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Social commentary with a psychiatric online counseling twist! Laura describes herself as an economic conservative who lives a liberal lifestyle. Here it's not about the political left and right...it's about the ethical right and wrong.

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Does Your Doctor Have A DUI?

Posted: Sunday, January 08, 2012 | Share This:

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There's so much controversy out there about professionals sharing their personal stuff on social media. I'm in the "so what" category when it comes to this topic. Then I had a patient who had some issues with my slightly-tea-partyish-sort-of-republican posts. So for just a flash of a second I thought...maybe I shouldn't say what I think. Maybe I should be nothing, say nothing.

NO WAY!

My ethics, education, life experience all have put me in a very special place. A place where I am confident and caring, empathic and understanding. I help people. Just because I don't agree with Obama's policies, doesn't mean I won't prescribe the right medication for you!

Your nurses and doctors are normal people with political and personal beliefs...just like you! Just as we see the politicians being scrutinized for their personal choices, so too should the nurses and doctors be raked over the coals. Enough of covering up for doctors with DUIs and other legal offenses. Somehow when you look up your doctor or nurse, their court records are all "closed files." That's not right! You should be able to see if your doctor got a DUI the night before your operation!

So health care providers should embrace social media. And... if you don't like what I have to say on my website....then pick another clinician!

It May Be Social Phobia

Posted: Friday, November 04, 2011 | Share This:

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Question: I am a 25 years old and I am belong from a village. I am recently completed my bcs(Hon's) and now search a job. I have a problem that I cant share with my family relatives and fellows
even my uncle is a doctor and I am not discussed it with him I don't know why?
now come to my problem yesterday I giving interview for a job I got very depressed and my body start vibration due to pressure I forgot everything. This is not now this situation is from the sixth standard of my school. Even in university life I can't present anything in the front of my class and don't ask any question from my teacher during class because of this situation that I wrote above. and one thing other I am living in a hostel, today when I went to take my breakfast from canteen on my turn another guy come and take my breakfast I told him that its mine he give me but I got the same situation. There is nothing wrong but I don't know why this happened with me. I am normal in the front of my very closed friend, family and relatives.
But I can't present anything(answers, opinion etc.) on the front of unknown. Please some suggestion to avoid this situation I shall be very thankful to you.

Answer:
Dear Abid,
It sounds like you may be suffering from social phobia. Social phobia is an ongoing irrational fear of situations that may involve people analyzing or judging you, such as at parties and other social events or at school. People with social phobia become overwhelmingly anxious and self-conscious in everyday social situations. They have an intense, persistent, and chronic fear of being watched and judged by others, and of doing things that will embarrass them. Sometimes, they worry for days or weeks before an upcoming situation. For some people, the fear may become so severe that it interferes with work, school, and other ordinary activities. Sometimes anti-anxiety or anti-depressant medications help. But what seems to help most is practice. What I mean by practice is, to look in the mirror before you have an encounter and tell yourself, "I'm in control of my mind and my body, everything will be ok and I will successfully present myself in class(or at a party or wherever you are going) today." Say it and believe it. Look at yourself and say it over and over. The key is not to avoid situations but to make yourself face them over and over. The other part to practice is with friends and family you feel comfortable with. If it's a speech, practice the speech in front of your family at home. If it's a social situation, practice with the friends you feel most comfortable with in a place where you feel comfortable. You will overcome this and you will be successful! Good Luck.
Laura

Out of Control Anxiety

Posted: Thursday, August 18, 2011 | Share This:

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Question: I'm in Denver away from my psychiatrist! Having very bad anxiety my psychiatrist put me on klonopin .05mg 3x daily not working was a crying mess so my psychiatrist told me to go to the emergency room where they gave me thru an i.v twice didn't work then they gave me valium it helped take the edge off but I still feel very manic can't see doctor for one 1/2 weeks what to do demand he see me when i get back home?

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Alcohol Issues In The ER

Posted: Saturday, August 06, 2011 | Share This:

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Every day I see several intoxicated people in the emergency room. Many of them drive themselves to the ER and ask for help. Some come in handcuffed and angry. Some are dropped off by family members who have had enough. Some are on probation or on parole and if they get caught drinking or using drugs, it would be a violation of their probation.

And what do I do with these people? I help them. I protect their privacy. I feed them and house them in the ER. I give them medications. I make sure they are comfortable and cared for. Alcohol withdrawal is life-threatening. It's a medical issue that most times warrants an inpatient admission.

25% of all emergency room admissions, 33% of all suicides, and more than 50% of all homicides and incidents of domestic violence are alcohol-related. According to the Center for Disease Control in Atlanta, there are 105,000 annual alcohol-related deaths due to drunk drivers and related injuries or diseases.

Somehow I feel that I am contributing to those statistics. You know why? Because I am ethically bound to protect my patients privacy. I can not call probation officers, I can not call the police and report that someone was driving under the influence. Some patients really want help. But some come to hide in the ER because they know we can't rat them out. And your tax dollars pay for us to harbor criminals in the ER.

It's a dirty little secret. I look through the newspapers all the time to see if a person I had in the ER has driven drunk and hurt people, or beat their spouses in a drunken rage. Am I responsible in some way?

My hospital legal team would say I'm not. But my heart and soul says maybe I am.

Maybe alcohol should be illegal like other drugs. It's certainly equally as lethal as heroine, cocaine, and meth. And it costs the health care system and the tax payers a great deal. Not to mention the heart ache, physical suffering, and death that inevitably comes.

O thou invisible spirit of wine, if thou hast no name to be known by, let us call thee devil. William Shakespeare:

Chronic Pain and Severe Depression

Posted: Friday, July 29, 2011 | Share This:

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Question: My question is how can I get over this severe depression that goes along with my chronic pain?

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Medications For Insomnia

Posted: Wednesday, July 20, 2011 | Share This:

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So you're having trouble sleeping and you went to your psychiatric clinician for help. And somehow you left their office with a prescription for remeron (also called mirtazapine). And you're thinking that this remeron medicine is for insomnia, to help you sleep because that's what the clinician said right!? And why oh why wouldn't you believe what a licensed professional tells you!?

Well guess what...remeron is an antidepressant, not a sleep aide! So if you happen to suffer with insomnia AND you're depressed, remeron may be the right medication for you. But if your only issue is a sleep problem...don't you want a medication that's only job is to put you to sleep!? Of course!

First, some effort needs to be put into developing good sleep habits. Sure all the other psych websites give you long lists and long articles of how to magically turn yourself into sleeping beauty! But here's the low-stress version:

* standardize your wake time
* limit amount of time awake in bed
* limit napping
* remove the clock from your vision
* avoid caffeine after 12noon and avoid alcohol after 6pm
* avoid stressful activities in the evening

Second, find a clinician whose not afraid to give you a thorough evaluation and an appropriate sleep medication if your primary diagnosis turns out to be insomnia. Remember, sometimes a sleep problem is really a symptom of some other medical or psychiatric diagnosis. Make sure you ask exactly what kind of medication you are being prescribed. Too often clinicians are prescribing medications that have a side effect of sedation to treat insomnia. Like the remeron...which is an antidepressant with a side effect of sedation. Trazodone is often prescribed for insomnia but it is an antidepressant with a side effect of sedation. And seroquel is an antipsychotic but sometimes prescribed for insomnia because its side effect is sedation! Don't expose your body to these medications just for insomnia.

As a Nurse Practitioner, I always ask myself..."Is this a medication I would prescribe for myself for this particular problem?" And guess what! I would NOT prescribe remeron or trazodone or seroquel for my own insomnia! I would prescribe ambien or restoril or lunesta. Take care of yourself. Don't accept second rate service. It's your body! And next time you see your clinician...ask them if the medication they are prescribing for you is something they would prescribe for themselves. http://www.eleventhhourllc.com/online-advice/default.aspx

Bath Salts May Kill You

Posted: Saturday, July 16, 2011 | Share This:

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My job here is to give you the straight story. All my followers out there know I tell it like it is. And as I go to work in the Emergency Room day after day, I see you guys coming in completely freaked out on bath salts. Some of you come in DOA....that's DEAD ON ARRIVAL in case you didn't know.

You are snorting, smoking, injecting, eating these bath salts and you are getting suicidal, homicidal, psychotic. You are dangerous to yourself and all of us around you. You bite, kick, scream, punch, hit, spit at those of us trying to help you. You end up with five officers on top of you as we tie you to a bed with restraints so we can pump your veins full of medications and fluids in an attempt to save your life. You look near death as you scream about wanting to kill yourself, as you scream about seeing and hearing things that aren't there, as you beg us to help you. And we do help you. But please help too...DON'T USE BATH SALTS!

Some treaters may sit here and try to explain to you what exactly the chemical compounds are in these bath salts and how they affect your brain. How they are a stimulant sort of like meth and cocaine and ecstasy all rolled into one. How if you inject them with a dirty needle, you can also get hepatitis, HIV. But none of that matters if you're dead....

Antidepressants, Serotonin, You and Me

Posted: Thursday, July 07, 2011 | Share This:

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Just wait a minute! Don't take that pill just yet! So you were at your primary care clinician's office getting your annual check up and you mention to your practitioner that you've been "out of sorts, kind of depressed, not myself." And before you know it, without further investigating your feelings, your clinician hands you a prescription for paxil or prozac or celexa or lexapro or zoloft or luvox. All these medications are antidepressants and known as SSRIs (Selective Serotonin Reuptake Inhibitors). Sounds fancy right? Sounds like a sure bet for happiness right? Well let's do a little more investigation.

Dr. Axelrod won the Nobel prize in 1970 for his research that led to the development of the SSRIs. The discovery of serotonin was a very cool thing because psychiatry became hopeful that they could now "cure" depression. Psychiatry thought they would be accepted as a legitimate arm of medicine because depression was actually a "medical illness," a "deficiency of serotonin." So quickly, the pharmaceutical companies got to work developing the SSRIs, medications that affect serotonin. The SSRIs simpy put, inhibit the reuptake of serotonin, thus allowing a build up of the serotonin.

Serotonin is in your blood. It works in your central nervous system. Serotonin affects mood, emotion, sleep, and appetite. But guess what...90% of your serotonin supply is in your digestive tract and in your blood platelets! So when we look at the side effects of the SSRIs, we can understand it.

The side effects from too much serotonin include insomnia, rash, muscle pain, bleeding, sweating, anxiety, and GI distress like nausea, diarrhea, vomiting, upset stomach. Well these make sense now that we know that serotonin works in the belly and works in the brain on mood, emotion, sleep, and appetite! In other words...too much serotonin can make you sweat, can make you anxious, can make you bleed, can make you have diarrhea, nausea, vomiting. And...the most annoying side effect...decreased sexual interest, desire, and performance.

There's a cool study that found migraine patients have a higher sex drive. Hmmm...you say?? Yup, it's true! People who suffer from migraines have low levels of serotonin. And people with low levels of serotonin have normal or higher than normal sex drives. So if you increase your levels of serotonin with an SSRI, you will decrease your sex drive! I bet your primary care clinician didn't explain that to you!

Well all the hype about serotonin seems to only be good news for some of the people some of the time. Some people don't need more serotonin and some people can't tolerate having increased serotonin.

So what should you do if you feel depressed? Should you try an SSRI? Well you should definitely try meeting with a psychiatric nurse practitioner. Because there just isn't a magic happy pill out there. And what may work for one person, may not work for another. Do you think low levels of serotonin cause depression or does depression cause low levels of serotonin? I sure don't know! But what I do know, is that when I meet with a client, together, we take the time and seriously examine all aspects of your health, your activities of daily living...what makes you tick. Sometimes the SSRIs work and sometimes they don't. Well how is that possible? If all those science and doctor dudes said serotonin is the thing that makes people depressed...why doesn't it work all the time for all the depressed people? Because maybe you have a dopamine issue. Or maybe you have a specific life event that's caused you emotional difficulties. Or maybe you have a norepinephrine issue. So maybe depression isn't just a serotonin problem.

Dr. Axelrod gave us a good start. But I think each person is unique and has very specific reasons and chemistry's and histories... that together, may cause mood disorders. So be good to yourself, don't just take that prescription from your primary care clinician, ask for a referral to a psychiatric nurse practitioner and explore what's really going on in your mind and body.

Why isn't the Adderall working?

Posted: Monday, July 04, 2011 | Share This:

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Question: My doctor has recently decided that his initial diagnosis of schizophrenia was incorrect. He has decided that I actually have ADHD and has put me back on medication I had been taking previously, Adderall IR.

The problem is that I'm not feeling the effects of the medication. I was on the Risperdal Consta injection for a little over a year, and it's been seven weeks since my last shot, which is the time required for elimination. However, I still feel nothing; I don't notice a difference when I take the Adderall.

I used to feel focused and calm when I took Adderall, but now... nothing. Is this a side effect of the Risperdal? When will the Risperdal stop having an influence on my body? My doctor said it would go away after eight weeks, but it hasn't. I don't understand. Thank you so much.

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Psychiatric Medications - Do You Really Need Them?

Posted: Saturday, June 25, 2011 | Share This:

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So you want a medication for your mood? You think a pill will make everything better right? Of course we think that...that's what the ads on TV tell us! As a psychiatric nurse practitioner, people come see me for prescriptions. People request pills for all kinds of things like poor sleep, mood swings, depression, racing thoughts, and to focus better. But sometimes you don't need a pill...actually, most of the time you don't need a pill! Shocking right? Five psychiatric medications made Forbes top 20 best-selling medications list. Three of those five are antipsychotics!

Let's take a look at this chart, NIMH (National Institute of Mental Health) shows us the percent of Americans with mental illness. It helps put things into perspective related to having 5 psychiatric medications on Forbes list of best-selling medications....in other words, I think people who don't necessarily need those medications are being prescribed those medications.

Courtesy of NIMH

Lots of people have difficulty with symptoms that seem to be part of a mental illness. And doctors are right there, ready to give you a prescription for your symptom. But what if your symptom was the result of a vitamin deficiency? What if your depression is the direct result of the loss of your spouse? What if your anxiety is the direct result of an overactive thyroid? Has your doctor ever said, "Gee, I'm sorry you lost your home and you have to care for your kids in a shelter, here's a prescription for zoloft, it will help with your mood."

But maybe all you really needed was help finding resources for homeless families, or a blood test for a B12 deficiency instead of a pill. Or maybe it's something that will take a while to figure out. Doctors don't have the kind of time needed to figure out what's causing your symptom. It's easier for them to give you a pill for the symptom! Really...it's an awful way to treat people. And we all deserve better care.

Some research has shown that antidepressants are no more effective than a placebo. Because maybe all you really need is therapy and learning some new coping skills. As a prescriber of psychiatric medications for 11 years, I know who needs a medication and who needs to learn good sleep hygiene habits!

And all the psychiatric medications have some significant side effects. Forbes top medication list has those 3 antipsychotics in there! Do you really think you need an antipsychotic?? According to Prescriber's Letter, more money is spent on antipsychotics than any other class of psychiatric medications. There are more than 10 antipsychotics I can pick from to prescribe for you. When we decide to add on an antipsychotic, it should be done with extreme care and a thorough history. There's cardiac issues, weight and metabolic issues, sedation issues and extrapyramidal issues, not to mention all the drug-drug interactions and cost.

So consider all the options and all the risks before you accept that prescription from your doctor. And, give a Nurse Practitioner a try! We are trained in a holistic manner. We look at the whole you. You deserve a complete work up for what ails you. You deserve a full explanation of each medication considered for you and you deserve to hear possible alternatives. Please don't settle for a pill.

My Spouse is Suicidal

Posted: Thursday, May 26, 2011 | Share This:

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Question: My husband recently relapsed after 9 years of sobriety. He is currently in a rehabilitation center. He has opened up to me and the staff of incestual sexual abuse as a child from ages 4-10. He says he has been wanting to commit suicide for years, he is very depressed and rarely happy. He will be released soon and I am very concerned about what I can do to support him. I found a detailed description of how and where he was going to commit suicide. What do I do?

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Don't overdo the benadryl

Posted: Saturday, February 12, 2011 | Share This:

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Question: They gave my mother benadryl in the hospital to calm her down but she got wild! She is 84 and the doctor said benadryl helps calm people down when they are nervous. So what happened? Is she allergic to it?

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Dizzy From Seroquel

Posted: Thursday, December 23, 2010 | Share This:

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Question: I just started taking seroquel and now I get dizzy. Is it the medicine or is something else wrong with me?

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Sometimes You Need A Lawyer

Posted: Sunday, November 21, 2010 | Share This:

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Question: I have a 15 year old son that has wanted to go live with his grandparents and father. I agree that child support be stopped and he pay for all medical and dental and so on. I will still have full custody and child will come visit with me every other weekend. I want to be adults about this. Am I doing the right thing and how would I go get everything that child needs while living with them?

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LauraNP

When Your Mate Is In A Rehab

Posted: Tuesday, November 16, 2010 | Share This:

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Question: Hey I'm kinda bummed out because my boyfriend who is in alcohol rehab is refusing to take my calls. He has been there for about a week now and haven't heard from him at all. So I called tonight and the night nurse informed me that he is not taking any of my calls. So I guess that we are no longer together and I won't be hearing from him again. Ouch that hurts!!!! And just to think that he wanted me to wait for him when he gets out. I'm confused do you think that it's over?

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LauraNP

How can I control my anxiety and depression?

Posted: Sunday, November 07, 2010 | Share This:

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Question: I feel anxiety and depression for a long time. Please help me get rid of this condition and disease.

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LauraNP

How To End A Relationship

Posted: Saturday, November 06, 2010 | Share This:

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Question: I just found out that my live in boyfriend of 17 years is cheating on me. What is the best way for me to end this relationship.

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LauraNP

Is It Me Or Is It My Husband?

Posted: Saturday, November 06, 2010 | Share This:

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Question: I have been married for seven years now and me and my husband have been having the same problem with him needing to talk to other females from sun up to sun down. Is this a sign that we are not made for each other? Or am I bringing this pain on myself by not doing something right in my marriage?

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LauraNP

Should You Hook Up with an Ex or Not?

Posted: Thursday, November 04, 2010 | Share This:

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Question: Okay so this guy I was best friends with for 3 years and I finally got together in a relationship back in February. Since then, he left the state and we broke up. For me, it's a lot easier to get over someone after a breakup if I just cut off contact with them completely. But he must IM me like...3 separate times a day! Granted, we DON'T talk romantically nor do mentionings of hooking up ever happen, but I can't help but think that if he keeps talking to me, despite his new and exciting life in another state, that he's trying to retain contact with me (maybe just because we're best friends--or at least once were) because he still has feelings for me. I still have feelings for him. We'd discussed when we knew our relationship was coming to an end the prospect of hooking up when he comes back home, though. He's coming home for the first time next week since I last saw him in June. And he's still consistently been talking to me online. What do you think? Is he going to try to hook up with me? I really don't think I'm going to be the one to initiate anything for fear of looking stupid and being rejected and like I can't get over him. Should I decline if he DOES try?

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LauraNP

Bipolar Medications Take My Emotions Away

Posted: Tuesday, November 02, 2010 | Share This:

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Question: I have been off bipolar medication for 10 months now. I did not like the way they made me feel. I had no emotions and always felt zoned out and when my mom passed, I did not feel a thing, no emotions at all, so I got off them with a doctor's help but I need them. My bipolar is affecting my marriage. What can I take that will help and not make me feel like that I am also very depressed due to constant pain?

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Laura NP

Background Check Your New Boyfriend

Posted: Tuesday, October 26, 2010 | Share This:

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Question: I have been with the most amazing man for nearly a year now. Life is wonderful,our normal ups&downs. Here's the problem, my sis did a background check on him right when I met him. There was some things that came up, nothing like an arrest or legal. It was some outstanding credit matters,which was the wrong person and of course she thought it was him. Long story short is, she called me that night and blasted me while he was sitting beside me. He heard everything, and now it is eating at him! He refuses to meet my son, saying he can just imagine what my sis told him and the rest of my family. He has been totally upfront with me. What was found was past relationships where the exs did this to his credit. I have no reason to distrust him. Now it is eating at him because there is a party coming up, he wants to go stating maybe my sis will have my ex there or maybe someone else that she feels may be better for me! I love this man, what can I do to convince him of this, how can I make him see that he is the wonderful man that I love and not some low life, which is what she has made him seem like. Help please!!

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LauraNP

What's Up With My Husband and Sister?

Posted: Sunday, October 24, 2010 | Share This:

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Question: I was supposed to go to a wine festival with my husband and sister which had been planned and they blew me off to watch a football game. Am I right in being angry at them and thinking they were both selfish?

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LauraNP

4 year olds like to test you!

Posted: Thursday, September 30, 2010 | Share This:

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Question: My daughter is 4 years old and she does not like to sleep at night. She has me up until 3-4am. I tried the old thing of waking her up early and that only worked for a day or two, but she went right back to where she was. I really don't want to put her on meds yet.

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LauraNP

Do You Need More or Less Medication?

Posted: Wednesday, September 29, 2010 | Share This:

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Question: My son is 19 yrs old and he has tourettes, OCD, and feels he also has anxiety. He takes risperidone for tourettes and fluvoxamine for OCD. Last night he seemed to have an attack. When he gets in a relationship, he feels he needs to break up. Does he need new medication?

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LauraNP

Dysfunctional father-daughter relationships

Posted: Sunday, September 26, 2010 | Share This:

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Question: I recently started a relationship with a man who has a 15 year old daughter. In the beginning he told me he was unable to have a relationship in the past due to his daughters behavior and emotional issues. She believes she is his girlfriend. She does everything for him a girlfriend would do. She keeps tabs on him, goes thru his phone & email. wears his clothes & walks around smelling them. We went to see a band the other nite & came back to his house to her in his bed in panties & a tshirt. What is this called when a daughter is this way towards her father?

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LauraNP

About

Recent Posts

Eleventh Hour - Laura Giesman, NP

online advice

licensed counselor

No appointment needed!

Does Your Doctor Have A DUI?

It May Be Social Phobia

Out of Control Anxiety

Alcohol Issues In The ER

Chronic Pain and Severe Depression

Medications For Insomnia

Bath Salts May Kill You

Antidepressants, Serotonin, You and Me

Why isn't the Adderall working?

Psychiatric Medications - Do You Really Need Them?

My Spouse is Suicidal

Don't overdo the benadryl

Dizzy From Seroquel

Sometimes You Need A Lawyer

When Your Mate Is In A Rehab

How can I control my anxiety and depression?

How To End A Relationship

Is It Me Or Is It My Husband?

Should You Hook Up with an Ex or Not?

Bipolar Medications Take My Emotions Away

Background Check Your New Boyfriend

What's Up With My Husband and Sister?

4 year olds like to test you!

Do You Need More or Less Medication?

Dysfunctional father-daughter relationships