Conditions Treated by  Psychiatrists
Encino Psychiatrists Karen L. Vause and Ramzi Kiriakos
Encino Psychiatrists
16550 Ventura Blvd.
Suite 212
Encino, CA 91436
Direct Contact Information
Karen Vause, MD (818) 995-0640
Ramzi Kiriakos, MD (818) 881-8208
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Anxiety Disorders 

You may be anxious about something in the present or the future. You may not know why you feel anxious and cannot focus the anxiety on any specific event, person or situation. These symptoms are called: generalized anxiety disorder.

When a person has a phobia, the anxiety is so severe, that it is almost intolerable. It could be fear of open spaces (agoraphobia), fear of strangers (xenophobia), fear of heights, and fear of snakes, of cars, of dogs, of planes or travel. Such fears are very handicapping. Severe anxiety is also associated with social phobia (fears of leaving home and going to school, to college and sometimes going to graduate school) Post-traumatic stress disorder is a more elaborate form of fear associated with nightmares, sleep disturbances and panic attacks associated with the memories of the trauma. (physical trauma, emotional trauma, rape, sexual abuse, and physical abuse)

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Depression is a very common condition. In a lifetime, 15% of the population of America needs treatment for depression. The important features of depression are changes in the basic appetites. Activity may decrease and the person may have no energy to accomplish anything.  The drive for sleep may change. Some people may sleep long hours and not feel refreshed. Other suffers from lack of sleep and feels tired all the time. Appetite for food can also change. Some people lose weight by not eating and some people gain weight. The drive for sex also changes. Some people lose interest in sex and some people become hypersexual when depressed. Other common symptoms of depression are: pessimism, lack of happiness and joy. Work feels dull or boring. There is a feeling of impending doom. Fear of poverty and destitution can appear.  Excessive preoccupation with health and worry about becoming ill with the worst illness may appear.

In teenagers, depression takes a different form. It can appear as boredom or risk taking behavior, irritability and self- destructive behavior, complaints of headaches and stomach pains.

Fifty percent of women may suffer from some degree of premenstrual syndrome (PMS). They may have depression with mood swings, tearfulness and they may have insomnia.

Depression may occur during the last 3 months of pregnancy, but more commonly after the birth of the baby (Postpartum depression).

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Bipolar Disorder

Bipolar Disorder is a condition where the person has periods of depression alternating with periods of mania (excessive energy, activity level, lack of need for sleep, racing thoughts, paranoid thoughts). During episodes of mania, the person experiences increased self-confidence, self-importance and may spend excessive amounts of money. Some individuals may become hypersexual and become less selective in the choice of sexual partners.

Some people may have mostly depressive episodes and rarely have manic episodes. In some individuals, they may have a combination of manic and depressive symptoms at the same time.

In teenagers, the diagnosis of bipolar disorder is complex and involves follow up for a longer period of time. ADHD and bipolar disorder are often confused in teenagers, because their symptoms are very similar.

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Obsessive Compulsive Disorder (OCD)

Obsessive Compulsive Disorder is characterized by obsessions and compulsions. Obsessions are intrusive thoughts the individuals experience occurring against their will and causing them anxiety. Frequently these thoughts are unrealistic or irrational. Compulsions are repetitive behaviors and rituals such as: keeping things in order, hand washing, checking the door to be sure it is locked and hoarding behavior. They can also be mental acts like repetitive counting or repeating words silently.

Both obsessions and compulsions are perceived by the person experiencing them as unwanted and intrusive. They cause significant stress and can interfere with work, social activities and relationships with others. Obsessive-Compulsive disorder usually starts in the first 10 years of life or in adolescence. It can be a chronic recurring condition, which appears in episodes lasting several months to several years. When treated, the frequency and the severity of the obsessions and compulsions are reduced substantially and even disappear.

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Delusions are a symptom of psychosis. They are irrational beliefs, which cannot be explained by the person’s cultural background.  Hallucinations are perceptions that others do not experience. (hearing voices or seeing things that do not exist). Deterioration in functioning, strange behaviors, persistent rituals and decreased socialization can also be symptoms of psychosis.

In children, visual or auditory hallucinations can be a product of their imagination or due to anxiety, depression or immature cognitive development. Hallucinations and delusions in children are not usually an indication of serious mental illness. In most cases, children outgrow these symptoms.

In late adolescence, psychotic symptoms may appear for the first time. These symptoms can be due to drug abuse, severe depression, severe anxiety or bipolar disorder. In most cases they resolve. In some cases, they can persist and the individual develops schizophrenia. Prompt attention to these symptoms, usually leads to a better outcome and a shorter period of illness.

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Eating Disorders

This condition may appear as anorexia nervosa. More commonly occurring in females, the individual may see themselves with a distorted body image. They see themselves as much larger than they are. These individuals restrict their food intake, exercise vigorously and usually have very high energy. It is common to also find hormonal imbalances and menstruation may stop.

Bulimia has symptoms of binging and vomiting after eating more frequently at the end of the day. Laxatives are commonly used. Large weight fluctuations can occur. Both anorexia and bulimia can occur at the same time or in succession. This condition, left untreated can lead to death 15-25% of the time due to electrolyte imbalances and weakness of the heart (cardiac) muscles; occasionally rupture of the esophagus from forced vomiting.

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Attention Deficit Hyperactivity Disorder

Attention Deficit Hyperactivity Disorder (ADHD) is defined by the symptoms of inattention, distractibility, impulsivity and hyperactivity as compared to other children of the same age, social development and same gender. About 6% of school age children have this condition.

A common variant of this condition is Attention Deficit Disorder (ADD). In ADD, the hyperactivity is missing. It is more common in females. They may appear quiet and not troublesome or excessively talkative in school, but they are unable to concentrate and may have poor grades. This poor performance may lead to low self-esteem. Some children or adolescents with ADD or ADHD may have other associated disorders like, anxiety disorders, conduct disorders, learning disabilities, depression and bipolar disorder.

Without treatment, it becomes very difficult for the student to perform as expected at school. Their grades drop and they are often rejected by their peers. They may drift to substance abuse, compounding their problems.

The symptoms of ADHD, if untreated, can continue into adulthood, causing occupational and social problems. It can become difficult to meet the expectations of employers and maintain healthy relationships with significant others.

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Addictions and Substance Abuse Disorders

Addiction is defined as the loss of control over one’s behavior. Addictive behavior can be seen in shopping, eating, exercising, gambling, sexual activities, pornography, use of the internet, and playing video games. These addictions are treatable and can improve the quality of life.

Substance abuse disorders are defined as the use of mind altering drugs beyond recreational use to the point that the use causes physical, mental, occupational and recreational damage. Substance use can include over the counter drugs like alcohol, tobacco or caffeine. Illicit drugs like marijuana, stimulants, amphetamines, methamphetamines, cocaine, LSD, club drugs (ecstasy, GAB, Ketamine). Prescription drugs can also be abused. Common ones are antianxiety medications like Ambien, Restoril, Xanax, Ativan, and Valium. Early diagnosis and treatment of abuse will prevent the complications that can affect the productivity of the user and their quality of life.

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Sleep Problems

Sleep problems (Insomnia) can occur anytime during the sleep period.  Sleep onset insomnia is defined as trouble falling asleep. Insomnia during the middle of the night is called fitful sleep or middle insomnia. Early awakening or morning insomnia can also occur. The individual will feel tired and drained from each of these forms of insomnia.

Hypersomnia occurs when the individual sleeps for more hours than their normal requirement or much longer than the average person of their age does. Hypersomnia can occur in depression and other mental illnesses like schizophrenia, conversion reactions and substance abuse.

Night terrors occur frequently between the ages of 4 and 12 years old. The child may awaken in a panicked state, but are not completely awake. They respond to reassurance and the next morning they usually have no memory of the event. It usually is a harmless condition that can be treated easily.

Sleepwalking is more common in children and adolescents. They may look awake, eat, perform tasks and interact with others, but have no memory in the morning for the events. Sleepwalking is not usually associated with dangerous activities.

Separation Anxiety can also appear associated with sleep. Often the child or teenager is frightened to sleep in another room from the parents. Its appearance can depend on the level of stress in the life of the child.

Excessive bed wetting after age 5 can be a form of sleep disorder. At age 18 years old 1 1/2% of males will be dismissed from military service due to bedwetting. It is associated with tension and stress and responds well to medication. Before age 5, bedwetting is a common symptom and more common in males. It usually will disappear on its own.

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Adjustment Disorders

Adjustment disorders are significant emotional or behavioral symptoms that occur in response to an identifiable stress.  The symptoms usually occur within three months from the onset of the stress and are symptoms that are more than what would be anticipated by the type of stress the individual experienced. The person may have symptoms in their occupational or personal life. Adjustment disorder resolves within 6 months from the end of the stressor. Sometimes adjustment disorder will last longer than 6 months if the stressor is chronic (a physical disability) or has long lasting consequences (divorce).  Adjustment disorders can be accompanied by: a depressed mood, anxiety, a combination of the two, a disturbance of behavior or a mix of emotions and behavior.

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Post-Traumatic Stress Disorder (PTSD)

The most important characteristic of posttraumatic stress disorder is that the individual has been exposed to a traumatic event that the individual believes threatened their wellbeing with the potential for serious injury or death. The threat can also threaten their physical integrity or the physical integrity of others. The typical reaction to such experiences is a combination of intense fear, intense horror or a feeling of helplessness. Any reminder of the initial threat can trigger an intense reaction.

Common threats that can cause these symptoms are; physical abuse or injury or sexual abuse or injury such as rape.  In some cases severe emotional neglect may trigger similar reactions. The affected individual may relive the experience mentally and experience the associated unpleasant emotions. Nightmares can occur that relive the traumatic event.

Other new symptoms can also occur after a traumatic event: sleep problems including insomnia, nightmares, irritability, overreaction to irritants, inability to concentrate, suspiciousness of others and the environment, and an excessive startle response. Post traumatic disorder can interfere with the ability to study or work. It can interfere with personal relationships and intimacy and it can interfere with the ability to enjoy leisure and recreation.

As in other anxiety disorders, the sooner the treatment is initiated the faster the recovery and better the prognosis. In many cases psychotherapy alone will bring a remission. In other cases, the use of psychotropic medication may be required for a period of time.

Post-traumatic stress disorder may trigger other psychiatric condition such as: anxiety disorders with or without panic, major depressive disorder, obsessive compulsive disorder, somatization disorder with headache, stomach pain, and weight loss. All these complicating disorders can be effectively treated.

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