David C. Booth, MD
Although no controlled studies have been reported in pa tients with anorexia nervosa prostate gland location 10mg alfuzosin visa, controlled trials of olanzapine and risperidone are under way man health 50 purchase 10 mg alfuzosin with mastercard. A small open-label study of low-dose haloperidol also showed improved insight and weight gain in severely ill patients (198) prostate 5k run buy cheap alfuzosin 10mg online. The quality of the available ev idence on using antipsychotic medications is also limited by the fact that studies rarely include male patients and have included only small numbers of adolescents; in addition man health be discount alfuzosin 10mg mastercard, only case re ports are available regarding prepubertal children. If antipsychotic medications are used, the possibility of extrapyramidal symp to ms, especially in debilitated patients, should be considered and routinely assessed. None has been shown to have specific value in the treatment of anorexia nervosa symp to ms (199). Other medications have been used to address associated features of anorexia nervosa. For example, antianxiety agents have been used selectively before meals to reduce anticipa to ry anx iety concerning eating (200, 201), and pro-motility agents, such as me to clopramide, are com monly offered for the bloating and abdominal pains that result from gastroparesis and that contribute to the premature satiety seen in some patients. However, before prescribing me to clopramide, clinicians should consider the fact that extrapyramidal symp to ms are more likely to be seen in underweight anorexia nervosa patients. However, no good supporting evidence exists to demonstrate the efficacy of this treatment (202, 203). Only in a subset of very-low-weight women (<70% average body weight) did it prevent further bone loss (204). Estrogen can cause the fusion of the epiphyses and should not be administered to girls before their growth is completed (3). This, in turn, may cause the patient to misunderstand that her body is functioning normally and therefore contribute to denial of the need to gain more weight. Clinicians stress that efforts should be made to allow patients to increase their weight and achieve resumption of normal menses before they are offered estrogen (205). There is no indication for the use of biphosphonates such as alendronate in patients with anorexia nervosa. Thus, the recommended treatment for low bone mineral density includes weight gain and calcium with vitamin D supplementation (207). A primary focus for nutritional rehabilitation is to help patients develop a structured meal plan that will allow them to reduce the episodes of dietary restriction and the urge to binge and purge. Because most bulimia nervosa patients who have been studied are of normal weight, nutritional res to ration will not be a central focus of treatment. In addition, even if their weight is within statistically normal ranges, many patients with bulimia nervosa weigh less than their appropriate biologically determined set points (or ranges) and may have to gain some weight to achieve physiological and emotional stability. Although many patients with bulimia nervosa report irregular menses, improvement in menstrual function has not been systematically assessed in the available outcome studies. Thus, even among patients of normal weight, nutritional counseling may be a useful adjunct to other treatment modalities in reducing behaviors related to the eating disorder, minimizing food restrictions, increasing the variety of foods eaten, and encouraging healthy but not compul sive exercise patterns (208). Those patients for whom some weight gain is indicated similarly require the establishment of a pattern of regular, non-binge meals, with attention on increasing their caloric intake and expanding macronutrient selection. Patients with bulimia nervosa who are overweight or obese have not been well studied. Behavioral techniques, such as planned meals and self-moni to ring, may also be helpful for managing initial symp to ms and interrupting binge-purge behaviors (213, 214). It should be pointed out that these study results may not be generalizable to typical clinical situations. It is also possible that the narrow inclusion cri teria of some studies limit the generalizability of the study results (216). These approaches address developmental issues; identity formation; body image concerns; self esteem; conflicts surrounding sexuality, anger, or aggression; affect regulation; gender role ex pectations; interpersonal conflicts; family dysfunction; coping styles; and problem solving. Some bulimia nervosa patients, particularly those with concurrent personality pathology or other co-occurring disorders, may require substantially longer treatment. Also unknown is how the length and characteristics of the treatments varied according to other clin ical dimensions of these patients. Exactly what is required over the long run to best help patients resolve lingering preoccupations with body image and the more subtle but impairing psycholog ical dimensions that may be associated with eating disorders requires additional study. These concerns are often approached in practice through a variety of longer-term psychotherapies. Family therapy should be considered whenever possible, especially for adolescents still living with parents or for older patients with ongoing conflicted interactions with parents. Support groups and 12-step programs such as Overeaters Anonymous may be helpful as ad juncts to initial treatment of bulimia nervosa and for subsequent relapse prevention but are not recommended as the sole initial treatment approach for bulimia nervosa (168, 223). As noted above, these support organizations emphasize in their literature that their programs are not sub stitutes for professional treatment and specifically recommend that members seek appropriate medical and nutritional guidance. However, clinicians should remain cognizant of the idiosyn cratic recommendations made in some self-help groups. Patients with bulimia nervosa occasionally have difficulties with certain elements of psycho therapy similar to what was discussed above for patients with anorexia nervosa. Available studies also suggest that antidepressants may be helpful for patients with substantial symp to ms of depression or anxiety, obsessions, or certain impulse disorder symp to ms or for patients who have not responded or had a suboptimal response to previous attempts at appropriate psychosocial therapy (228, 229). A small open trial demonstrated the safety and effectiveness of 60 mg/day of fluoxetine for treating bulimia nervosa in adolescents (225). Thus, many clini cians initiate fluoxetine treatment for bulimia nervosa at the higher dosage, titrating downward if necessary to manage side effects. Often, several different antidepressants may have to be tried sequentially to identify the spe cific medication with the optimum effect in a particular patient. In the bulimia nervosa patient whose symp to ms do not respond to medication, it is important to assess whether the patient has taken the medication shortly before vomiting. Correlations between serum levels and re sponse have not been identified; however, if serum levels of the medication are available, they may help determine whether presumably effective levels of the drug have actually been achieved. As in most clinical situations, careful education of the patient regarding possible side effects of medications and their symp to matic management. Side effects vary widely across studies depending on the type of antidepressant med ication used. The to xicity and potential lethality of tricyclic antidepressant overdosage also dictate cau tion in prescribing this class of drug for patients who are at risk for suicide. There are few reports on the use of antidepressant medications in the maintenance phase of treating bulimia nervosa patients. Although there are data indicating that fluoxetine can be ef fective in preventing relapse in these patients (226), other data suggest that high rates of relapse occur while antidepressants are being taken and possibly higher rates are seen when the medi cation is withdrawn (240). In the absence of more systematic data, most clinicians recommend continuing antidepressant therapy for a minimum of 9 months and probably for 1 year in most patients with bulimia nervosa. For patients with bulimia nervosa who require mood stabilizers, the use of lithium carbonate is problematic, because lithium levels may shift markedly with rapid volume changes. Both lithium carbonate and valproic acid frequently lead to undesirable weight gains that may limit their acceptability to bulimia ner vosa patients. Selecting a mood stabilizer that avoids these problems may result in better patient adherence and medication effectiveness. Topiramate is not an effective mood stabilizer but may be potentially useful for bulimia nervosa and binge eating disorder (242, 243). However, in con trast to the low rates of adverse effects observed in clinical trials with to piramate, practitioners have reported several patients experiencing adverse effects with the drug, such as word-finding difficulties and paresthesias in a sizable minority of patients, although these may have been re lated to excessively rapid rates of dosage increases (242, 243). Also of note, patients receiving to piramate for bulimia nervosa lost an average of 1. The current management is combination therapy consisting of high-dose corticosteroids and cy to to xic immunosuppressive drugs (cyclophosphamide and rituximab) prostate oncology fellowship generic 10mg alfuzosin visa. Two randomized trials indicate that rituximab is an effective alternative to cyclophosphamide in new or relapsing patients mens health zucchini carbonara order alfuzosin with visa. Other drugs that have been used include leflunomide prostate cancer 7 on gleason score buy alfuzosin 10mg without prescription, deoxyspergualin prostate cancer doctor cheap alfuzosin 10mg without a prescription, tumor necrosis fac to r blockers, calcineurin inhibi to rs, mycophenolate mofetil, and anti bodies against T-cells. Later subset analysis in two tri als consisting of 62 patients found benefit in patients who were dialysis-dependent at presentation but not those with less severe acute kidney injury. Plasmapheresis therapy for diffuse alveolar hemor Tcherakian C, Guillevin L; French Vasculitis Study Group. Plasma exchange for renal vasculitis and idiopathic rapidly Flossmann O, Tesar V, Vanhille P, de Groot K, Luqmani R, progressive glomerulonephritis: a meta-analysis. The three principles are to rapidly remove circulating antibody, to s to p further production of antibodies, and to remove offending agents (hydrocarbon fumes, metallic dust, to bacco smoke, infections [influenza A], cocaine, etc). In general, the disease does not relapse in a successfully treated patient and therefore such patients do not require chronic immunosuppression. A single randomized prospective trial involving a small number of patients has been reported and demonstrated improved survival of both the patients and their kidneys. The presence or absence of antibody should not be used to initiate or terminate ther apy, because antibody is not demonstrable in a few patients with the disease and may be present in patients without active disease. Alveolar hemorrhage in anti-basement membrane antibody disease: a series of 28 cases. Clinical and morphological aspects of the manage brane antibody disease: analysis of prognostic significance of ment of crescentic anti-glomerular basement membrane antibody clinical, pathologic and treatment fac to rs. Acquired disease can be idiopathic or secondary to malignancy, thymoma, au to immune or infectious diseases, certain drugs, and chemicals. Patients present with bleeding and bruising (most common), along with anemia and/or infection. Hema to poietic growth fac to rs and androgens are sometimes used as adjunctive therapies. Diagnosis and manage References of the identified articles were searched for additional ment of acquired pure red cell aplasia. Treatment of erythropoietin-induced pure red tation after pretransplant isoagglutinin reduction with donor-type cell aplasia: a retrospective study. Pure red cell aplasia following immunotherapy in aplastic anemia and pure red cell aplasia. Complete remission of idiopathic incompatible allogeneic hema to poietic stem cell transplantation. Apheresis: Principles and Prac peripheral blood stem cell transplantation successfully treated tice, 3rd edition. Persis tent skin inflammation may be associated with a relative lack of T-regula to ry cells in the skin. IgE measurements or prick tests can identify allergens to which the patient is sensitized. Treatments for third-line or under investigation are interferon-g, omalizumab, allergen immunotherapy, probiotics, Chinese herbal medications, and antimetabolites. Relapse could be treated by returning to the interval frequency of the previously effective treatment schedule. Double-filtration apy, and plasma exchange and plasmapheresis for articles published plasmapheresis for the treatment of patientswith recalcitrant in the English language. Knobler R, Berlin G, Calzavara-Pin to n P, Greinix H, Jaksch P, Laroche L, Ludvigsson J, Quaglino P, Reinisch W, Scarisbrick J, 1. Apheresis in the treatment of recalcitrant a to pic der Bohbot A, Bruckner-Tuderman L, Dreno B, Enk A, French L, matitis: case series and review of the literature. Guidelines on the use of extracorporeal pho to phere ment of severe a to pic dermatitis. Philadelphia: Elsev Improvement of treatment-refrac to ry a to pic dermatitis by immu ier. It is typically seen in the post-infectious setting (as polyclonal au to antibodies) or in lymphoproliferative disorders (as monoclonal au to antibodies). The thermal amplitude is defined as the highest temperature at which the antibody reacts with its cognate antigen. Prednisone suppresses antibody production and down-regulates Fc-recep to r-mediated hemolysis in the spleen. Splenec to my, despite being underutilized, is perhaps the most effective and best-evaluated second-line therapy, but there are only limited data on long term efficacy. In patients who have severe disease, the most effective and best-evaluated treatment is rituximab in the standard lymphoma dose and is now recom mended first-line therapy, although complete and sustained remissions are uncommon. In these situations, therapy may require a controlled, high temperature setting of 378C both in the room and within the extracorporeal circuit. Alemtuzumab plus cyclosporine treatment terms warm/cold au to immune hemolytic anemia, cold agglutinin of the au to immune hemolytic anemia in an adult bowel trans disease, plasma exchange/plasmapheresis for reports published in plant. How I treat au to immune hemolytic anemias searched for additional cases and trials. A case report of tive analysis of 30 severe au to immune hemolytic anemia refrac to ry warm au to immune hemolytic anemia treated with plas patients treated by whole blood exchange transfusion. Cold agglutinins in patients undergoing cardiac sur A life-threatening paediatric case of acute au to immune haemo gery requiring cardiopulmonary bypass. Hema to logy, Basic Principles and Prac prospective study of 37 courses of therapy in 27 patients. Plasma term efficacy of the complement inhibi to r eculizumab in cold exchange and rituximab treatment for lenalidomide-associated agglutinin disease. Au to immune pathogenesis and au to plasma exchange: a case report and review of the literature. Patients treated with therapeutic plasma exchange: a to ry, and fatal primary au to immune hemolytic anemias. A new cold au to ag of clinical outcome data with respect to evidence-based medi glutinin specificity: the third external loop of band 3. Cold agglutinin syndrome in pediatric blood cell antigens occur frequently with hemolysis among pedi liver transplant recipients. The disease is usually transmitted from an animal reservoir to humans by the bites of Ixodes ticks, usually between May through Oc to ber. Excessive cy to kine production is thought to be a major cause of severe babesiosis and is associated with tissue pathology that can lead to significant end-organ damage and can result in persistent relapsing disease or death (all-cause mortality <1% of clinical cases and about 10% in transfusion transmitted cases). The detection of IgM is indicative of recent infection while IgG titer of 1:1,024 or greater usually signify active or recent infection. Combination of quinine sulfate and clindamycin is equally effective but associated with more adverse reactions.
Control: the term is used in three contexts (1) the process of keeping the relevant conditions of an experiment constant (2) causing an independent variable to vary in a specified and known manner (3) using a spontaneously occurring and discover able fact as a check or standard of comparison to evaluate the facts obtained after the manipulation of the independent variable mens health december 2013 order genuine alfuzosin line. Control group: In an experimental design control androgen hormone naturally order 10mg alfuzosin visa, the group in which a condition or fac to r being tested is deli berately omitted prostate cancer 82 year old purchase 10 mg alfuzosin fast delivery. For example prostate cancer exam age order discount alfuzosin line, in a study measuring the effects of a new drug, the control group may be given a placebo, instead of the drug. Conventional level:Type of thinking about moral issues in which value is placed on maintaining the conventional order and satisfying the expectancies of others. Conventional morality: this is the second of the three stages of moral development proposed by Kohlberg. In the early part of the stage the individual adopts moral codes in order to avoid social sanctions. In the second part of the stage, such moral codes or rules are seen as intrinsically right because they facilitate the smooth operation of society, and therefore 92 Dictionary of Psychology & Allied Sciences should not be challenged. Convergent thinking: Problem solving which works consistently to wards a defined solution; a way of thinking that assumes there is single right answer and that the way to reach that answer is to work directly to wards it. It has been pointed out that within the educational system students are trained in convergent thinking and that intelligence tests depend entirely on convergent thinking ability. Rather less justifiably it is then assumed that convergent thinking is opposed to creativity and is inferior to creative or divergent thinking. It could be argued that the reason that most people use convergent thinking most of the time is because it works for most problems. Conversational catharsis: Release of repressed or suppressed thoughts and feelings in group and individual psychotherapy as a result of verbal interchange. Conversion: A defense mechanism, operating uncon sciously, by which intrapsychic conflicts that would otherwise give rise to anxiety are, instead, give symbolic external expression. The repressed ideas or impulses and the psychologic defenses against them, are converted in to a variety system. Conversion disorder:A soma to form disorder in which the patient experiences an involuntary limitation or alteration of physical function that is an expression of psychological conflict or need, not physical disorder. Conversion symp to m:A loss or alteration of physical functioning that suggests a physical disorder but that is actually a direct expression of a psycho logical conflict or need. The disturbance is not under voluntary control, and is not explained by any physical disorder (this possibility having been Dictionary of Psychology & Allied Sciences 93 excluded by appropriate investigation). Conversion symp to ms are observed in conversion disorder, and may occur in schizophrenia. Convulsive therapy: A form of therapy involving a group of techniques that induces seizures. In the strictest sense the seizures are patterned electrical discharges that are termed central seizures and that can be measured by use of an electro-encephal ograph. Coprophilia: Excessive interest in filth or feces or their symbolic representations. Corrective emotional experience: Reexposure under favourable circumstances to an emotional situation that the patient could not handle in the past. As advocated by Franz Alexander, the therapist temporarily assumes a particular role to generate the experience and facilitate reality testing. Correlation: the extent to which two measures vary to gether, or a measure of the strength of the relationship between two variables. The correlation coefficient signifies the degree to which 94 Dictionary of Psychology & Allied Sciences knowledge of one score or variables does not necessarily indicate a causal relationship between them; the correlation may follow because each of the variables is highly related to a third yet un measure fac to r. May have their body or self has disappeared and they no longer exist, even that the whole universe no longer exists. Co-therapy: A form of psychotherapy in which more than one therapist treat the individual patient or the group. It is also known as combined therapy, cooperative therapy, dual leadership, multiple therapy, and three-cornered therapy. Counselling: the term has two rather opposed meanings (i) counseling is a form of therapy derived from the non-directive counseling of Carl Rogers in which the client is supported while they gain insight in to their problem and work on finding their own solution. Within this use, people who offer therapy but who have no formal qualification or whose therapy is carried out a part of another job. These counselors are much note active in providing information, offering advice practitioners are called counseling psycho logist. Counterbalancing: A strategy used it the design of those experiments in which it is possible that the order of presentation of the conditions of the study could produce an unwanted effect, such as a practice effect or a fatigue effect. Counterbalancing involves systematically varying the order of presentation of the conditions, such that, for example half of the group of subjects would have conditions. A followed by condition B, while the Dictionary of Psychology & Allied Sciences 95 other half would have condition B first, followed by condition A. Counter-conditioning: In behaviour therapy, the conditioning of a response which is incompatible with an existing undesirable behaviour. Some one who is afraid of spiders might be trained to relax whenever they think of a spider, so that first reaction prevents them from feeling fear. Couvade syndrome: Husband (usually) developed extreme anxiety and various physical symp to ms as of pregnancy, when wife is pregnant. Creativity has been studied as a counterpart to intelligence, represented by divergent and convergent thinking abilities respectively. However, it is difficult to devise tests, as a creative response is by definition unpredict able, so correct answers cannot be specified in advance. In fact there is no agreed way of mea suring how creative any particular achievement may be. Also it is probably even less appropriate than with intelligence to think of creative as a quality of which an individuals has a certain measurable amount. The classic theory of creativity is that it requires preparation (doing the group-work), incubation (a period of subconscious processing), inspiration (a sudden insight), and verification (checking the solution works). So the 96 Dictionary of Psychology & Allied Sciences present state of the field is that we have no plausible theory of how creativity happens, no reliable way of measuring the creativity of a person, and no real characteristics of the individual or because of particular kinds of circumstances. We clearly need a creative solution to these problems, but we do not have much idea of how to achieve this. Criminal responsibility: Legal term meaning the ability to formulate a criminal intent at the time of an alleged crime. A person cannot be convicted of a crime if it can be proved that he lacked criminal responsibility by reason of insanity. Crisis intervention:A brief therapeutic approach used in emergency rooms of general or psychiatric hospitals that is ameliorative, rather than curative, of acute psychiatric emergencies. Often treatment fac to rs focus on environmental modification although interpersonal and intrapsychic fac to rs are also considered. Individual, group, family, or drug therapy is used within a time limited structure of several day to several weeks. Crisis-intervention group psychotherapy: Group therapy aimed at decreasing or eliminating an emotional or situational crisis. One use of the term is for the level of probability required for a statistical result to be regarded as significant. Critical period: A time period during the development of the individual in which a particular function can readily be acquired. Order 10 mg alfuzosin visa. Lose Weight | Lose Belly Fat | How To Lose Belly Fat. Diseases
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