Dr. Deborah Perlick, PH.D

Caffeine, the active ingredient in coffee is addicting. Withdrawal symptoms include headache, tiredness and others. You can google caffeine to learn more. As I am not a medical doctor I can’t speak to the long term health effects of such relatively high doses of coffee, but several systems may be involved. Google or consult your PCP.

Clearly you are concerned about your sister and rightfully so. Have you shared your concerns with her in a nonjudgmental way? I would ask her why she feels she needs so much. I would also ask about her sleep quantity and quality. She may drink coffee in order to compensate for inadequate sleep. Since caffeine at such high doses impairs sleep and its many important restorative functions, one problem may be compounding another.
I would recommend that your sister get an evaluation at a sleep disorders center; if she has sleep problems she may be amenable to that, and they will almost certainly discharge caffeine with her. If she agrees go with her. People typically underreport consumption of coffee, alcohol and other substances.
Finally, is it possible your sister is depressed and us using caffeine, a stimulant to boost her mood?

While you might discuss this people are generally more receptive to seeking treatment for sleep than mental health problems, but the sleep clinic work up will evaluate this as well.

Have a calm and candid discussion with your wife and express your concern, both for her discomfort as well as your own desire for more frequent marital relations in a way that she can enjoy. Suggest consulting a couples or sex therapist.

Maybe. I am a psychoanalyst myself, and dream analysis can be very helpful. But first I’d want to know whether you have been exposed to extreme stress and have other symptoms of PTSD, bad dreams being a cardinal symptom. If so, I would seek psychiatric treatment for PTSD. But it could also be good (with that knowledge in hand) to consult a psychoanalyst. Be sure to meet with 2-3 and have a list of questions about his/her orientation. Analysis differs both in theory, how interactive the practitioner is, use of the couch, # of recommended sessions, and other factors. Have the initial consultation sitting up, even if the analyst recommends otherwise. Go with your gut, and pocketbook. Ask about reduced fees for second and perhaps even third sessions.

Behavioral, desensitization therapies are usually the most effective treatments for phobias such as this. Seek a consultation with a recommended behavior therapist. Ask your PCP.

Yes you and he should both go to counseling ASAP. Look for someone who works with families.

Depression related to bereavement, following the death of a loved one is very common. What to expect depends on the doctor’s evaluation of the symptoms you have been experiencing. Depending on your symptoms, he or she might prescribe anti-depressant medication to help relieve your discomfort, sessions with a therapist to help process and recover from your symptoms-or both. Research has shown that a combination is often most effective. But remember, you are in the driver’s seat. You can try both or one or the other. It is important to feel a good rapport with the doctor. It is not uncommon to consult with 2 or even 3 drs, unless you take an immediate liking to the first one. You should discuss treatment goals and expected length of treatment. Also, Google bereavement support groups - many of my people find the group format more congenial - it offer social support which is a known buffer against depression. Appropriate treatment can help you return to acceptance of the loss and restore your mental health.

Yes, you can help your wife, which will be helpful to you and your newborn as well. Post-partum depression, as you know, is not uncommon, and should not persist with good treatment. Find out if your wife's therapist is agreeable to you coming to sessions with her. This is a family matter, and discussing your concerns for your wife, for yourself, and for your newborn (if your wife is unable to bond with him, which is sometimes the case), openly and non-judgmentally, would be helpful. If your wife's therapist is not open to this--or doesn't have experience with couples' or family treatment, ask for a referral. It would be helpful for you to ask both your wife and her therapist how you can help. Taking action this way will go a long way towards letting your wife know that you are in this together. Also, if she is seeing a nonmedical practitioner, she should be evaluated for medication by a psycho-pharmacologist to help her recover from this common episode. It should not be needed after she has recovered, but the appropriateness should be explored. Many family members hold back from candid communication with their loved ones for fear they will say the wrong thing and make things worse. The partner then may interpret this as not caring or rejections. Don't be afraid to talk to your wife. But plan out what you will say, you want to nonjudgmentally express your concerns and ask her how you can help. She may be too depressed to answer, but she will take in your caring overture. Make sure you are in a calm frame of mind before discussing. You can always role play what you would say with a friend. Finally, if you are concerned that your child may be negatively impacted, do not hesitate to see your paediatrician, or get additional help in the household in the short-run, while she is recovering.

I would recommend you seek help from a family/couples' therapist. Also, there are many support groups for parents of children with autism. You should be able to google or find on National Institute of Mental Health website. You are not alone, and sharing experience with other couples with similar experience can be very helpful. Also, your wife should be evaluated for treatment for depression. She likely needs therapy and may need medication if the depression meets criteria for MDD or subsyndromal depression.

Yes it is a problem both psychologically, and likely financially. There is no official diagnosis for shopaholicism, and there may be differing underlying causes. First, it could be part of a manic or hypomanic episode, so this should be ruled out. Does she exhibit excesses in other areas, e.g., travel, pressured speech, elated mood? Alternatively, the behavior might fall into the obsessive-compulsive (OCD) anxiety disorder. Finally, if her only enjoyment is shopping, she is likely experiencing symptoms of depression. I highly recommend that you and your wife have a consultation with a marital or couples' therapist. Your wife may also benefit from medication, and I would raise this with the therapist, if he/she is a nonmedical practitioner, e.g., a psychologist or social worker.

Consult your primary care physician or family doctor. She will not outgrow it without help. If your PCP feels that her condition is serious, I think you should enroll her in an inpatient treatment program. She will be unhappy and angry, but there is no other way you can help her. Sometimes we have to make tough decisions about our loved ones. Good luck!

Consult a mental health practitioner. There may be a why you can uncover, but more importantly, biofeedback can help you get over this fear which is interfering with you life. You may also want to see someone in "insight oriented therapy" to view this sudden onset in the context of your life. But use biofeedback to extinguish it first.

Counseling might or might not be helpful. If your son is amenable, you might try it. However, if your son has no other mental health problems, then you might try reassuring him that this is not an uncommon problem and is probably temporary. I notice you characterize this a s "huge problem" whereas some degree of stage fright is not uncommon and is not part of a serious psychiatric disorder, presuming it's an isolated problem. I would be loving and supportive and assure him this is something that comes and goes. I would try to alleviate any pressure on him to perform, which will only exacerbate the problem.

There could be a lot of reasons for the behavior you describe. I would go to the National Institute of Mental Health website or google ADHD, A professional evaluation with a mental health provider is a good idea. There are many treatment approaches to ADHD if that is indeed what he has. But he should be professionally diagnosed to differentiate these symptoms from symptoms of another disorder.

There are medications that help reduce alcohol cravings, but our husband would have to want to quit. Alcoholism is a disease which is very hard to treat. I would consult a psychiatrist specializing in alcohol treatment, or to start with, a family or couples' therapist so the problem can be fully evaluated. The extent of the outbursts and the consequences need to be evaluated for safety reasons for both youand the children. If there has been even mild violence, don't wait--get help right away.

Your husband's sexual behavior is undoubtedly linked to his mental health and/or medical problems. But it may also be linked to family or couples' dynamics. I would recommend a thorough evaluation--perhaps a "second opinion" since he seems to be receiving treatment, for this problem, as well as a couples' and marital therapy evaluation for the two of you.

Yes taking him to a psychologist or psychiatrist would be a good start. Better yet, most major cities have sleep disorders specialty clinics, often affiliated with medical centers/schools.
Heart catheterization at age 9 is surely a traumatic experience, and it would be important for a mental health professional to explore his understanding of the procedure and his prognosis. Does he fear death, for example? Was the procedure successful? What is his understanding?

I would recommend biofeedback

Definitely, she should be evaluated for depression by a psychiatrist

Hi,

I recommend that you ask a psychopharmacologist, psychiatrist, or nurse practitioner, i.e., people who dispense medications and are more aware of adverse reactions.

However, I will offer some general input. First, the main and long-prevailing view of psychosis -- and manifestation of psychotic symptoms in particular, is the stress-vulnerability model. That you had a break at age 13-14 suggests you have an underlying probably genetic vulnerability to experience psychotic symptoms. The idea is that you may be doing relatively well, but if your nervous system is "stressed" which a substance such as nitrous oxide that alters one's mental state and perception of reality (i.e., such that pain is not experienced as pain), you are at higher risk for an adverse reaction in the form of psychotic symptoms.

I would be less concerned with the dental work (since nitrous oxide has a very short half-life, i.e., it only lasts a short time, than with your overall mental status and assessment of need for medication. You say you have not been able to get to a psychologist. Given your report of a break at age 13-14, all the data on early onset psychosis show that the prognosis is much, much better if you begin taking regular antipsychotic medication as soon as the symptoms manifest. So, I would very strongly encourage you to seek medication treatment as well as individual or group psychotherapy.