorder, GAD will not be the diagnosis. For example, a physician may diagnose panic disorder if the anxiety is focused on worrying about having a panic attack, social phobia if worrying about being embarrassed in public, separation anxiety disorder if worrying about being away from home or relatives, anorexia nervosa if worrying about gaining weight, or hypochondriasis if worrying about having a serious illness.

Patients with anxiety disorder often present symptoms similar to clinical depression and vice-versa. It is rare for a patient to exhibit symptoms of only one of these.

How is anxiety treated?

Anxiety can be treated medically, with psychological counseling, or independently. Ultimately, the treatment path depends on the cause of the anxiety and the patient's preferences. Often treatments will consist of a combination of psychotherapy, behavioral therapy, and medications.
Sometimes alcoholism, depression, or other coexisting conditions have such a strong effect on the individual that treating the anxiety disorder must wait until the coexisting conditions are brought under control.

Self treatment

In some cases, anxiety may be treated at home, without a doctor's supervision. However, this may be limited to situations in which the duration of the anxiety is short and the cause is identified and can be eliminated or avoided. 

There are several exercises and actions that are recommended to cope with this type of anxiety:

· Learn to manage stress in your life. Keep an eye on pressures and deadlines, and commit to taking time away from study or work. 

· Learn a variety of relaxation techniques. Information about physical relaxation methods and meditation techniques can be found in book stores and health food shops. 

· Practice deep abdominal breathing. This consists of breathing in deeply and slowly through your nose, taking the air right down to your abdomen, and then breathing out slowly and gently through your mouth. Breathing deeply for too long may lead to dizziness from the extra oxygen.
 
· Learn to replace "negative self talk" with "coping self talk." Make a list of the negative thoughts you have, and write a list of positive, believable thoughts to replace them. Replace negative thoughts with positive ones. 

· Picture yourself successfully facing and conquering a specific fear. 
· Talk with a person who is supportive. 
· Meditate
· Exercise. 
· Take a long, warm bath. 
· Rest in a dark room. 


Counseling

A standard method of treating anxiety is with psychological counseling. This can include cognitive-behavioral therapy, psychotherapy, or a combination of therapies.
Cognitive-behavioral therapy (CBT) aims to recognize and change the patient's thinking patterns that are associated with the anxiety and troublesome feelings. This type of therapy has two main parts: a cognitive part designed to limit distorted thinking and a behavioral part designed to change the way people react to the objects or situations that trigger anxiety.

For example, a patient undergoing cognitive-behavioral therapy for panic disorder might work on learning that panic attacks are not really heart attacks. Those receiving this treatment for obsessive-compulsive disorder for cleanliness may work with a therapist to get their hands dirty and wait increasingly longer amounts of time before washing them. Post-traumatic stress disorder sufferers will work with a therapist to recall the traumatic event in a safe situation to alleviate the fear it produces. Exposure-based therapies such as CBT essentially have people confront their fears and try to help them become desensitized to anxiety-triggering situations 

Psychotherapy is another type of counseling treatment for anxiety disorders. It consists of talking with a trained mental health professional, psychiatrist, psychologist, social worker, or other counselor. Sessions may be used to explore the causes of anxiety and possible ways to cope with symptoms.

Call Dr. Calderon now for an appointment: 99-927-5813 








What is Depression? 


 BACK
Depression is a "whole-body" illness, involving your body, mood, and thoughts. It affects the way you eat and sleep, the way you feel about yourself, and the way you think about things. A depressive disorder is not the same as a passing blue mood. It is not a sign of personal weakness or a condition that can be willed or wished away. People with a depressive illness cannot merely "pull themselves together" and get better. 

Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people who suffer from depression.
 
The symptoms of depression may vary from person to person, and also depend on the severity of the depression. Depression causes changes in thinking, feeling, behavior, and physical well-being.  

· Changes in Thinking - You may experience problems with concentration and decision making. Some people report difficulty with short term memory, forgetting things all the time. Negative thoughts and thinking are characteristic of depression. Pessimism, poor self-esteem, excessive guilt, and self-criticism are all common. Some people have self-destructive thoughts during a more serious depression. 

· Changes in Feelings - You may feel sad for no reason at all. Some people report that they no longer enjoy activities that they once found pleasurable. You might lack motivation, and become more apathetic. You might feel "slowed down" and tired all the time. Sometimes irritability is a problem, and you may have more difficulty controlling your temper. In the extreme, depression is characterized by feelings of helplessness and hopelessness. 

· Changes in Behavior - Changes in behavior during depression are reflective of the negative emotions being experienced. You might act more apathetic, because that's how you feel. Some people do not feel comfortable with other people, so social withdrawal is common. You may experience a dramatic change in appetite, either eating more or less. Because of the chronic sadness, excessive crying is common. Some people complain about everything, and act out their anger with temper outbursts. Sexual desire may disappear, resulting in lack of sexual activity. In the extreme, people may neglect their personal appearance, even neglecting basic hygiene. Needless to say, someone who is this depressed does not do very much, so work productivity and household responsibilities suffer. Some people even have trouble getting out of bed. 

                                                                                                                                               

· Changes in Physical Well-being - We already talked about the negative   emotional feelings experienced during depression, but these are coupled with negative physical emotions as well. Chronic fatigue, despite spending more time sleeping, is common. Some people can't sleep, or don't sleep soundly. These individuals lay awake for hours, or awaken many times during the night, and stare at the ceiling. Others sleep many hours, even most of the day, although they still feel tired. Many people lose their appetite, feel slowed down by depression, and complain of many aches and pains. Others are restless, and can't sit still. 

Now imagine these symptoms lasting for weeks or even months. Imagine feeling this way almost all of the time. Depression is present if you experience many of these symptoms for at least several weeks. Of course, it's not a good idea to diagnose yourself. If you think that you might be depressed, see a psychologist as soon as possible. A psychologist can assess whether you are depressed, or just under a lot of stress and feeling sad. Remember, depression is treatable.

 Instead of worrying about whether you are depressed, do something about it. Even if you don't feel like it right now.

Call Dr. Calderon now for an appointment: 99-927-5813 







What is Bipolar Disorder? 

BACK
Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks. Symptoms of bipolar disorder are severe. They are different from the normal ups and downs that everyone goes through from time to time. Bipolar disorder symptoms can result in damaged relationships, poor job or school performance, and even suicide. But bipolar disorder can be treated, and people with this illness can lead full and productive lives.

Bipolar disorder often develops in a person's late teens or early adult years. At least half of all cases start before age 25.1 Some people have their first symptoms during childhood, while others may develop symptoms late in life.

Bipolar disorder is not easy to spot when it starts. The symptoms may seem like separate problems, not recognized as parts of a larger problem. Some people suffer for years before they are properly diagnosed and treated. Like diabetes or heart disease, bipolar disorder is a long-term illness that must be carefully managed throughout a person's life.

What are the symptoms of bipolar disorder?

People with bipolar disorder experience unusually intense emotional states that occur in distinct periods called "mood episodes." An overly joyful or overexcited state is called a manic episode, and an extremely sad or hopeless state is called a depressive episode. Sometimes, a mood episode includes symptoms of both mania and depression. This is called a mixed state. People with bipolar disorder also may be explosive and irritable during a mood episode.

Extreme changes in energy, activity, sleep, and behavior go along with these changes in mood. It is possible for someone with bipolar disorder to experience a long-lasting period of unstable moods rather than discrete episodes of depression or mania.

A person may be having an episode of bipolar disorder if he or she has a number of manic or depressive symptoms for most of the day, nearly every day, for at least one or two weeks. Sometimes symptoms are so severe that the person cannot function normally at work, school, or home.

Symptoms of bipolar disorder are described below.
 
Symptoms of mania or a manic episode include:
  
Mood Changes

· A long period of feeling "high," or an overly happy or outgoing mood 
· Extremely irritable mood, agitation, feeling "jumpy" or "wired."

Behavioral Changes

· Talking very fast, jumping from one idea to another, having racing thoughts 
· Being easily distracted 
· Increasing goal-directed activities, such as taking on new projects 
· Being restless 
· Sleeping little 
· Having an unrealistic belief in one's abilities 
· Behaving impulsively and taking part in a lot of pleasurable,
high-risk behaviors, such as spending sprees, impulsive sex, and impulsive business investments.

Symptoms of depression or a depressive episode include:

Mood Changes

· A long period of feeling worried or empty 
· Loss of interest in activities once enjoyed, including sex.

Behavioral Changes

· Feeling tired or "slowed down" 
· Having problems concentrating, remembering, and making decisions 
· Being restless or irritable 
· Changing eating, sleeping, or other habits 
· Thinking of death or suicide, or attempting suicide.  

In addition to mania and depression, bipolar disorder can cause a range of moods, as shown on the scale.

One side of the scale includes severe depression, moderate depression, and mild low mood. Moderate depression may cause less extreme symptoms, and mild low mood is called dysthymia when it is chronic or long-term. In the middle of the scale is normal or balanced mood.

At the other end of the scale are hypomania and severe mania. Some people with bipolar disorder experience hypomania. During hypomanic episodes, a person may have increased energy and activity levels that are not as severe as typical mania, or he or she may have episodes that last less than a week and do not require emergency care. A person having a hypomanic episode may feel very good, be highly productive, and function well. This person may not feel that anything is wrong even as family and friends recognize the mood swings as possible bipolar disorder. Without proper treatment, however, people with hypomania may develop severe mania or depression.

During a mixed state, symptoms often include agitation, trouble sleeping, major changes in appetite, and suicidal thinking. People in a mixed state may feel very sad or hopeless while feeling extremely energized.

Sometimes, a person with severe episodes of mania or depression has psychotic symptoms too, such as hallucinations or delusions. The psychotic symptoms tend to reflect the person's extreme mood. For example, psychotic symptoms for a person having a manic episode may include believing he or she is famous, has a lot of money, or has special powers. In the same way, a person having a depressive episode may believe he or she is ruined and penniless, or has committed a crime. As a result, people with bipolar disorder who have psychotic symptoms are sometimes wrongly diagnosed as having schizophrenia, another severe mental illness that is linked with hallucinations and delusions.

People with bipolar disorder may also have behavioral problems. They may abuse alcohol or substances, have relationship problems, or perform poorly in school or at work. At first, it's not easy to recognize these problems as signs of a major mental illness.

How does bipolar disorder affect someone over time?

Bipolar disorder usually lasts a lifetime. Episodes of mania and depression typically come back over time. Between episodes, many people with bipolar disorder are free of symptoms, but some people may have lingering symptoms.

Doctors usually diagnose mental disorders using guidelines from the Diagnostic and Statistical Manual of Mental Disorders, or DSM. According to the DSM, there are four basic types of bipolar disorder:

1. Bipolar I Disorder is mainly defined by manic or mixed episodes that last at least seven days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, the person also has depressive episodes, typically lasting at least two weeks. The symptoms of mania or depression must be a major change from the person's normal behavior. 

2. Bipolar II Disorder is defined by a pattern of depressive episodes shifting back and forth with hypomanic episodes, but no full-blown manic or mixed episodes. 

3. Bipolar Disorder Not Otherwise Specified (BP-NOS) is diagnosed when a person has symptoms of the illness that do not meet diagnostic criteria for either bipolar I or II. The symptoms may not last long enough, or the person may have too few symptoms, to be diagnosed with bipolar I or II. However, the symptoms are clearly out of the person's normal range of behavior. 

4. Cyclothymic Disorder, or Cyclothymia, is a mild form of bipolar disorder. People who have cyclothymia have episodes of hypomania that shift back and forth with mild depression for at least two years. However, the symptoms do not meet the diagnostic requirements for any other type of bipolar disorder.

Some people may be diagnosed with rapid-cycling bipolar disorder. This is when a person has four or more episodes of major depression, mania, hypomania, or mixed symptoms within a year. 

Some people experience more than one episode in a week, or even within one day. Rapid cycling seems to be more common in people who have severe bipolar disorder and may be more common in people who have their first episode at a younger age. One study found that people with rapid cycling had their first episode about four years earlier, during mid to late teen years, than people without rapid cycling bipolar disorder. Rapid cycling affects more women than men.

Bipolar disorder tends to worsen if it is not treated. Over time, a person may suffer more frequent and more severe episodes than when the illness first appeared.

 Also, delays in getting the correct diagnosis and treatment make a person more likely to experience personal, social, and work-related problems. Proper diagnosis and treatment helps people with bipolar disorder lead healthy and productive lives. In most cases, treatment can help reduce the frequency and severity of episodes.

What illnesses often co-exist with bipolar disorder?

Substance abuse is very common among people with bipolar disorder, but the reasons for this link are unclear.7 Some people with bipolar disorder may try to treat their symptoms with alcohol or drugs. However, substance abuse may trigger or prolong bipolar symptoms, and the behavioral control problems associated with mania can result in a person drinking too much.

Anxiety disorders, such as post-traumatic stress disorder (PTSD) and social phobia, also co-occur often among people with bipolar disorder.8-10 Bipolar disorder also co-occurs with attention deficit hyperactivity disorder (ADHD), which has some symptoms that overlap with bipolar disorder, such as restlessness and being easily distracted.

People with bipolar disorder are also at higher risk for thyroid disease, migraine headaches, heart disease, diabetes, obesity, and other physical illnesses. These illnesses may cause symptoms of mania or depression. They may also result from treatment for bipolar disorder.

Other illnesses can make it hard to diagnose and treat bipolar disorder. People with bipolar disorder should monitor their physical and mental health. If a symptom does not get better with treatment, they should tell their doctor.

What are the risk factors for bipolar disorder?

Scientists are learning about the possible causes of bipolar disorder. Most scientists agree that there is no single cause. Rather, many factors likely act together to produce the illness or increase risk.
BACK
Genetics

Bipolar disorder tends to run in families, so researchers are looking for genes that may increase a person's chance of developing the illness. Genes are the "building blocks" of heredity. They help control how the body and brain work and grow. Genes are contained inside a person's cells that are passed down from parents to children.

Children with a parent or sibling who has bipolar disorder are four to six times more likely to develop the illness, compared with children who do not have a family history of bipolar disorder. However, most children with a family history of bipolar disorder will not develop the illness.

Genetic research on bipolar disorder is being helped by advances in technology. This type of research is now much quicker and more far-reaching than in the past. One example is the launch of the Bipolar Disorder Phenome Database, funded in part by NIMH. Using the database, scientists will be able to link visible signs of the disorder with the genes that may influence them. 

So far, researchers using this database found that most people with bipolar disorder had:

· Missed work because of their illness 
· Other illnesses at the same time, especially alcohol and/or substance abuse and panic disorders 
· Been treated or hospitalized for bipolar disorder.

The researchers also identified certain traits that appeared to run in families, including:

· History of psychiatric hospitalization 
· Co-occurring obsessive-compulsive disorder (OCD) 
· Age at first manic episode 
· Number and frequency of manic episodes.

Scientists continue to study these traits, which may help them find the genes that cause bipolar disorder some day.

But genes are not the only risk factor for bipolar disorder. Studies of identical twins have shown that the twin of a person with bipolar illness does not always develop the disorder. This is important because identical twins share all of the same genes. The study results suggest factors besides genes are also at work. Rather, it is likely that many different genes and a person's environment are involved. However, scientists do not yet fully understand how these factors interact to cause bipolar disorder.

Brain structure and functioning

Brain-imaging studies are helping scientists learn what happens in the brain of a person with bipolar disorder.

 Newer brain-imaging tools, such as functional magnetic resonance imaging (fMRI) and positron emission tomography (PET), allow researchers to take pictures of the living brain at work. These tools help scientists study the brain's structure and activity.

Some imaging studies show how the brains of people with bipolar disorder may differ from the brains of healthy people or people with other mental disorders. 

For example, one study using MRI found that the pattern of brain development in children with bipolar disorder was similar to that in children with "multi-dimensional impairment," a disorder that causes symptoms that overlap somewhat with bipolar disorder and schizophrenia.16 This suggests that the common pattern of brain development may be linked to general risk for unstable moods.

Learning more about these differences, along with information gained from genetic studies, helps scientists better understand bipolar disorder. Someday scientists may be able to predict which types of treatment will work most effectively. They may even find ways to prevent bipolar disorder.

How is bipolar disorder diagnosed?

The first step in getting a proper diagnosis is to talk to a doctor, who may conduct a physical examination, an interview, and lab tests. 

Bipolar disorder cannot currently be identified through a blood test or a brain scan, but these tests can help rule out other contributing factors, such as a stroke or brain tumor. 

If the problems are not caused by other illnesses, the doctor may conduct a mental health evaluation. The doctor may also provide a referral to a trained mental health professional, such as a psychiatrist, who is experienced in diagnosing and treating bipolar disorder.

The doctor or mental health professional should conduct a complete diagnostic evaluation. He or she should discuss any family history of bipolar disorder or other mental illnesses and get a complete history of symptoms. The doctor or mental health professionals should also talk to the person's close relatives or spouse and note how they describe the person's symptoms and family medical history.

People with bipolar disorder are more likely to seek help when they are depressed than when experiencing mania or hypomania. Therefore, a careful medical history is needed to assure that bipolar disorder is not mistakenly diagnosed as major depressive disorder, which is also called unipolar depression. Unlike people with bipolar disorder, people who have unipolar depression do not experience mania. Whenever possible, previous records and input from family and friends should also be included in the medical history.

How is bipolar disorder treated?

To date, there is no cure for bipolar disorder. But proper treatment helps most people with bipolar disorder gain better control of their mood swings and related symptoms.18-20 This is also true for people with the most severe forms of the illness.

Because bipolar disorder is a lifelong and recurrent illness, people with the disorder need long-term treatment to maintain control of bipolar symptoms. An effective maintenance treatment plan includes medication and psychotherapy for preventing relapse and reducing symptom severity.

Call Dr. Calderon now for an appointment: 99-927-5813 








Mental Health Problems in Children 


BACK
Children’s mental health problems are real, common and treatable. 

Although one in five children has a diagnosable mental health problem, nearly two-thirds of them get little or no help. 

Untreated mental health problems can disrupt children’s functioning at home, school and in the community. Without treatment, children with mental health issues are at increased risk of school failure, contact with the criminal justice system, dependence on social services, and even suicide.

Parents and family members are usually the first to notice if a child has problems with emotions or behavior. Your observations, along with those of teachers and other caregivers, can help determine whether you need to seek help for your child.

The following signs may indicate the need for professional help:

· Decline in school performance
· Poor grades despite strong efforts
· Constant worry or anxiety
· Repeated refusal to go to school or to take part in normal activities
· Hyperactivity or fidgeting
· Persistent nightmares
· Persistent disobedience or aggression
· Frequent temper tantrums
· Depression, sadness or irritability


Early identification, diagnosis and treatment can help children reach their full potential. If you suspect a problem or have questions, talk with your child’s pediatrician or contact a mental health professional.

An evaluation may include consultation with a child psychiatrist, psychological testing and medical tests to rule out any physical condition that could be causing the symptoms. 

A comprehensive treatment plan should include psychotherapy and, in some cases, may include medication. The plan should be developed with the family. Whenever possible, the child should be involved in treatment decisions.

Call Dr. Calderon now for an appointment: 99-927-5813 







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Schizophrenia 
 
 
Signs and Symptoms    

Schizophrenia is a mental illness that usually strikes in late adolescence or early adulthood, but can strike at any time in life. The signs and symptoms vary from individual to individual, but all people with the disorder show one or more of the following symptoms:
 
1. Delusions: These are beliefs that are not true, such as feeling people are following or trying to hurt them, believing other people can read their minds, or beliefs that they have special powers or abilities.  
  
2. Hallucinations: This usually takes the form of hearing voices that are not there, but people with schizophrenia may also see, smell, taste, and feel things that are not there.   

3. Bizarre behavior: This can be expressed in many different ways. In short, the individual behaves in ways that seem inappropriate or strange to other people.   

4. Disorganized speech: The individual speaks in ways that are hard to understand. For instance, sentences might not make sense, or topic of conversation changes with little or no connection between sentences. Sometimes speech is completely incomprehensible.  
  
5. "Negative symptoms": This includes lack of motivation or interest, diminished cognitive functioning, and decreased emotional expression. Individuals may lose interest in attending to their own personal hygiene, have little interest in interacting with others, and rarely seem to feel or express strong emotions.  

    In addition to these above symptoms, people with schizophrenia suffer a decline in their level of functioning; for instance, they may not be able to work at a job that requires the same level of skill or concentration as the job they held before they became ill required, or they may lose all ability to withstand the pressures of the working world. They may show a decline in their ability to attend to household chores or all the demands of raising their children, and/or they may not be able to have a full social life anymore.

    Sometimes schizophrenia is a chronic condition, and the individual afflicted is constantly experiencing hallucinations or other symptoms of the disorder. Other people have periods of time when they are relatively symptom-free but have periods of more acute psychosis. Every individual is different, and every person with schizophrenia experiences the disease in a different way.

A brief history of schizophrenia    

    Mental illness has been recognized for thousands of years. At one point, all people who were considered "abnormal," whether due to mental illness, mental retardation, or physical deformities, were largely treated the same.

 Early theories supposed that mental disorders were caused by evil possession of the body, and the appropriate treatment was then exorcising these demons, through various means, ranging from innocuous treatments, such as exposing the patient to certain types of music, to dangerous and sometimes deadly means, such as releasing the evil spirits by drilling holes in the patient's skull.

One of the first to classify the mental disorders into different categories was the German physician, Emil Kraepelin. He used the term "dementia praecox" for individuals who had symptoms that we now associate with schizophrenia. The classifications for mental disorders continue to be revised. The most recent diagnostic classification system that is most commonly used in the United States is the Diagnostic and Statistical Manual for Mental Disorders - Fourth Edition (DSM-IV).

   The Swiss psychiatrist, Eugen Bleuler, coined the term, "schizophrenia" in 1911. This word comes from the Greek roots schizo (split) and phrene (mind) to describe the fragmented thinking of people with the disorder. His term was not meant to convey the idea of split or multiple personality, a common misunderstanding by the public at large. 

Since Bleuler's time, the definition of schizophrenia has continued to change, as scientists attempt to more accurately delineate the different types of mental diseases. Without knowing the exact causes of these diseases, scientists can only base their classifications on the observation that some symptoms tend to occur together.

    Both Bleuler and Kraepelin subdivided schizophrenia into categories, based on prominent symptoms and prognoses. 

Over the years, those working in this field have continued to attempt to classify types of schizophrenia. Five types were delineated in the DSM-III: disorganized, catatonic, paranoid, residual, and undifferentiated. The first three categories were originally proposed by Kraepelin. 

These classifications, while still employed in DSM-IV, have not shown to be helpful in predicting outcome of the disorder, and the types are not reliably diagnosed. Many researchers are using other systems to classify types of the disorder, based on the preponderance of "positive" vs "negative" symptoms (see symptoms of schizophrenia above), the progression of the disorder in terms of type and severity of symptoms over time, and the co-occurrence of other mental disorders and syndromes. It is hoped that differentiating types of schizophrenia based on clinical symptoms will help to determine different etiologies or causes of the disorder. 

What treatments are currently available?

Just as different people with schizophrenia can experience different symptoms, the effective treatment for each person is different. 

Each individual's treatment program can include one or more of the following:
 
Medication:   Finding the right medication can be difficult, and a trial-and-error process may have to occur. It is important to be open with the psychiatrist, reporting what symptoms and side-effects are occurring, so the doctor can help to find the best medication to meet individual needs of each patient. It is also important to learn the contraindications of certain medications, such as the effects of alcohol or sunlight on the effectiveness of the medication.    

Education: The person with schizophrenia and his or her family members can benefit from learning all they can about the disorder, including how to diminish stress and conflict, which can sometimes help spark a relapse. It is also important to learn what resources are available in the community for treating mental illnesses.   

Individual, group, and family therapy: This can help with problems that arise day to day, as well as setting realistic goals and defining strategies for reaching those goals.   

Hospitalization: This is required during some acute phases of the illness or sometimes in order to make changes in medication in a well-controlled, monitored environment.   

Support groups: These can be very important for those with schizophrenia and for their family members and friends.  See below for a list of support groups.   

Residential, day-treatment, and vocational programs: These programs can help the person with schizophrenia reach his or her highest potential and greatest level of independence. Staff in these programs become well-acquainted with their clients and can help find living arrangements, work, and recreational activities that are well-suited to each client's needs.

Call Dr. Calderon now for an appointment: 99-927-5813 




Addictions 

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Definition- 

  
Addiction is a dependence on a behavior or sub-stance that a person is powerless to stop. The term has been partially replaced by the word dependence for substance abuse. Addiction has been extended, however, to include mood-altering behaviors or activities. Some researchers speak of two types of addictions: substance addictions (for example, alcoholism, drug abuse, and smoking); and process addictions (for example, gambling, spending, shopping, eating, and sexual activity). There is a growing recognition that many addicts, such as polydrug abusers, are addicted to more than one sub-stance or process. 
  
Description 
  
Addiction is one of the most costly public health problems in the United States. It is a progressive syndrome, which means that it increases in severity over time unless it is treated. Substance abuse is characterized by frequent relapse, or return to the abused substance. Substance abusers often make repeated attempts to quit before they are successful. 
  
In 1995 the economic cost of substance abuse in the United States exceeded $414 billion, with health care costs attributed to substance abuse estimated at more than $114 billion. 
  
By eighth grade, 52% of adolescents have consumed alcohol, 41% have smoked tobacco, and 20% have smoked marijuana. Compared to females, males are almost four times as likely to be heavy drinkers, nearly one and a half more likely to smoke a pack or more of cigarettes daily, and twice as likely to smoke marijuana weekly. 
  
 However, among adolescents these gender differences are decreasing. Although frequent use of tobacco, cocaine and heavy drinking appears to have remained stable in the 1990s, marijuana use increased. 
In 1999, an estimated four million Americans over the age of 12 used prescription pain relievers, sedatives, and stimulants for "nonmedical" reasons during one month. 
  
In the United States, 25% of the population regularly uses tobacco. Tobacco use reportedly kills 2.5 times as many people each year as alcohol and drug abuse combined. According to 1998 data from the World Health Organization, there were 1.1 billion smokers worldwide and 10,000 tobacco-related deaths per day. Furthermore, in the United States, 43% of children aged 2-11 years are exposed to environmental tobacco smoke, which has been implicated in sudden infant death syndrome,low birth weight, asthma, middle ear disease, pneumonia, cough, and upper respiratory infection. 
  
Eating disorders, such as anorexia nervosa, bulimia nervosa, and binge eating, affect over five million American women and men. Fifteen percent of young women have substantially disordered attitudes toward eating and eating behaviors. 

More than 1,000 women die each year from anorexia nervosa. A 1997 Harvard study found that an estimated 15.4 million Americans suffered from a gambling addiction. Over half that number (7.9 million) were adolescents.
 
- Bill Asenjo, MS, CRC 


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