Claustrophobia

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Claustrophobia is a form of anxiety disorder, in which an irrational fear of having no escape or being closed-in can lead to a panic attack.
It is considered a specific phobia according to the Diagnostic and Statistical Manual 5 (DSM-5).

Triggers may include being inside an elevator, a small room without any windows, or even being on an airplane.

Some people have reported that wearing tight-necked clothing can provoke feelings of claustrophobia.

Fast facts on claustrophobia:
Here are some key points about claustrophobia. More detail is in the main article.
Claustrophobia affects some people when they are in a small space.
It can lead to feelings of panic.
Causes may include conditioning and genetic factors.
A variety of tips and treatments may help people overcome their fear.
What is claustrophobia?
Claustrophobia
Claustrophobia is the fear of a closed-in place from which escape would be difficult or impossible.
The word claustrophobia comes from the Latin word claustrum which means “a closed-in place,” and the Greek word, phobos meaning “fear.”

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People with claustrophobia will go to great lengths to avoid small spaces and situations that trigger their panic and anxiety.

They may avoid places like the subway and prefer to take the stairs rather than an elevator, even if many floors are involved.

Up to 5 percent of Americans may experience claustrophobia.

Diagnosis
A psychologist or psychiatrist will ask the patient about their symptoms.

A diagnosis of claustrophobia may emerge during a consultation about another anxiety-related issue.

The psychologist will:

ask for a description of the symptoms and what triggers them
try to establish how severe the symptoms are
rule out other types of anxiety disorder
To establish some details, the doctor may use:

a claustrophobia questionnaire to help identify the cause of anxiety
a claustrophobia scale to help establish the levels of anxiety
For a specific phobia to be diagnosed, certain criteria need to be met.

These are:

a persistent unreasonable or excessive fear caused by the presence or anticipation of a specific situation
anxiety response when exposed to the stimulus, possibly a panic attack in adults, or, in children, a tantrum, clinging, crying or freezing
a recognition by adult patients that their fear is out of proportion to the perceived threat or danger
employing measures to avoid the feared object or situation, or a tendency to face the experiences but with distress or anxiety
the person’s reaction, anticipation or avoidance interferes with everyday life and relationships or causes significant distress
the phobia has persisted for some time, usually 6 months or longer
symptoms cannot be attributed to another mental condition, such as obsessive-compulsive disorder (OCD) or post-traumatic stress disorder (PTSD)
Symptoms
Claustrophobia is an anxiety disorder. Symptoms usually appear during childhood or adolescence.

Being in or thinking about being in a confined space can trigger fears of not being able to breathe properly, running out of oxygen, and distress at being restricted.

When anxiety levels reach a certain level, the person may start to experience:
sweating and chills
accelerated heart rate and high blood pressure
dizziness, fainting, and lightheadedness
dry mouth
hyperventilation, or “over breathing”
hot flashes
shaking or trembling and a sense of “butterflies” in the stomach
nausea
headache
numbness
a choking sensation
tightness in the chest, chest pain, and difficulty breathing
an urge to use the bathroom
confusion or disorientation
fear of harm or illness
It is not necessarily the small spaces that trigger the anxiety, but the fear of what can happen to the person if confined to that area.
This is why the person fears running out of oxygen.

Examples of small spaces that could trigger anxiety are:
Claustrophobia trapped.
Claustrophobia can stem from a feeling of being trapped, and what could happen if they stayed confined to that area.
elevators or changing rooms in stores
tunnels, basements, or cellars
trains and subway trains
revolving doors
airplanes
public toilets
cars, especially those with central locking
crowded areas
automatic car-washes
some medical facilities, such as MRI scanners
small rooms, locked rooms, or rooms with windows that do not open
Reactions include:
checking the exits and staying near them when entering a room
feeling anxious when all the doors are closed
staying near the door in a crowded party or gathering
avoiding driving or traveling as a passenger when traffic is likely to be congested
using the stairs instead of the elevator, even if this is difficult and uncomfortable
Claustrophobia involves a fear of being restricted or confined to one area, so, having to wait in line at a checkout may also cause it in some people.

Treatment
Cognitive behavioral therapy
Cognitive behavioral therapy (CBT) can be used to reduce the frequency and potency of the fear reaction’s triggers.
Following a diagnosis, the psychologist may recommend one or more of the following treatment options.

Cognitive behavioral therapy (CBT): The aim is to retrain the patient’s mind so that they no longer feel threatened by the places they fear.

It may involve slowly exposing the patient to small spaces and helping them deal with their fear and anxiety.
Having to face the situation that causes the fear may deter people from seeking treatment.

Observing others: Seeing others interact with the source of fear may reassure the patient.
Drug therapy: Antidepressants and relaxants can help manage symptoms, but will not solve the underlying problem.

Relaxation and visualization exercises: Taking deep breaths, meditating and doing muscle-relaxing exercises can help deal with negative thoughts and anxiety.

Alternative or complementary medicine: Some supplements and natural products, for example, lavender oil or a “rescue remedy,” may help patients manage panic and anxiety.

Treatment often lasts around 10 weeks, with sessions twice a week. With appropriate treatment, it is possible to overcome claustrophobia.

Tips for coping
Strategies that can help people cope with claustrophobia include:
staying put if an attack happens. If driving, this may include pulling over to the side of the road and waiting till symptoms have passed.
Reminding yourself that the frightening thoughts and feelings will pass
trying to focus on something that is not threatening, for example, the time passing or other people
Breathing slowly and deeply, counting to three on each breath
challenging the fear by reminding yourself that it is not real
visualizing positive outcomes and images
Longer-term strategies may include joining a yoga class, working out an exercise program, or booking an aromatherapy massage, to help cope with stress.

Information video
In this video, Stella Lourency, Assistant Professor of Psychology at Emory University, explains that people with higher levels of claustrophobic fear tend to underestimate distances.

Causes
Past or childhood experience is often the trigger that causes a person to associate small spaces with a sense of panic or imminent danger.

Experiences that can have this effect may include:
being trapped or kept in a confined place, by accident or on purpose
being abused or bullied as a child
getting separated from parents or friends when in a crowded area
having a parent with claustrophobia
The trauma experienced at that time will affect the person’s ability to cope with a similar situation rationally in future. This is known as classic conditioning.

The person’s mind is believed to link the small space or confined area with the feeling of being in danger. The body then reacts accordingly, or in a way that seems logical.

Classic conditioning can also be inherited from parents or peers. If a parent, for example, has a fear of being close in, the child may observe their behavior and develop the same fears.

Possible genetic or physical factors
Other theories that may explain claustrophobia include:

Having a smaller amygdala: This is the part of the brain that controls how the body processes fear.

Genetic factors: A dormant evolutionary survival mechanism causes reactions that are no longer needed in today’s world.

Mouse studies have indicated that a single gene may cause some individuals to have a greater degree of “resident-intruder stress.”

One group of researchers has suggested that people who experience claustrophobia perceive things as being nearer than they are, and that this triggers a defense mechanism.

https://www.medicalnewstoday.com/articles/37062.php

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It’s not enough to develop drugs for cancer. We have to develop plans to help improve lives

Senior Vice President of Oncology at Astellas Pharma

Tens of thousands of researchers, clinicians, and industry leaders descended upon Chicago for the annual meeting of the American Society of Clinical Oncology (ASCO), where breakthrough science and promising statistics in cancer care were on full display.

The Annual Report to the Nation on the Status of Cancer, published this spring by the Centers for Disease Control and Prevention, the American Cancer Society and other public and private-sector organizations, showed that mortality rates for the most common cancers in men and women, including lung, colorectal, female breast, and prostate, have continued to decline. With the exciting progress we’re seeing in immunotherapies, personalized medicine and other therapeutic areas, there is every reason to believe that meaningful progress will continue well into the future.

However, defeating cancer is about more than breakthroughs or statistics alone. In the midst of all the scientific excitement, we must not lose sight of the fact that a disease like cancer, even if treatments are ultimately successful, fundamentally changes the life of the person battling it.

Those of us who have devoted our careers to changing lives need to define “life” in a holistic way, beyond the cellular level. This begins with supporting ways to reduce the impact of cancer treatments on patients. At Astellas, our team is deeply encouraged by what we’ve seen, for example, in the use of virtual reality to help people better manage the high degrees of stress that accompany treatment. What’s more, the continuing proliferation of online and community-based support networks is increasingly helping to ensure that people fighting this disease never have to feel alone.

Even beyond that, though, we need to focus our ideas and energies on how we can help cancer patients regain the lives that the disease stole from them. We’re learning more about the benefits of helping people process the emotions they experience during diagnosis and treatment, establish post-treatment plans, and rebuild their confidence regarding career, education, finances, and relationships.

As a company and industry, one of the most important things we can do to help achieve this holistic approach to cancer care is put ourselves squarely in the shoes of those fighting the disease. Not too long ago, this hit close to home when my father was diagnosed with head and neck cancer and my perspective of our healthcare system completely changed. Although I had been working in the industry for more than 20 years, I found myself confused and frustrated when I was put into the caregiver role. As I attempted to navigate the system and coordinate the right care for my father, I was met with both discrepancies in treatment options and constant misunderstandings.

My experience as a caregiver reinforced my view that we must ask patients and their caregivers about their lives with the disease and how it has affected them on a daily basis. Only then can we truly understand the impact of the disease and help patients live fully after their diagnoses.

In 2015, Astellas co-developed a prospective patient registry for individuals with castration-resistant prostate cancer (CRPC). The program, Treatment Registry for Outcomes in CRPC Patients (TRUMPET), is designed to follow 1,200 patients for up to six years and evaluate each patient’s clinical and quality of life experience with the disease. With more than 600 CRPC patients already enrolled, TRUMPET helps us understand how these men manage CRPC, navigate the healthcare system, and make treatment decisions with family and caregivers. Importantly, it helps us shape future research and allows our company to make use of real world evidence with patient outcomes and quality of life in mind.

I’m both encouraged and excited that cancer is losing ground every day to our scientific progress. The major breakthroughs and the continual incremental successes are critically important. But I also believe that we, combined with other leaders across healthcare, have the obligation, will and the resources to achieve the most important victories – helping individuals regain the bright outlook they had before the day they received that life-altering diagnosis.

As we celebrate all the exciting research and advances shared at ASCO this week, let’s also be sure to keep this bigger picture in mind.

This post was originally published on The Astellas Way.

Medical errors now third leading cause of death in United States

May 3, 2016

These common medical errors are major killers

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A new study by patient safety researchers shows common medical errors may be the third leading cause of death in the U.S., after heart disease and cancer. (Deirdra O’Regan/The Washington Post)

Nightmare stories of nurses giving potent drugs meant for one patient to another and surgeons removing the wrong body parts have dominated recent headlines about medical care. Lest you assume those cases are the exceptions, a new study by patient-safety researchers provides some context.

Their analysis, published in the BMJ on Tuesday, shows that “medical errors” in hospitals and other health-care facilities are incredibly common and may now be the third-leading cause of death in the United States — claiming 251,000 lives every year, more than respiratory disease, accidents, stroke and Alzheimer’s.

Martin Makary, a professor of surgery at the Johns Hopkins University School of Medicine who led the research, said in an interview that the category includes everything from bad doctors to more systemic issues such as communication breakdowns when patients are handed off from one department to another.

“It boils down to people dying from the care that they receive rather than the disease for which they are seeking care,” Makary said.

The issue of patient safety has been a hot topic in recent years, but it wasn’t always that way. In 1999, an Institute of Medicine report calling preventable medical errors an “epidemic” shocked the medical establishment and led to significant debate about what could be done.

The IOM, based on one study, estimated deaths because of medical errors as high as 98,000 a year.  Makary’s research involves a more comprehensive analysis of four large studies, including ones by the Health and Human Services Department’s Office of the Inspector General and the Agency for Healthcare Research and Quality that took place between 2000 to 2008. His calculation of 251,000 deaths equates to nearly 700 deaths a day — about 9.5 percent of all deaths annually in the United States.

Makary said he and co-author Michael Daniel, also from Johns Hopkins, conducted the analysis to shed more light on a problem that many hospitals and health-care facilities try to avoid talking about.

Although all providers extol patient safety and highlight the various safety committees and protocols they have in place, few provide the public with specifics on actual cases of harm due to mistakes. Moreover, the Centers for Disease Control and Prevention doesn’t require reporting of errors in the data it collects about deaths through billing codes, making it hard to see what’s going on at the national level.

The CDC should update its vital statistics reporting requirements so that physicians must report whether there was any error that led to a preventable death, Makary said.

“We all know how common it is,” he said. “We also know how infrequently it’s openly discussed.”

Kenneth Sands, who directs health-care quality at Beth Israel Deaconess Medical Center, an affiliate of Harvard Medical School, said that the surprising thing about medical errors is the limited change that has taken place since the IOM report came out. Only hospital-acquired infections have shown improvement. “The overall numbers haven’t changed, and that’s discouraging and alarming,” he said.

Sands, who was not involved in the study published in the BMJ, formerly known as the British Medical Journal, said that one of the main barriers is the tremendous diversity and complexity in the way health care is delivered.

“There has just been a higher degree of tolerance for variability in practice than you would see in other industries,” he explained. When passengers get on a plane, there’s a standard way attendants move around, talk to them and prepare them for flight, Sands said, yet such standardization isn’t seen at hospitals. That makes it tricky to figure out where errors are occurring and how to fix them. The government should work with institutions to try to find ways improve on this situation, he said.

Makary also used an airplane analogy in describing how he thinks hospitals should approach errors, referencing what the Federal Aviation Administration does in its accident investigations.

“Measuring the problem is the absolute first step,” he said. “Hospitals are currently investigating deaths where medical error could have been a cause, but they are underresourced. What we need to do is study patterns nationally.”

He said that in the aviation community every pilot in the world learns from investigations and that the results are disseminated widely.

CONTENT FROM THE CLEVELAND CLINIC
Why empathy matters in healthcare
More hospitals are putting patient comfort and wellbeing at the forefront of their operations—from staff hires to building design to team structure.

“When a plane crashes, we don’t say this is confidential proprietary information the airline company owns. We consider this part of public safety. Hospitals should be held to the same standards,” Makary said.

Frederick van Pelt,  a doctor who works for the Chartis Group, a health-care consultancy, said another element of harm that is often overlooked is the number of severe patient injuries resulting from medical error.

“Some estimates would put this number at 40 times the death rate,” van Pelt said. “Again, this gets buried in the daily exposure that care providers have around patients who are suffering or in pain that is to be expected following procedures.”

Nashville Community Outreach

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Daily Marketing Services supports the non-profit Community Outreach group “Ashley’s Voice”. Ashley’s Voice provides Community Service information to the residents of Nashville and Middle Tennessee. Connecting the Dots to helping people find the free services they need. Services include Medical Services, Palliative Care, Hospice, Caregivers, Victims of Violent Crimes, Veterans Benefits, Grief Counseling and Medicaid. Information – 615-673-2221

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About Alive Hospice

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Alive Hospice Nashville TN

Alive Hospice is a nonprofit organization that provides compassionate end-of-life care, palliative care, bereavement support and community education. Founded in Middle Tennessee in 1975, Alive Hospice is accredited by The Joint Commission and has held its Gold Seal of Approval for many years. It is also accredited by the National Institute for Jewish Hospices.

Alive Hospice entered the Middle Tennessee landscape in November 1975, only one year after the founding of the first hospice program in the United States. At the time, and through grassroots movements, other hospices also began appearing across the country. Like the group of individuals gathered together by Alive Hospice’s founders, Dr. David Barton and the late Dr. John Flexner, what unified those movements was compassionate people committed to helping patients live in comfort until death occurred and families to grieve with support.

Alive Hospice was chartered in 1975 as a nonprofit organization dedicated with three core goals: providing comprehensive care for terminally ill patients and their families; offering support for grieving adults and children; and serving the community as a center for research and education.

Today, Alive Hospice serves more than 3,600 patients and their families annually (more than 430 daily) and provides grief support services for nearly 600 adults and children in Middle Tennessee in addition to training for tomorrow’s caregivers and education for the community at large.


Our mission

We provide loving care to people with life-threatening illnesses, support to their families

and service to the community in a spirit of enriching lives.

Our vision

To be recognized as expert providers of hospice care, palliative care, management of

advanced disease and grief support and to be the agency of choice for the provision of

these services.

To be recognized as innovators and leaders in all aspects of end-of-life resources.
To influence the perceptions within the community and among medical professionals so

that the end of life is accepted as a meaningful component of the human experience.

Our values

We believe death to be a natural part of life’s journey.

We believe in honesty and integrity in all we say and do.

We believe in compassion to those we serve and to each other.

We believe in respect and dignity for all.

We value competent knowledgeable staff motivated to achieve personal and

professional growth.

We believe in accountability to society, our community and each other.

We believe in responsible stewardship of the resources with which we have been entrusted.

We believe in the continuous pursuit of organizational excellence.

We believe in teamwork to achieve our vision and mission, and to support our values.

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As the only not-for-profit, community-based hospice in Middle Tennessee, Alive Hospice never turns anyone away, regardless of ability to pay, insurance status, race, religion, creed, color, sex, age, national origin, veteran status, sexual orientation, or disability.  We live our mission to provide loving care to people with life-threatening illnesses, support to their families, and service to the community in a spirit of enriching lives.

Nashville Victim Intervention Program

Victim Intervention Program (VIP)

“Putting Lives Back Together”

Want to ask questions about V.I.P ? Call Ashley’s Voice Outreach – 615-673-2221

When Someone You Know Is Touched By Crime

Victim Intervention Program logoWhenever a crime occurs, many people are affected — the victim, family members, friends and the entire community. The latest national statistics show that one out of four families in the United States will be touched by violent crime every year. Moved by the very real suffering of the people who make up these alarming figures, the Nashville Police Department developed the Victim Intervention Program as a way to help restore a sense of peace and balance to lives torn apart by violent crime.

The mission of the Victim Intervention Program of the Metropolitan Nashville Police Department is to provide mental health services and criminal justice system advocacy whenever individuals, families, and/or the community are affected by violent crime. All services are free, confidential, and provided in an environment which supports cultural diversity: with respect to race, religion, creed, and sexual orientation.

Help Is Here

The Victim Intervention Program (VIP) was first launched in 1975 as a crisis counseling and victim advocacy program. VIP was founded on the idea that anyone who endures a trauma as a result of a criminal act should be offered free and immediate crisis intervention and follow up counseling. Staffed by mental health professionals, VIP is available to victims, their families, and other individuals in crisis who come in contact with the police department. Anyone victimized by a crime who wants counseling or court advocacy is eligible for services. A victim’s decision about prosecution does not affect eligibility.

A Wide Range of Services

As the number of violent crimes has continued to climb, the Victim Intervention Program has added services to fill a growing need. A professional and compassionate staff provides:

Crisis Intervention

A 24-hour on call service to victims and citizens involved in crimes reported to the police department.

Counseling

Professional counseling services to individuals, family members and others affected by crime and traumatic police related events. Support groups for victim populations are provided at various times throughout the year and referral services when appropriate.

Critical Incedent Debriefings

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Advocacy

Guidance, support, clarification and explanation throughout police and court proceedings.

Consultation and Training

A series of lectures and workshops for community groups and professionals that help to increase awareness and understanding of victimization issues and crisis intervention.

Information and Referral

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It’s Your Call

The main goal of the Victim Intervention Program is to help individuals and their loved ones reclaim a sense of health and well-being in the aftermath of a crisis. If you or someone you know is the victim of a crime, please call the appropriate number listed below.

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Contact Numbers

Resource Phone number
Police Emergencies 911
Police Dispatcher (615) 862-8600
Sex Crimes Section (615) 862-7540
Youth Services Division (615) 862-7417
Domestic Violence Division (615) 880-3000
Domestic Violence Counselors (615) 880-3000
Victim Intervention Program (615) 862-7773
District Attorney’s Office (615) 862-5500
Victim Witness Services (615) 862-5500
TN Criminal Injury Compensation Program (615) 741-2734

Additional Resources