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However symptoms ulcer cheap leflunomide 20mg, reduction in 24 hour acid production is less than H2 blockers because of shorter duration of action (~3 hr symptoms syphilis discount leflunomide 10mg visa. Some patients may even complain of increased pain during the first week of therapy medicine keri hilson lyrics buy generic leflunomide 10 mg. Major problems in the use of misoprostol are-diarrhoea medications high blood pressure quality leflunomide 10mg, abdominal cramps symptoms bone cancer buy leflunomide 10 mg online, uterine bleeding medicine x topol 2015 generic 20mg leflunomide mastercard, abortion, and need for multiple daily doses. Magnesium trisilicate has low solubility and reactivity; 1 g can react with 10 mEq acid, but in clinical use only about 1 mEq is neutralized. About 5% of administered Mg is absorbed systemically-may cause problem if renal function is inadequate. All Mg salts have a laxative action by generating osmotically active MgCl2 in the stomach and through Mg2+ ion induced cholecystokinin release. On keeping it slowly polymerizes to variable extents into still less reactive forms. This may: (a) cause osteomalacia (b) be used therapeutically in hyperphosphatemia and phosphate stones. This is impaired in renal failure-aluminium toxicity (encephalopathy, osteoporosis) can occur. Magaldrate It is a hydrated complex of hydroxymagnesium aluminate that initially reacts rapidly with acid and releases alum. Such regimen often produced a syndrome characterized by headache, anorexia, weakness, abdominal discomfort, abnormal Ca deposits and renal stones due to concurrent hypercalcaemia and alkalosis. These may be superior to any single agent on the following accounts: (a) Fast (Mag. Healing efficacy has been found similar to cimetidine at 4 weeks, and may be superior in patients who continue to smoke. Antacids should not be taken with sucralfate because its polymerization is dependent on acidic pH. It has potential for inducing hypophosphatemia by binding phosphate ions in the intestine. This practice is considered to contribute to occurrence of pneumonia due to overgrowth of bacteria in the stomach. Intragastric sucralfate provides effective prophylaxis of stress ulcers without acid suppression, and is an alternative to i. Interactions Sucralfate adsorbs many drugs and interferes with the absorption of tetracyclines, fluoroquinolones, cimetidine, phenytoin and digoxin. Drug interactions By raising gastric pH and by forming complexes, the non-absorbable antacids decrease the absorption of many drugs, especially tetracyclines, iron salts, fluoroquinolones, ketoconazole, H2 blockers, diazepam, phenothiazines, indomethacin, phenytoin, isoniazid, ethambutol and nitrofurantoin. Uses Antacids are no longer used for healing peptic ulcer, because they are needed in large and frequent doses, are inconvenient, can cause acid rebound and bowel upset, afford little nocturnal protection and have poor patient acceptability. Antacids are now employed only for intercurrent pain relief and acidity, mostly self-prescribed by the patients as over the counter preparations. Gastroesophageal reflux Antacids afford faster symptom relief than drugs which inhibit acid secretion, but do not provide sustained benefit. Sucralfate polymerizes at pH < 4 by cross linking of molecules, assuming a sticky gel-like consistency. It preferentially and strongly adheres to ulcer base, especially duodenal ulcer; has been seen endoscopically to remain there for ~ 6 hours. Surface proteins at ulcer base are precipitated, together with which it acts as a physical barrier preventing acid, pepsin and bile from coming in contact with the ulcer base. Sucralfate has no acid neutralizing action, but delays gastric emptying-its own stay in stomach is prolonged. It attaches to the surface epithelium beneath the mucus, has high urease activity- produces ammonia which maintains a neutral microenvironment around the bacteria, and promotes back diffusion of H+ ions. Resistance develops rapidly, especially to metronidazole/ tinidazole and clarithromycin, but amoxicillin resistance is infrequent. In tropical countries, metronidazole resistance is more common than clarithromycin resistance. This is a higher degree of round-theclock acid suppression than is needed for duodenal ulcer healing or for reflux esophagitis. One week regimens are adequate for many patients, but 2 week regimens achieve higher (upto 96%) eradication rates, though compliance is often poor due to side effects. For patients who have, in the near past, received a nitroimidazole (for other infections) or a macrolide antibiotic, metronidazole or clarithromycin, as the case may be, should be excluded. All regimens are complex and expensive, side effects are frequent and compliance is poor. Repeated reflux of acid gastric contents into lower 1/3rd of esophagus causes esophagitis, erosions, ulcers, pain on swallowing, dysphagia, strictures, and increases the risk of esophageal carcinoma. Hormonal: gastrin increases, progesterone decreases (reflux is common in pregnancy). Stage 2: > 3 episodes/week of moderately severe symptoms, nocturnal awakening due to regurgitation, esophagitis present or absent. Stage 3: Daily/chronic symptoms, disturbed sleep, esophagitis/erosions/stricture/extraesophageal symptoms like laryngitis, hoarseness, dry cough, asthma. Dietary and other lifestyle measures (light early dinner, raising head end of bed, weight reduction and avoidance of precipitating factors) must be taken. Intragastric pH >4 maintained for ~18 hr/day is considered optimal for healing of esophagitis. Prolonged (often indefinite) therapy is required in chronic cases because symptoms recur a few days after drug stoppage. Antacids are no longer employed for healing of esophagitis, which they are incapable of. Sodium alginate It forms a thick frothy layer which floats on the gastric contents like a raft may prevent contact of acid with esophageal mucosa. Combination of alginate with antacids may be used in place of antacids alone, but real benefit is marginal. Alginate floats on gastric contents and prevents contact of esophageal mucosa with gastric acid 5. Upper gastrointestinal endoscopy reveals an ulcer measuring 12 mm X 18 mm in the 1st part of duodenum. His medical records show that he suffered similar episode of pain about 9 months ago. Subsequently, nearly 3 months back, he suffered from loose motions and abdominal pain which was treated with a 5 day course of metronidazole + norfloxacin. The vestibular apparatus generates impulses when body is rotated or equilibrium is disturbed or when ototoxic drugs act. These impulses reach the vomiting centre mainly relayed from the cerebellum and utilize muscarinic as well as H1 receptors. Various unpleasant sensory stimuli such as bad odour, ghastly sight, severe pain as well as fear, recall of an obnoxious event, anticipation of an emetic stimulus (repeat dose of cisplatin) cause nausea and vomiting through higher centres. In the emetic response fundus and body of stomach, esophageal sphincter and esophagus relax, glottis closes, while duodenum and pyloric stomach contract in a retrograde manner. Rhythmic contractions of diaphragm and abdominal muscles then compress the stomach and evacuate its contents via the mouth. Oral use of apomorphine is not recommended because the emetic dose is larger, slow to act and rather inconsistent in action. Apomorphine has a therapeutic effect in parkinsonism, but is not used due to side effects. It is less dependable than parenteral apomorphine and takes 15 min or more for the effect, but is safer; has been used as a household remedy. All emetics are contraindicated in: (a) Corrosive (acid, alkali) poisoning: risk of perforation and further injury to esophageal mucosa. H1 antihistaminics Promethazine, Diphenhydramine, Dimenhydrinate, Doxylamine, Meclozine (Meclizine), Cinnarizine. Neuroleptics Chlorpromazine, (D2 blockers) Triflupromazine, Prochlorperazine, Haloperidol, etc. However, it has a brief duration of action; produces sedation, dry mouth and other anticholinergic side effects; suitable only for short brisk journies. Antiemetic action is exerted probably by blocking conduction of nerve impulses across a cholinergic link in the pathway leading from the vestibular apparatus to the vomiting centre and has poor efficacy in vomiting of other etiologies. Applied behind the pinna, it suppresses motion sickness while producing only mild side effects. Promethazine is a phenothiazine; has weak central antidopaminergic action as well. Doxylamine It is a sedative H1 antihistaminic with prominent anticholinergic activity. After over 2 decades of worldwide use of a combination product of doxylamine for morning sickness, some reports of foetal malformation appeared and the product was withdrawn in 1981. The product remained suspended in these countries, probably to avoid litigation, but not due to safety or efficacy concerns. Recently, the American College of Obstetricians and Gynaecologists have recommended a combination of doxylamine + pyridoxine as first line treatment of morning sickness. They are useful mainly in motion sickness and to a lesser extent in morning sickness, postoperative and some other forms of vomiting. Their antiemetic effect appears to be based on anticholinergic, antihistaminic, weak antidopaminergic and sedative properties. Meclozine (meclizine) It is less sedative and longer-acting; protects against sea sickness for nearly 24 hours. It probably acts by inhibiting influx of Ca2+ from endolymph into the vestibular sensory cells which mediates labyrinthine reflexes. Once sickness has started, it is more difficult to control; higher doses/ parenteral administration may be needed. Morning sickness the antihistaminics are suspected to have teratogenic potential, but there is no conclusive proof. Most cases of morning sickness can be managed by reassurance and dietary adjustment. If an antiemetic has to be used, dicyclomine, promethazine, prochlorperazine or metoclopramide may be prescribed in low doses. Neuroleptics are less effective in motion sickness: the vestibular pathway does not involve dopaminergic link. Acute muscle dystonia may occur after a single dose, especially in children and girls. These agents should not be administered until the cause of vomiting has been diagnosed; otherwise specific treatment of conditions like intestinal obstruction, appendicitis, etc. Prochlorperazine this D2 blocking phenothiazine is a labyrinthine suppressant, has selective antivertigo and antiemetic actions. Muscle dystonia and other extrapyramidal side effects are the most important limiting features. This excludes traditional cholinomimetics and anti-ChEs which produce tonic and largely uncoordinated contraction. Metoclopramide Metoclopramide, a substituted benzamide, is chemically related to procainamide, but has no pharmacological similarity with it. This action is independent of vagal innervation, but is stronger when vagus is intact. It also increases intestinal peristalsis to some extent, but has no significant action on colonic motility and gastric secretion. Mechanism of action: Metoclopramide acts through both dopaminergic and serotonergic receptors (see. Pharmacokinetics Metoclopramide is rapidly absorbed orally, enters brain, crosses placenta and is secreted in milk. Sedation, dizziness, loose stools, muscle dystonias (especially in children) are the main side effects. Long-term use can cause parkinsonism, galactorrhoea and gynaecomastia, but it should not be used to augment lactation. Though the amount secreted in milk is small, but suckling infant may develop loose motions, dystonia, myoclonus. Though no teratogenic effects have been reported, metoclopramide should be used for morning sickness only when not controlled by other measures.
As existential courage medicine used to induce labor generic leflunomide 20mg with mastercard, hardiness (1) is not considered inborn medications not to take after gastric bypass discount leflunomide 20mg with visa, but rather is learned through encouragement to struggle with stresses symptoms stomach cancer generic 20 mg leflunomide fast delivery, and (2) leads to resiliency medicine allergies order 20 mg leflunomide visa, such that there is not only survival but also enhancement of performance and health under stress holistic medicine order 10mg leflunomide with mastercard. In this research treatment of shingles purchase leflunomide 10 mg free shipping, a wide range of stressful contexts have been used, from life-threatening events of military combat, through the culture shock of immigration or work missions abroad, to everyday work, school, or sports pressures and demands. Across such contexts, hardiness leads to enhanced performance, leadership, conduct, morale, stamina, and health. In adulthood, the personality type resulting from regularly choosing the future is called authenticity, or individualism. Characteristics of this type include defining (1) oneself as someone who can, through decision making and interpretation, influence ongoing experiencing, and (2) society as formed out of the actions of individuals and, therefore, changeable by them. Authentic persons can learn by failures, and their lifestyle shows unity and innovativeness. Their biological and social experiencing shows subtlety, taste, intimacy, and love. Because of hardiness, doubt (ontological anxiety) is regarded as a natural concomitant of creating meaning and does not undermine the decisionmaking process. Although authentic people can fall into self-deception, they tend to correct this rapidly through their commitment to self-scrutiny and reflectiveness. In contrast, the personality type resulting from regularly choosing the past is the conformist. This type is characterized by defining (1) oneself as nothing more than a player of social roles, and (2) society as an unchangeable, incontrovertible source of meaning and rules. Expression of symbolization, imagination, and judgment is inhibited, leading to stereotypic, fragmentary functioning. Biological and social experiencing is unsubtle and contractual, rather than discerning and intimate. Conformists feel worthless and insecure because of the buildup of ontological guilt through choosing the past rather than the future. Their worldview emphasizes materialism and pragmatism, and they deny and persist in failures rather than learning from them. These two personality types refer to everyday functioning, rather than expressions of psychopathology. These major stresses are of three sorts, namely, experiencing significant social upheavals, lifethreatening circumstances, and unavoidable and insistent indications of personal superficiality. Conformists are especially vulnerable to these major stresses, whereas individualists tend to use them as springboards to further growth and development. The most extreme form of psychopathology resulting from the breakdown of the conformist lifestyle in reaction to major stresses is vegetativeness, which is characterized by the inability to believe in the value of anything one can do or imagine doing, constant boredom, and actions that are listless and aimless. A less extreme form of existential psychopathology is nihilism, characterized by the sole cogency of paradoxical (or anti) meaning, feelings of anger and disgust, and the pursuit of hurtful actions against any positive meaning and those who believe in it. Least extreme is the psychopathology of adventurousness, wherein only extreme or dangerous activities retain any meaningfulness, and there are resulting wide swings in mood and action as the person tries to avoid everyday circumstances and pursue more dramatic experiences. Two distinct purposes can be identified for such interviews: information gathering and information giving. This is also an opportunity for the employer to make certain that the employee has checked in all keys and other company property. Maintaining good relations with past employees is a more recent consideration in the literature on the exit interview, but in an era of declining employee loyalty to organizations, it is always possible to have an employee work in or around the organization again, either as a rehire or as an employee of an organization that does business with the former employer. Research has shown that these interviews and a later follow-up questionnaire gave different reasons for leaving, with questionnaire results being more negative toward the company. The same general results have been found in a study comparing exit interviews to results obtained by an interview with an outside consultant. At the actual time of departure, the employee may well not give accurate or honest information, because he or she is emotionally elsewhere-the new job. In order for them to be effective, the organization should carefully consider the information to be gathered, who should be doing the interview, how that interviewer should be prepared for the task, and what kinds of organizational support are required (Finney, 1999). Interpretation of any information obtained should carefully consider biases, but ignoring the problem altogether is not a generally preferable alternative. Possession is said to occur when the Devil enters and takes over the physical and mental faculties of the victim. This ritual, described in the Ritual Romanum in 1614 and still accepted as the official procedure, was directed at the Devil or "unclean spirit" assumed to inhabit the body of the possessed. One of the most popular and dramatic explanations of disordered behavior, demonic possession was mentioned only once in the Old Testament of the Bible. The possessed person may be either an innocent victim or targeted by the Devil because of previous evil behavior. Explanations relying on demonic possession have been reported in most countries at various times throughout history. During the early Christian era, exorcistic skills were considered to be a special talent. Later, during the middle of the third century, the Catholic Church created the position of exorcist. The exorcist was typically a minor cleric who exhibited the necessary piety, judgment, and character for the position. The Devil was subsequently attacked, insulted, and commanded to leave the body of the possessed. Recovery was assumed to have occurred when the person returned to a prepossessed state. Contemporary Roman Catholic belief distinguishes between major and minor exorcisms, depending upon the degree of possession. A brief exorcistic rite is often included in the baptismal ceremony of the Catholic Church. The new guidelines encourage making a thorough medical and psychological evaluation before recommending an exorcism. The psychological literature regarding exorcisms is limited primarily to case studies and anecdotal reports. Experiential therapy comprises a method for applying theory, and in this way it is metatheoretical. Experiencing is seen as the entry point to processes leading to personality change and psychological improvement. It is the primary navigational aid regarding a productive course of therapeutic interaction. Therapeutic moves (empathic response, interpretation, suggestion, question, confrontation, chair work, psychoeducation, etc. When experiencing becomes more open, emotional, complex, intricate, sensation based, and accurately expressible in words or other symbols, the move has had a desirable experiential effect. The experiential therapist can thereby quickly correct unhelpful moves, rather than persisting with faulty plans and generating problems in the therapeutic relationship. References to the experiential way of doing therapy are found in the works of many major early psychotherapists. Carl Rogers developed a method of psychotherapy in which client experiencing is centrally relied upon to guide the course of therapy, as counterpoint to the widely held belief that the doctor should guide the therapy. Malone may have been the first to use the term experiential psychotherapy to describe their approach. Eugene Gendlin, who worked closely with Rogers, developed the philosophical basis that makes systematic the experiential method. This is the tendency, found in any living organism, to behave in ways that fulfill and further perfect the capacities, according to its nature, of the organism as a whole. Experiencing is considered inherently life-promoting for both the individual and the social group, and generally more so with more awareness. The actualization of healthy potentials implicit in experiencing does not depend only on the individual, but is seen as highly dependent on the interpersonal (and other environmental) conditions with which the person interacts currently and with which the person has interacted historically. Certain patterns of relating to experiencing (or avoiding it) may result; these patterns shape the positive potential of experiencing into negative and ineffective forms of expression. Therapy, then, is very much about changing problematic attitudes toward experiencing. The therapeutic relationship establishes a safe climate within which, aided by the expertise of the therapist, the client can better articulate, express, and live out experiencing. The process of doing this takes time and involves many little successes before major and lasting change is accomplished. When something in experiencing that has been poorly symbolized is finally approached with an empathic attitude that results in more accurate symbolization, there is a bodily sigh of relief known as a felt shift. When a person regularly and reliably relates to experiencing so as to get these felt shifts, he or she is said to have a high level of experiencing. Many studies have found psychological benefits associated with high levels of experiencing. Thus many different approaches to helping the client are usable, limited only by what the therapist knows and can work with skillfully. Therapist and client both rely on responses from their body senses to the steps of therapeutic interaction in order to guide the way toward improvement that is both uniquely right for the client and in the theoretically and interpersonally desirable direction. Boring (1954) developed three meanings in psychology for the word control: (1) a check, in the sense of verification; (2) a restraint, in the sense of maintaining constancy; and (3) a guide or direction. Since people not in psychological experiments do learn, mature, and change from experiences in daily living, experimental control groups for comparison purposes are valuable, almost necessary, in most of psychology in order to have a context in which to interpret meaningful research findings. In addition, the almost inherent lack of ability to measure with precision in psychology has a decided influence on changes in observations over time. The research context in which the observations are made, the possible reaction of participants to the somewhat unusual conditions of the psychological research study, and motivational differences between the experimental and control groups can also reduce the quality of the comparisons needed for interpretation. These concerns are also the subject of experimental design and research methodology. Early attempts to develop experimental controls in psychological research included attempting to hold all variables constant except those being deliberately manipulated. This is difficult to do with human participants; it can be done only within rather broad limits, and it often makes the experimental conditions so artificial that generalizations to the everyday psychological world are difficult. Participants in psychological research are sometimes used as their own experimental controls; they are observed, an experimental condition is applied, and then they are observed again. This method is useful if a large number of observations are made prior to and after the experimental condition. When the experimental treatment can be applied and withdrawn over time-again with many observations made in each interval between conditions-the experimental control is better. If a stable change can be observed after each of the conditions, then good comparisons and interpretations can be made. In psychology, experimenters often match participants on one or more variables or group participants by characteristics or prior conditions. If the groups are matched on variables such as gender, residential area, or other accurately observed characteristics, the method is acceptable. If the matching or grouping can be followed by a chance allocation of participants (i. Sometimes statistical adjustments are attempted as a control method in psychological research. Unless accompanied by allocation of participants to experimental and control groups by chance, these methods often are less than adequate to obtain good research comparisons. During this century psychology has developed a rather mature, rigorous, and sometimes elaborate set of experimental controls for its research methodology, taking into account the special characteristics and problems associated with human participants and psychological variables. Its research methodology is still growing, however, and undoubtedly more and better experimental controls will be developed. True experiments involve the careful observation of the effects of one or more variables (independent variables) on one or more outcome variables (dependent variables) under carefully controlled conditions with subjects randomly assigned to treatments. For example, a study of the effect of adrenaline on activity level could be done by randomly assigning subjects to an experimental group (who receive adrenaline) or to a control group (who receive an inert substance, a placebo) and then recording their activity levels in an objective way. More levels of the independent variable could be used; for example, subjects might be given 0-mg, 3-mg, 10-mg, or 25-mg doses of adrenaline, so that the independent variable would have four levels. The experiment could be made more complex by adding additional independent or dependent variables. For example, time of day might be used as a second independent variable with three levels (morning, afternoon, evening), so that subjects might be randomly assigned to any of 12 different conditions (0 mg in the morning, 10 mg in the evening, etc. It is clear that the number of subjects required for more complex designs would be greater than for simpler designs because the number of subjects under each condition. Although other scientific methods exist, the true experiment is the only method that allows researchers to make conclusions about cause-and-effect relationships. In the simple experiment with one independent variable (drug dosage) with two levels, if subjects in both the experimental and the control group are treated in identical ways (except for the independent variable), and if subjects are randomly assigned to treatment conditions (drug vs. To infer causation, it is essential that the subject groups not differ with respect to anything other than the independent variable. For example, if only men were in the experimental group and only women were in the control group, observed differences might reflect gender rather than dosage differences. For example, a researcher with gender, ethnicity, political party, frequency of marijuana use, or educational level as an independent variable cannot randomly assign subjects to levels of independent variables. The study of such variables cannot make use of a true experiment, but they are frequently studied in quasi-experiments. Interpretation of results for nonmanipulated variables is complicated, since various additional variables generally are confounded with them. For example, social class, intelligence, and a number of personality variables are confounded with educational level, so observed difference between high school and college graduates may reflect these confounded variables rather than the effect of education. One way to facilitate interpretation of nonmanipulated independent variables is to match subjects on relevant confounding variables.
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This is similar to what is seen in animals with selective brain-stem lesions described previously treatment zoster ophthalmicus cheap 10 mg leflunomide with amex. Despite many decades of research medicine vocabulary purchase leflunomide 10mg on-line, the precise function of sleep is not certain (Reiser medications causing thrombocytopenia leflunomide 20 mg with mastercard, 2001) medication 3 checks generic 20 mg leflunomide with mastercard. Sleep-onset rapid eye movement periods in neuropsychiatric disorders: Implications for the pathophysiology of psychosis medications 563 purchase leflunomide 20 mg fast delivery. While many of these errors are idiosyncratic symptoms 0f pneumonia discount 10mg leflunomide otc, the following types of rating errors are common across many situations. The leniency error occurs when average ratings tend to be higher than the midpoint of a scale because of pressure on the rater to rate subordinates high, a perception that subordinate rating reflects that of the rater, and the prescreening of students or subordinates before evaluation time. The central tendency error occurs when the rater checks the midpoint of the scale continuously. Halo effect implies a positive generalization to other traits; devil effect implies a negative one. The sequential error occurs when the particular order of traits has a special effect on the following ones, such as the halo effect. The logical error occurs when a rater correlates specific traits in a manner believed to be consistent with the performance on others. The recency error occurs when an incident close in time to the rating has a greater effect on the rater than it would have had it happened much earlier. This is especially a problem when the incident is an emotional one such as a grievance, accident, or fight. Furthermore, ratings that differ in time may accurately reflect a change in behavior even though this difference would demonstrate an artificial lack of reliability. High interrater reliability is a useful tool if both raters are knowledgeable about the individual being rated. The problem caused by rater error for rating validity is the most serious problem of all because ratings are frequently used when a more objective measure cannot be developed. To the extent that rater errors exist and are not statistically adjusted out, the validity of the ratings is seriously contaminated. These include training for raters, statistical adjustment for systematic differences between raters. Introduced by Francis Galton in the nineteenth century, rating scales have been widely employed in business, industry, educational institutions, and other organizational contexts to evaluate various behavioral and personality characteristics. Types of Rating Scales On a numerical rating scale, the rater assigns to the person being rated (ratee) one of several numbers corresponding to particular descriptions of the characteristic being rated. A simple example of a numerical scale for rating a person on friendliness is to assign an integer from 0 to 4, depending on how friendly the person is perceived as being. Another widely used rating method is a graphic rating scale, in which the rater checks the point on the line corresponding to the appropriate description of the ratee. On a standard rating scale, the rater supplies, or is supplied with, a set of standards against which ratees are to be compared. A man-to-man scale is constructed for rating individuals on a given trait, such as leadership ability, by having the rater think of five people who fall at different points along a hypothetical continuum of leadership ability. Then the rater compares each person to be rated with these five individuals and indicates which of them the ratee is most like in leadership ability. On a forced-choice rating scale, raters are presented with two or more descriptions and are asked to indicate the one that best characterizes the ratee. If there are three or more descriptions, raters also may be told to indicate which description is least characteristic of the ratee. Ellis traces the origins of his insight about human upset back nearly 200 years to the writing of the later Stoic, Epictetus. Marcus Aurelius, emperor of Rome, wrote in his Meditations, "It is not this thing which disturbs you, but your own judgment about it. Biological Origins of Personality the lowest organisms may show complex, instinctive behavior in the apparent absence of learning. Such behaviors tend to be found in all members of a species and are performed in fixed stereotypical ways. For the most part, humans lack these fixed, universal behaviors, instead possessing a highly evolved capacity to acquire behaviors through learning and to retain them through habit. What is preprogrammed in humans is the clear predisposition to learn and form habits. Children easily learn the desire to be loved rather than hated and readily prefer satisfaction of a want to its frustration. Among human predispositions with unfortunate consequences are tendencies to acquire desires for obviously hurtful things, to shed even grotesquely inappropriate habits only with great difficulty, and to think in terms of absolutes that distort even relatively accurate beliefs into disturbingly inaccurate ones. Errors in Rating An advantage of the forced-choice rating method is that it does a better job than other types of scales in controlling for certain errors in rating. Two errors are giving ratings that are higher than justified (leniency error) or lower than justified (severity error). Other errors are checking the average or middle category too often (central tendency error) and rating an individual highly on a certain characteristic or behavior simply because he or she rates highly in other areas (halo effect). Raters may also make the contrast error of rating a person higher than justified merely because a preceding ratee was very low or rating a person lower than justified because a preceding ratee was very high. Thus, while people tend by nature to be happiest when their interpersonal relationships are best, most emotional disturbances result from caring too much about the opinions of others and from holding catastrophic expectations about the consequences of breached relationships. It emphasizes the role of unrealistic expectations and irrational beliefs in human misery. People tend to be happier and more effective when they reduce their natural human tendency toward irrational self-reindoctrination and begin to think and behave more rationally. The therapist seeks to reeducate the client and to break down old patterns and establish new ones, using logic, reason, confrontation, exhortation teaching, prescription, role-playing, behavioral assignments and more. The central technique is disputation, a logicoempirical analysis through which irrational beliefs are identified and challenged. Ellis has said that effective psychotherapy blends full tolerance of the client as an individual with a ruthless, hardheaded campaign against his self-defeating ideas, traits, and performances. The second insight is that these irrational, magical beliefs remain in force only because of the continued mixed-up thinking and foolish behaviors that reinforce them. People remain disturbed for only so long as they continue to reindoctrinate themselves. Role-playing, for example, may elicit actual occurrences of irrational beliefs, upsets and behavioral tendencies, which can then be logically analyzed and corrected. Emotive methods are also employed to evoke feelings and reactions leading directly to changes in attitudes or values. Perfectionistic clients may be instructed to fail deliberately at some real task to observe the noncatastrophic nature of the consequences. Shy persons may be required to take progressively larger risks in social settings to learn that failure is neither inevitable nor intolerable. Once clients begin to behave in ways that challenge their major behavioral beliefs, they are encouraged to continue to do so because actions may in fact speak louder than words in maintaining positive change. Ellis observed that people are rarely able to keep disbelieving their profoundly self-defeating beliefs unless they persistently act against them. Regardless of the methods used, it remains constant: to help clients to foster what Ellis described as their natural human tendencies to gain more individuality, freedom of choice, and enjoyment and to help them discipline themselves against their natural human tendencies to be conforming, suggestible, and unenjoying. Poor phoneme awareness is believed to make the major contribution to this difficulty learning to read and spell. Phoneme awareness refers to the ability to detect, manipulate, and order the individual sounds (phonemes) within words. Difficulty with this process makes learning the alphabetic code more difficult, leading to the reading and spelling difficulties that are the hallmark of dyslexia. A good evaluation for dyslexia has several major components and taps several sources of information. These components include a careful history, quantitative test results, and a qualitative analysis of errors. Early developmental histories of children with dyslexia are typically normal, although there may be some slight speech delay or articulation difficulties. In mildly affected or quite bright children who are educationally advantaged, there may be little concern about progress in kindergarten. Other children show striking difficulties with learning the alphabet in spite of much extra help. Difficulty with learning to read and spell is typically noted in the early grades. Difficulty with learning the multiplication tables is a very common problem and is related to difficulties with rote verbal memory that are typically seen in children with dyslexia. For older children, there are often concerns about poor spelling and slow, effortful reading, which often leads to poorer performance on timed tests. A typical assessment battery might take approximately 3 to 4 hours or even more, depending on whether there are other related questions. A description of specific tests in a sample battery follows, but other tests that assess the same functions and skills could be substituted. The important issue is that the various functions and skills described be evaluated. Specifically, scores are often somewhat weaker on the Arithmetic and Digit Span subtests, which both require verbal working memory among other capacities. On the Performance scale, the Coding subtest, which requires learning a new symbolic code and good visuomotor skill, is often somewhat weak. Qualitatively, word-finding difficulties are often evident on the Picture Completion subtest as the child may correctly locate the missing element in the picture but be unable to provide the name quickly. Likewise, on the Information subtest, it is not uncommon for the child to make errors on relatively easier items where specific names of people or months are required, even though more difficult items that are more conceptual are subsequently passed. After general intellectual ability, another major function to be assessed is phonological processing. The Lindamood Test of Auditory Conceptualization is another useful test in this category. In addition to testing single-word and nonsense-word reading, it is also important to test contextual reading in a way that takes time into account. It is not unusual for a child with dyslexia to obtain a score close to grade level on an untimed test of reading; their genuine deficit may not become readily apparent until the rate and accuracy of their reading are taken into account. Another test that taps reading rate is the Test of Word Reading Efficiency, in which the child reads lists of sight words and nonsense words in a specified time, and the score is based on the number of words which the child is able to read. In addition to the quantitative scores on these reading tests, a qualitative analysis of errors should be made, which can be helpful in guiding remedial efforts. In assessing spelling, it is important that a dictation-type test (rather than multiple choice) be used so that a qualitative analysis of the types of spelling errors can also be made. Children with dyslexia are particularly prone to dysphonetic errors (errors that indicate poor tracking of the sound sequence in the word). The evaluation should conclude with a feedback conference with parents at which results are carefully explained and recommendations made. Because the most important goal of an assessment for dyslexia is to provide guidance about appropriate interventions, the information from the evaluation should be summarized in a written report. Interventions can be thought of in terms of two broad categories: remediation and compensation. A good remedial program also includes considerable practice in contextual reading, using techniques such as guided oral repetitive reading to address the difficulties children with dyslexia have with achieving silent reading. Finally, it should be emphasized that the knowledgeable assessment of dyslexia is particularly important because so much can be done to help the child with dyslexia when this condition is correctly identified and remediated. An important aim in neurobiology is to identify the neuronal circuits underlying these rhythmic behaviors and to understand how the rhythmic motor patterns arise from neuronal connections and neuronal properties (Friesen & Stent, 1978). The term reciprocal inhibition refers to a model or concept that was formulated at the beginning of the previous century by Brown (1911) to explain the neuronal origins of rhythmic walking movements. This first explanation for how a circuit of neurons can cause alternating limb movements was formulated long before specific neuronal circuits were identified. At that time, experiments by several researchers, including Brown, demonstrated that the stepping movements of animal limbs could be elicited even in deafferented mammalian preparations. Because of the synaptic inhibitory connections, only one of the two inhibitory neurons (or perhaps pools of inhibitory neurons) can be active at any one time. With appropriate connections to motor neurons, output of these inhibitory neurons can control the activity of first flexor and then extensor motor neurons. Thus, the alternating neuronal patterns generated by the central circuit can drive the appropriate impulse patterns needed to command rhythmic flexion and extension, and hence to forward and backward movements of individual limbs (Brown, 1911). Three neurons, one excitatory (E) and two inhibitory (I1 and I2) are interconnected by excitatory (- ) and inhibitory (-o) synapses. Upper traces in each part show the activity of presynaptic neurons; lower traces illustrate the effects on postsynaptic cells. Excitatory drive to I1 generates an initially large, then declining, hyperpolarization in I2. When neuron I1 is hyperpolarized briefly, the termination of the inhibition is followed by an excitatory response whereby the membrane potential overshoots rest to generate a burst of impulses. Excitatory drive to neuron I1 elicits a train of impulses whose frequency declines with time. The effect on neuron I2 is hyperpolarization, whose amplitude gradually decreases. D designates delayed onset of excitation, which might either be synaptic or cellular.
Thus medicine technology leflunomide 10mg with mastercard, strategies are called for that can result in a high level of motivational readiness (including reduction of avoidance motivation and reactance) so that a student is mobilized to participate and learn symptoms testicular cancer generic 10 mg leflunomide. Second treatment neutropenia order 20 mg leflunomide with visa, motivation is a key ongoing process concern; processes must elicit medicine woman strain order leflunomide 10 mg without prescription, enhance medicine kit for babies generic 10mg leflunomide otc, and maintain motivation so that the student stays mobilized symptoms for hiv buy leflunomide 20 mg line. For instance, a student may value a specific outcome but may not be motivated to pursue certain processes for obtaining it or may be motivated at the beginning of an activity but not maintain that motivation. Third, it is necessary to avoid or at least minimize conditions likely to produce avoidance and reactance. Finally, development of intrinsic motivation is an outcome concern (Deci & Ryan, 1985). Environmental Factors Facilitating school learning by focusing on the environmental side of the person-environment match has two facets: (1) directly enhancing facilitative factors and (2) minimizing extrinsic factors that are barriers to learning. Research of relevance to these matters comes from ecological and environmental psychology, systems theory and organizational research, and the study of social and community interventions. Examples of key variables include setting and context characteristics associated with school learning; characteristics of persons in the setting; and task, process, and outcome characteristics. Because teachers can affect only a relatively small segment of the physical environment and social context in which school learning occurs, increasing attention is being given to analyses of school-wide factors and combinations of school, home, and community variables. The behavior is apparent in school-age youth who miss entire school days, skip classes, or arrive to school late (excluding legitimate absences). However, the behavior also refers to youth who show severe behavior problems in the morning to try to stay home from school as well as youth who attend school with great dread. School refusal behavior affects up to 28% of youth at some time in their lives and can lead to several negative consequences. In the short term, for example, school refusal behavior may lead to family conflict, legal trouble, declining grades, social alienation, and distress. In the long term, extensive school refusal behavior may lead to delinquency, school dropout, and occupational, economic, and social problems in adulthood. For example, these youth often have general and social anxiety, fear, depression, somatic complaints. In addition, however, these youth also show many disruptive behaviors such as noncompliance, defiance, aggression, tantrums, clinging, refusal to move, and running away from school or home. In general, school refusal behavior is not largely related to gender, income level, or race, although dropout rates tend to be highest for Hispanics and African Americans. Historically, school refusal behavior has been defined in different ways, and many terms have been used to describe the population. School phobia, for example, often refers to youth who are fearful of something at school, although few children in this population report specific fears. This may include youth with separation anxiety or those who become worried at the prospect of being apart from parents or significant others. Truancy often refers to youth who refuse school without parental knowledge and who show other delinquent acts. The phrase school refusal behavior was designed as an umbrella term to include all of these children. Treatment for youth with school refusal behavior usually begins with a systematic assessment by a school or mental health professional. In most cases, assessment includes the child, parents, school officials, and relevant others. Assessment may consist of interviews, questionnaires, observations of the family and child, standardized tests, daily ratings of distress, and reviews of school records, among other methods. A thorough medical examination should also be conducted to identify any genuine physical ailments. Identified reasons for school refusal behavior include desires to escape from painful items at school, to obtain attention from parents, and to pursue tangible rewards outside of school. Common examples of school-related items that children sometimes avoid include buses, fire alarms, gymnasiums, playgrounds, hallways, animals, and transitions from one place to another. Common examples of school-related people that children sometimes avoid include peers. Common examples of school-related situations that children sometimes avoid include tests, recitals, athletic performances, and writing or speaking before others. Many children, however, refuse school not because of something painful there but because they wish to pursue something more appealing outside of school. For children who refuse school because of anxiety while attending, treatment often focuses on the child to help him or her master anxiety and gradually return to school. This is done by educating the child about his or her anxiety, helping the child relax muscles and control breathing, changing irrational thoughts that might prevent attendance, and gradually reintegrating the child back into school. The latter is usually done by having the child identify classes or time periods during the day that he or she likes most. The child initially attends these times only and reports different thoughts and other anxiety-based symptoms that occur. Over time, the child gradually increases classroom attendance, working to control anxiety, until full-time attendance is achieved. In this approach, parents are encouraged to design set routines in the morning, daytime (if the child is home from school), and evening. The child is also required gradually to reattend school and face appropriate consequences for successes and failures. Parents are sometimes instructed forcibly to bring a child to school under certain circumstances. For children who refuse school for tangible rewards outside of school, family therapy is often used. The latter sometimes involves increasing supervision of the child and escorting him or her from class to class. Related procedures include communication skills training to reduce conflict and increase negotiation among family members and peer refusal skills training so that youth can appropriately refuse offers to miss school. School refusal behavior is a serious problem that must be addressed quickly and must involve the cooperation of the child, parents, educators, and relevant others. In addition, ongoing monitoring of the child is necessary to prevent relapse and address any new problems that may occur during the academic year. Early introduction to new school settings and starting the typical weekday routine one to two weeks before the start of school is often recommended as well. Even those entering such professional fields as clinical or counseling psychology usually pursue their graduate studies in departmental programs comparable in size and administrative structure to programs in experimental, developmental, or social psychology. Increasing numbers of psychologists preparing for careers in practice, however, are educated in schools of professional psychology administratively comparable to schools of law, medicine, engineering, or business. The earliest schools of professional psychology were free-standing institutions, unaffiliated with universities. Currently, many of the schools are situated in universities, although many others continue to operate independently. Second, their organizational structure is that of a school or college rather than of a departmental program. The academic unit is accorded a high degree of autonomy in defining its curriculum, selecting faculty, admitting students, and other matters of policy and procedure. Administrative resources and controls are relatively direct, usually through officers of the central administration in university-based schools and through boards of directors in free-standing schools. A third characteristic of professional schools is that the curriculum is specifically designed to prepare people for professional work. Supervised experience in psychological practice is therefore emphasized throughout graduate study as well as in an internship. A dissertation is required in the programs of nearly all professional schools, but the inquiry is conceived as a form of practice, not as an end in itself. Fourth, the faculties include large numbers of practitioners, and all faculty members are ordinarily expected to maintain some involvement in professional activity. Finally, the degree awarded on completion of graduate study is in nearly all cases the doctor of psychology (PsyD) degree rather than the doctor of philosophy (PhD). The forerunner of contemporary schools of professional psychology was the program in clinical psychology at Adelphi University. When the Adelphi program was approved by the American Psychological Association Committee on Accreditation in 1957, it became the first accredited program whose primary objective was to educate clinicians for practice, instead of to educate them as scientists or scientistpractitioners. Prior to that time, all of the clinical and counseling programs in the United States and Canada had followed the Boulder model of education that was defined in a conference on the training of clinical psychologists in Boulder, Colorado, in 1949. The conference held that clinical psychologists were to be trained in academic psychology departments, prepared to conduct research as well as to practice psychology, and awarded the PhD degree on completion of graduate studies. The early Adelphi program preserved the administrative structure that was common to other departmental programs, changed the curriculum mainly by introducing more supervised clinical experience than usual, and retained the PhD as the terminal degree. It differed fundamentally from all other programs at the time, however, by affirming the legitimacy of direct education for psychological practice, with or without the promise of contributory research. The first institution administratively organized as a school for practitioners of psychology was the Graduate School of Psychology in the Fuller Theological Seminary. Large-scale development of schools of professional psychology did not begin, however, until the California School of Professional Psychology was founded in 1969. Overwhelmed by demands for psychological services in an increasingly populous state and frustrated by repeated refusals of academic psychologists to increase the size and implicitly change the emphases of their tiny, researchoriented clinical programs, a group of practitioners resolved to create their own professional school that would be independent of any university. The curriculum duplicated the Adelphi pattern and, as at Adelphi, the PhD degree was to be awarded to graduates. For the first year, the founding group offered their time as administrators and faculty free of charge as an operational endowment. The plan was approved in 1969, and in 1970 the California School of Professional Psychology admitted students to its first two campuses, in San Francisco and Los Angeles. In 1973 another conference on professional training in psychology was held in Vail, Colorado. The conference concluded that psychology had matured sufficiently to justify creation of explicit professional programs, in addition to those for scientists and scientist-professionals. Professional schools were recognized as appropriate settings for training, and the PsyD degree was endorsed as the credential of choice on completion of graduate requirements in practitioner programs. Over the following years, schools of professional psychology were established in many locations throughout the United States. The Graduate School of Applied and Professional Psychology, established at Rutgers University in 1974, was the first universitybased professional school to offer the PsyD. At Rutgers, as in the Illinois PsyD program that preceded it, a scientistpractitioner program leading to the PhD was maintained for students interested primarily in research. This pattern-a relatively large school of professional psychology designed expressly to train practitioners and awarding the PsyD degree alongside a smaller PhD program to prepare students for research careers-has since been adopted by several other universities and independent professional schools. Toward the end of the 20th century, more than 35 professional schools were in operation, approximately half in universities and half as free-standing institutions. During this period, nearly one-third of students receiving doctorates in clinical psychology were graduated from professional schools. Early faculties in free-standing schools were employed almost entirely on a part-time basis. Proportions of full-time faculty in the independent schools have increased over the years, and professional schools in universities employed large proportions of full-time faculty from the beginning. Psychological centers, analogous to the teaching hospitals of medical schools, are now an integral part of nearly all professional schools and provide the controlled settings in which faculty and students offer public services, students are trained, and research is conducted. Dissertation requirements, which were eliminated completely in some of the early schools, are now an essential part of nearly every program, though the emphasis on direct education for practice and the view of systematic investigation as a form of professional service has been retained. The PsyD degree has replaced the PhD degree in almost all of the professional schools in operation at this time. In 1976 the National Council of Professional Schools was established to provide a forum for exchange of information among professional schools, to develop standards for the education and training of professional psychologists, and to improve in every way possible the educational process so that graduates would serve public needs most effectively. Later, the name of the organization was changed to the National Council of Schools and Programs of Professional Psychology to acknowledge the inclusion of some 20 programs that share the fundamental aims, curricula, and degreegranting practices of professional schools but differ in their smaller enrollments and departmental administrative structures. Through a series of conferences and reports, the council has conducted self-studies, defined curricula, and established means for quality assurance among its member organizations. Along with the Council of Graduate Departments of Psychology and the Councils of University Directors of Clinical, Counseling, and School Psychology, the National Council of Schools and Programs of Professional Psychology is an influential participant in shaping educational policy in American psychology. The National Council of Schools and Programs of Professional Psychology educational model. Hypotheses are made from such theories; the hypotheses are evaluated using objective, controlled, empirical investigations; and conclusions are open to public scrutiny, analysis, and replication. Conclusions about reality can be made in at least four different ways: on faith ("I believe that God created heaven and earth"), on common sense or intuition ("I feel that women have a maternal drive"), on logic ("I think, therefore I am"), or on the analysis of empirical data (the scientific method). Complex events are analyzed into relevant variables; relationships among these variables are investigated; and theories consistent with the empirical results are created and critically evaluated. For example, if disease is more common among the poor, the scientist may postulate a set of variables that are the cause of this phenomenon, such as differences in diet, education, medical availability, environmental factors, and genetic susceptibility. Then empirical data are collected to analyze the effect of such variables on disease so that a general theory can be constructed and tested by other scientists. The scientific method involves a critical approach to data analysis and interpretation. The scientific method involves a broad array of alternative procedures ranging from carefully observing the variables as they naturally occur to collecting data under controlled situations with subjects randomly assigned to conditions. Studies can be designed to describe events, to describe correlational relationships among events, or to establish cause-and-effect relationships between events. Descriptive and correlational studies can be used to provide information for theory construction and hypothesis testing. Causal research allows the researcher to establish the direct effect of one variable on another, rather than simply to establish that two variables may correlate.
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