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By A. Elber. Southern California University of Professional Studies.

Have you ever neglected your obligations cheap 0.1 mg clonidine otc, your family or your work for more than 2 days in a row because you were drinking? Have you ever had a drink first thing in the morning to steady your nerves buy generic clonidine 0.1 mg on-line, or to get rid of a hang over (Eye-opener)? Some content that appears in print may not be available in electronic books Library of Congress Cataloging-in-Publication Data Thomas cheap clonidine 0.1mg with visa, Gareth, Dr. Ltd, Pondicherry, India Printed and bound in Great Britain by Antony Rowe Ltd This book is printed on acid-free paper responsibly manufactured from sustainable forestry, in which at least two trees are planted for each one used for paper production. C ontents Preface xi Acknowledgements xii Abbreviations/Acronyms xiii 1 Biological Molecules 1 1. It is also intended for students whose degree courses contain a limited reference to medicinal chemistry. The text assumes that the reader has a knowledge of chemistry at level one of a university life sciences degree. The text discusses the fundamental chemical principles used for drug discovery and design. Chapter 1 gives a brief review of the structures and nomenclature of the more common classes of naturally occurring compounds found in biological organ- isms. It is included for undergraduates who have little or no background knowledge of natural product chemistry. For students who have studied natural product chemistry it may be used as either a revision or a reference chapter. The basic approaches used to discover and design drugs are outlined in Chapters 3–6 inclusive. Chapter 7 is intended to give the reader a taste of main line medicinal chemistry. It illustrates some of the strategies used, often within the approaches outlined in previous chapters, to design new drugs. For a more encyclopedic coverage of the discovery and design of drugs for specific conditions, the reader is referred to appropriate texts such as some of those given under Medicinal Chemistry in the Selected Further Reading section at the end of this book. Chapters 8 and 9 describe the pharmacokinetics and metabolism respectively of drugs and their effect on drug design. Chapter 10 attempts to give an introductory overview of an area that is one of the principal objectives of the medicinal chemist. For a more in depth discussion, the reader is referred to the many specialized texts that are available on organic synthesis. Drug develop- ment from the research stage to marketing the final product is briefly outlined in Chapter 11. Answers, sometimes in the form of references to sections of the book, are listed separately. A list of recommended further reading, classified according to subject, is also included. Gareth Thomas A cknow ledgem ents I wish to thank all my colleagues, past and present without, whose help this book would have not been written. P Cox for the molecular model diagrams and his patience in explaining to me the intricacies of molecular modelling and Mr. I wish also to thank the following friends and colleagues for proof-reading chapters and supplying information: Dr. Finally, I would like to thank my wife for her support whilst I was writing the text. Some of these naturally occuring compounds and ions (endogenous species) are present only in very small amounts in specific regions of the body, whilst others, such as peptides, proteins, carbohydrates, lipids and nucleic acids, are found in all parts of the body. A basic knowledge of the nomenclature and structures of these more common endogenous classes of biological molecules is essential to under- standing medicinal chemistry. This chapter introduces these topics in an attempt to provide for those readers who do not have this background knowledge. The structures of biologically active molecules usually contain more than one type of functional group. This means that the properties of these molecules are a mixture of those of each of the functional groups present plus properties characteristic of the compound. The latter are frequently due to the interaction of adjacent functional groups and/or the influence of a functional group on the carbon–hydrogen skeleton of the compound. This often involves the electronic activation of C–H bonds by adjacent functional groups. Their structures contain both an amino group, usually a primary amine, and a carboxylic acid. The structures of amino acids can also contain other functional groups besides the amine and carboxylic acid groups (Table 1. Methionine, for example, contains a sulphide group, whilst serine has a primary alcohol group. Amino acids with hydrophobic side chains will be less soluble in water than those with hydrophilic side chains. The hydrophobic/hydrophilic nature of the side chains of amino acids has a considerable influence on the conformation adopted by a peptide or protein in aqueous solution. Furthermore, the hydrophobic/hydro- philic balance of the groups in a molecule will have a considerable effect on the ease of its passage through membranes (Appendix 5). In aqueous solution the structure of amino acids are dependent on the pH of the solution (Figure 1. The pH at which an aqueous solution of an amino acid is electrically neutral is known as the isoelectric point (pI) of the amino acid (Table 1. They are used in the design of electrophoretic and chromatographic analytical methods for amino acids. In peptide and protein structures their structures are indicated by either three letter groups or single letters (Table 1. Amino acids such as ornithine and citrulline, which are not found in naturally occuring peptides and proteins, do not have an allocated three or single letter code (Figure 1. Most naturally occuring amino acids have an L configur- ation but there are some important exceptions. Note that the carboxylic acid group must be drawn at the top and the R group at the bottom of the Fischer projection. They consist of amino acid residues linked together by amide functional groups (Figure 1. The lone pair of its nitrogen atom is able to interact with the p electrons of the carbonyl group. Regulatory These are proteins that control the physiological activity of other proteins. Transport These transport specific compounds from one part of the body to another haemoglobin transports carbon dioxide too and oxygen from the lungs.

This is facilitated purchase 0.1mg clonidine fast delivery, partly through background knowledge (step 1) discount 0.1mg clonidine with visa, both by uncovering and understanding a patient’s own circumstances and beliefs towards non- conventional approaches order clonidine 0.1 mg without a prescription, and by critically evaluating published information. A three-step strategy implies one step after the other; however, this may change in practice depending on a particular situation (e. Moreover, the understanding of a specific concept (step 1’s preparation) may need to be revisited or learned for the first time after a case history has been taken (step 2). In this situation, admitting lack of knowledge to a patient is often appro- priate. Although this is problematic for many practitioners, they can be reas- sured that patients accept practitioners’ frank statement that they need to research a topic outside their customary practice before giving advice. The three-step strategy is therefore intended primarily to ensure that all relevant information is considered when responding to issues of efficacy and safety in the context of cultural sensitivity. The strategy for evaluating remedies used empirically Practitioners (and nowadays many patients) want ‘scientific’ evidence to support effectiveness and safety. Indeed, it is noteworthy that some aborig- inal peoples are backing scientific research in the hope of marketing their traditional medicines. Anecdotal knowledge (or evidence) is that which has been built up over an extended period of time among generations of practitioners and others who develop a specialised knowledge (e. Anecdotal knowledge not only is a feature of much aboriginal/traditional medical practice, but also has long been a key element of conventional medical practice. Examples of applying the three-step approach to herbal remedies in aboriginal usage Selection of examples of herbs out of the vast armamentarium of aborig- inal/traditional remedies (with much regional variation) is not easy. The two chosen (alder and black cohosh) have been selected to illustrate different challenges in response to questions about aboriginal usage. Alder, unlike black cohosh, has not become a major dietary supplement and few scientific data are available to assist in evaluation. In contrast, the top-selling black cohosh has been subjected to many laboratory and clinical studies, albeit with inconsistent findings. At least both herbs reflect a widespread belief that a core of empirical knowledge, long held by herbalists (some called yerberos), lies behind the use of herbs – a view that underpins much research on constituents of aboriginal and other traditional medicinal plants. On the other hand, whether or not some form of ceremony or ritual accompanied the administration and contributed to therapeutic benefits is not always clear (see below). On hearing about its use by Mi’kmaq people in Newfoundland, a patient asked whether it was good for headache – better than aspirin which upset the questioner’s stomach. It is also an example of one of many herbs about which the busy practitioner has difficulty finding useful information to confirm whether or not it has some general value. One is to Alnus rubra (a different species) as an ‘emetic and purgative for headache and other maladies’, and the other is to an infusion of the twigs as a ‘liniment for pain of sprains, bruises, backache Aboriginal/traditional medicine in North America | 51 and headache’. However, citing Moerman’s work to support any specific usage needs a critical appraisal of the sources of information culled by Moerman; these, variable in quality, commonly raise questions over, for example, the correctness of plant identification, type of preparation used or other details, some of which Moerman felt necessary to omit given the scope of the database. Such limited information strongly suggests that the use of alder for a headache is a local reputation – all the more so as published accounts of Mi’kmaq usage do not record ‘headache’. Black cohosh This second herb for consideration, black cohosh, offers a different set of circumstances for discussion with patients. As a top-selling dietary supple- ment – largely because of a reputation for relieving menopausal symptoms (and, to a lesser extent, menstrual symptoms, e. However, although tradi- tional aboriginal knowledge has seemingly been superseded by modern scientific/clinical studies, practitioners may well face queries on at least two matters: (1) the aboriginal reputation and (2) efficacy and safety. Uses Published accounts of both the herb and its commercial promotion commonly refer to a history of aboriginal usage, e. Aboriginal women have specifically 52 | Traditional medicine asked practitioners about how it was used by their people before modern natural healthcare products marketed it in capsules. Safety and efficacy Questions/concerns arise because recent research studies offer conflicting conclusions. Aboriginal women today are among the women who are concerned about hormone replacement therapy; many look to such ‘natural remedies’ as black cohosh. As mentioned, assessing the evidence of whether a herb reaches the level of anecdotal knowledge is not easy. Two topics are noted here as illustra- tions, both pertinent to an evaluation of black cohosh. Evaluating recorded information In addition to issues already noted in Moerman’s Native American Ethno- botany, step 1’s preparation also needs to examine the often glib claims that a herb has been used for ‘hundreds of years’ by ‘Indians’ and others. Careful historical study is often required to determine whether this is justified. Information on aboriginal treatments published up to the early nineteenth century generally came from travellers who, often with some knowledge of medicine, were curious about aboriginal ways. However, understanding aboriginal therapeutic practices was far from easy given the limited time and opportunities; thus early observations, although in many ways invaluable, have to be treated cautiously. Moreover, because of copying by one author from another, the frequency of references to a particular usage cannot be accepted, without careful review, as providing the level of evidence that reaches, say, anecdotal knowledge. Specifically, with regard to black cohosh, early observers undoubtedly found it more difficult to assess emmenagogue action and effects on menstruation among aboriginal women than, for example, the obviously vigorous purgative action of mayapple (Podophyllum peltatum). Yet emme- nagogue activity quickly became noted as an aboriginal usage; it persists in current promotions that do not necessarily take information from the most reliable of sources. One is a quote found in Virgil Vogel’s still widely used, if somewhat dated, American Indian Medicine (1970); it states that Indians introduced black cohosh to early American medicine and that no early non- aboriginal writers on materia medica ‘added anything not given by the Indians as far as the field of action of the drug is concerned except for some nineteenth-century instances of the use of the plant for treating smallpox’. Recently compiled lists of uses by, for example, North Carolina Cherokees continue to reflect this with all the appearance of information taken from non-aboriginal sources: ‘roots in alcoholic spirits for rheumatism; tonic; diuretic; anodyne; emmenagogue; slightly astringent; tea for colds; coughs; consumptions; constipation; tea for rheumatism; fatigue; hives; to make baby sleep; backache’ (Hamel and Chiltosky,18 page 30). As already indicated, practitioners generally find such lists problematic and difficult to interpret. Moreover, they offer no sense of the differences of opinion that have existed among practitioners over time. In the nineteenth century, some physicians who questioned or expressed caution over efficacy for ‘female conditions’ were widely recognised medical ‘authorities’ at a time of widespread usage of herbs, e. Questioning comments about its effects on the uterus were in line with doubts about the general value of the herb for female complaints, although it was felt that a tonic action – as with many other medications – might be helpful. Further instances of questioning comments cannot be given here, although they do support an ongoing uncertainty about effectiveness for women’s complaints. Lay (sometimes called social) validation of a treatment: concepts of disease An important aspect of step 1’s preparation is an understanding of why the persistent reputation of many non-conventional therapies over time rests on lay validation. This aspect is multifactorial and complex, and certainly demands effective communication skills for a practitioner to uncover relevant issues for individual patients. They may include: • popular interpretation of medical advances • testimonials from relatives and others about successful outcomes • treatments rationalised on the basis of beliefs about a disease (often popular beliefs current at the time such as blood purifiers) • treatment by a practitioner (perhaps an aboriginal healer) who supports beliefs that are compatible with those that the person holds, e. These – often relating to the causative agents acting from both outside and within the body – involve both natural and supernatural explanations. Depending on the demographics of their practice, a practitioner will want to be familiar with aboriginal diagnoses and treatments that confound conventional medicine, e.

Family therapy is based on the assumption that the problem order clonidine cheap, even if it is primarily affecting one person order 0.1mg clonidine with mastercard, is the result of an interaction among the people in the family buy cheap clonidine on line. Self-Help Groups Group therapy is based on the idea that people can be helped by the positive social relationships that others provide. One way for people to gain this social support is by joining a self-help group, which is a voluntary association of people who share a common desire to overcome [4] psychological disorder or improve their well-being (Humphreys & Rappaport, 1994). Self- help groups have been used to help individuals cope with many types of addictive behaviors. Three of the best-known self-help groups are Alcoholics Anonymous, of which there are more than two million members in the United States, Gamblers Anonymous, and Overeaters Anonymous. The idea behind self-groups is very similar to that of group therapy, but the groups are open to a broader spectrum of people. As in group therapy, the benefits include social support, education, and observational learning. Community Mental Health: Service and Prevention Attributed to Charles Stangor Saylor. Community mental health services are psychological treatments and interventions that are distributed at the community level. Community mental health services are provided by nurses, psychologists, social workers, and other professionals in sites such as schools, hospitals, police stations, drug treatment clinics, and residential homes. The goal is to establish programs that will help people get the mental health services that they need (Gonzales, Kelly, Mowbray, Hays, & [5] Snowden, 1991). Unlike traditional therapy, the primary goal of community mental health services is prevention. Just as widespread vaccination of children has eliminated diseases such as polio and smallpox, mental health services are designed to prevent psychological disorder (Institute of Medicine, [6] 1994). Community prevention can be focused on one more of three levels: primary prevention, secondary prevention, and tertiary prevention. Primary prevention is prevention in which all members of the community receive the treatment. Examples of primary prevention are programs designed to encourage all pregnant women to avoid cigarettes and alcohol because of the risk of health problems for the fetus, and programs designed to remove dangerous lead paint from homes. Secondary prevention is more limited and focuses on people who are most likely to need it— those who display risk factors for a given disorder. Risk factors are the social, environmental, and economic vulnerabilities that make it more likely than average that a given individual will [7] develop a disorder (Werner & Smith, 1992). The following presents a list of potential risk factors for psychological disorders. Some Risk Factors for Psychological Disorders Community mental health workers practicing secondary prevention will focus on youths with these markers of future problems. Community prevention programs are designed to provide support during childhood or early adolescence with the hope that the interventions will prevent disorders from appearing or will keep existing disorders from expanding. Interventions include such things as help with housing, counseling, group therapy, emotional regulation, job and skills training, literacy training, social responsibility training, exercise, stress management, rehabilitation, family therapy, or removing a child from a stressful or dangerous home situation. The goal of community interventions is to make it easier for individuals to continue to live a normal life in the face of their problems. Community mental health services are designed to make it less likely that vulnerable populations will end up in institutions or on the streets. In summary, their goal is to allow at-risk individuals to continue to participate in community life by assisting them within their own communities. Suicide is a leading cause of death worldwide, and prevention efforts can help people consider other alternatives, particularly if it can be determined who is most at risk. Determining whether a person is at risk of suicide is difficult, however, because people are motivated to deny or conceal such thoughts to avoid intervention or hospitalization. One recent study found that 78% of patients who die by suicide explicitly deny suicidal thoughts in their last verbal communications [8] before killing themselves (Busch, Fawcett, & Jacobs, 2003). They measured implicit associations about death and suicide in 157 people seeking treatment at a psychiatric emergency department. Using a notebook computer, participants classified stimuli representing the constructs of ―death‖ (i. Response latencies for all trials were recorded and analyzed, and the strength of each participant‘s association between ―death‖ and ―me‖ was calculated. The researchers then followed participants over the next 6 months to test whether the measured implicit association of death with self could be used to predict future suicide attempts. These results suggest that measures of implicit cognition may be useful for determining risk factors for clinical behaviors such as suicide. Imagine the impact of a natural disaster like Hurricane Katrina on the population of the city of New Orleans. How would you expect such an event to affect the prevalence of psychological disorders in the community? What recommendations would you make in terms of setting up community support centers to help the people in the city? The efficacy of group psychotherapy for depression: A meta-analysis and review of the empirical research. Researching self-help/mutual aid groups and organizations: Many roads, one journey. Reducing risks for mental disorders: Frontiers for preventive intervention research. Measuring individual differences in implicit cognition: The Implicit Association Test. Summarize the ways that scientists evaluate the effectiveness of psychological, behavioral, and community service approaches to preventing and reducing disorders. We have seen that psychologists and other practitioners employ a variety of treatments in their attempts to reduce the negative outcomes of psychological disorders. But we have not yet considered the important question of whether these treatments are effective, and if they are, which approaches are most effective for which people and for which disorders. Accurate empirical answers to these questions are important as they help practitioners focus their efforts on the techniques that have been proven to be most promising, and will guide societies as they make decisions about how to spend public money to improve the quality of life of their citizens [1] (Hunsley & Di Giulio, 2002). Psychologists use outcome research, that is, studies that assess the effectiveness of medical treatments, to determine the effectiveness of different therapies. In some cases we might simply ask the client if she feels better, and in other cases we may directly measure behavior: Can the client now get in the airplane and take a flight? In every case the scientists evaluating the therapy must keep in mind the potential that other effects rather than the treatment itself might be important, that some treatments that seem effective might not be, and that some treatments might actually be harmful, at least in the sense that money and time are spent on programs or drugs that do not work. One threat to the validity of outcome research studies is natural improvement—the possibility that people might get better over time, even without treatment. People who begin therapy or join a self-help group do so because they are feeling bad or engaging in unhealthy behaviors. After being in a program over a period of time, people frequently feel that they are getting better. But it is possible that they would have improved even if they had not attended the program, and that the program is not actually making a difference.

His children should have their lipid profile measured so that they can be treated to prevent premature cor- onary artery disease discount 0.1mg clonidine with amex. There is clear evidence from clinical trials that primary prevention of coronary artery disease can be achieved by lowering serum cholesterol order clonidine with amex. In patients who have evidence of cardiovascular disease secondary prevention is even more important order 0.1mg clonidine with visa, aiming for a cho- lesterol level as low as possible. He has a 12-year history of chronic cough and sputum production, but she thinks that these symptoms may have increased a little over the last 8 weeks. He has smoked 20 cigarettes daily for the last 50 years and he drinks around 14 units of alcohol per week. Two years ago he became depressed and was treated with an antidepressant for 6 months with good effect. There are no abnormalities to find in the cardiovascular, respiratory or abdominal systems. Addison’s disease might be linked with respiratory problems through adrenal involvement by metastases or tuberculosis. This can be confirmed by measurement of serum and urine osmolarities to show serum dilution while the urine is concentrated. Fluid restriction to 750 mL daily produced an increase in serum sodium to 128 mmol/L with improvement in the confusion and weakness. Such treatment often produces a response in terms of shrinkage of the tumour, improved quality of life and increased survival. Small-cell undifferentiated carcinomas of the lung are fast-growing tumours, usually unresectable at presentation. Her 20-year-old son has asthma and she has tried his salbutamol inhaler on two or three occasions but found it to be of no real benefit. She has tested herself on her son’s peak flow meter at home and she has obtained values of about 100 L/min. On direct question- ing she says that the shortness of breath tends to be worse on lying down but there are no other particular precipitating factors or variations through the day. There is a generalized wheeze heard all over the chest but no other abnormalities. It is similar in both inspiration and expiration as shown in the flow volume loop (Fig. The spirometry trace of volume against time in such cases shows a straight line of the same reduced flow right up to the vital capacity. On examination, this airway narrowing is likely to produce a single monophonic wheeze which may be heard over a wide area of the chest. Differential diagnosis of rigid large-airway obstruction The situation may easily be confused with asthma if the peak flow and the wheezing are accepted uncritically. The wheezing in asthma comes from many narrowed airways of different calibre and mass, and the wheezes are often described as polyphonic. The fixed flow in inspiration and expiration in this case suggest a rigid large-airway nar- rowing. If the narrowing can vary a little with pressure changes, then the pattern will depend on the site of the narrowing (Figs 99. If it is outside the thoracic cage, as in a laryngeal lesion, it will be more evident on inspiration. Large-airway narrowing can be caused by inflammatory conditions such as tuberculosis or Wegener’s granulomatosis, damage from prolonged endotracheal intubation or by extrinsic pressure such as a retrosternal goitre. The great majority of symp- tomatic lung tumours are visible on plain chest X-ray but central lesions in large airways may not be seen. In this case, fibre-optic bronchoscopy showed a carcinoma in the lower trachea reducing the lumen to a small orifice. Treatment was by radiotherapy with oral steroids to cover any initial swelling of the tumour which might increase the degree of obstruction in the trachea. She has had two previous admissions to hospital within the last 6 months, once for an overdose of heroin and once for an infection in the left arm. The heart sounds are normal and there are no abnormal findings on examination of the respiratory system. The respiratory rate is18/min, jugular venous pressure is not raised, there are no new heart murmurs and oxygen saturation is 97 per cent on room air. This complication is not unusual in intravenous drug users and can be associated with sepsis although there was no sign of this on the initial investigations. She has been treated for the thrombosis and for alcohol withdrawal and her opiate use. The deep vein thrombosis would have predisposed her to a pulmonary embolus, but the normal respiratory rate, lack of elevation of jugular venous pressure and normal oxygen saturation make this unlikely. As an intravenous drug user she might have taken more drugs even under supervision in hospital. The tachycardia and lowered blood pressure raise the possibility of haemorrhage which might be precipitated by the anticoagulants. In an intravenous drug user one would think of infective endocarditis which may occur on the valves of the right side of the heart and be more difficult to diagnose. Lung abscesses from septic emboli are another possibility in an intravenous drug user with a deep vein thrombosis, and a chest X-ray should be taken although the lack of respiratory symptoms makes this less likely. In this case the intravenous line has been left in place longer than usual because of the difficulties of intravenous access and it has become infected. Lines should be inspected every day, changed regularly and removed as soon as possible. On recovery and discharge there were problems with the question of anticoagulation. Warfarin treatment raised difficulties because of the unreliability of dosing, attendance at anticoagulant clinics and blood sampling. It was decided to continue treatment as an out- patient with subcutaneous heparin for 6 weeks. No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise without written permission from the Publisher. The content and opinions expressed in this book are the sole work of the authors and editors, who have war- ranted due diligence in the creation and issuance of their work. The publisher, editors, and authors are not responsible for errors or omissions or for any consequences arising from the information or opinions presented in this book and make no warranty, express or implied, with respect to its contents. Cleary For additional copies, pricing for bulk purchases, and/or information about other Humana titles, contact Humana at the above address or at any of the following numbers: Tel: 973-256-1699; Fax: 973-256-8341; E-mail: orders@humanapr. 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Diagnosis may be com- sumptions by asking the patient to name friends and plicated by the fact that avoidant personality disorder can family who enjoy his company quality clonidine 0.1 mg, or to describe past social either be the cause or result of other mood and anxiety dis- encounters that were fulfilling to him order generic clonidine line. For example cheap 0.1mg clonidine with mastercard, individuals who suffer from major patient that others value his company and that social sit- depressive disorder may begin to withdraw from social uations can be enjoyable, the irrationality of his social situations and experience feelings of worthlessness, symp- fears and insecurities are exposed. This process is known toms that are also prominent features of avoidant person- as cognitive restructuring. On the other hand, the insecurity and isola- tion that are symptoms of avoidant personality disorder can naturally trigger feelings of depression. Diagnostic and Statistical Cognitive therapy may be helpful in treating indi- Manual of Mental Disorders 4th ed. Graduating in 1952, Bandura completed a one-year internship at the Wichita Guidance Center before accepting an appointment to the depart- ment of psychology at Stanford University, where he has remained throughout his career. In opposition to more radical behaviorists, Bandura considers cognitive factors as causal agents in human behavior. His area of research, social cognitive theory, is concerned with the interaction between cognition, behavior, and the environment. Much of Bandura’s work has focused on the ac- quisition and modification of personality traits in children, particularly as they are affected by observa- tional learning, or modeling, which, he argues, plays a highly significant role in the determination of subse- Albert Bandura (Archives of the History of American quent behavior. Skinner, with their focus on learning through sponsible for building a solid empirical foundation for conditioning and reinforcement. However, it has been the concept of learning through modeling, or imita- demonstrated that punishment and reward can have an tion. His work, focusing particularly on the nature of effect on the modeling situation. A child will more aggression, suggests that modeling plays a highly sig- readily imitate a model who is being rewarded for an nificant role in determining thoughts, feelings, and be- act than one who is being punished. Bandura claims that practically anything that can learn without actually being rewarded or punished can be learned by direct experience can also be learned himself—a concept known as vicarious learning. Dissociative identity disor- der, popularly known as multiple personality, is also Based on his research, Bandura has developed mod- common among abused children. The patient is encouraged to modify his or her behavior by identifying with and im- Detecting and preventing battered child syndrome is itating the behavior of the therapist. Although modeling difficult because society and the courts have traditionally was first studied in relation to children, it has been found left the family alone. Out of fear and guilt, victims rarely to be effective in treating phobias in adults as well. Nearly one-half of child abuse victims are patient watches a model in contact with a feared object, under the age of one and therefore unable to report what at first under relatively non-threatening conditions. The parents or guardians who bring patient is encouraged to perform the same actions as the a battered child to a hospital emergency room rarely model, and the situation is gradually made more threat- admit that abuse has occurred. Instead, they offer compli- ening until the patient is able to confront the feared ob- cated, often obscure, explanations of how the child hurt ject or experience on his or her own. However, a growing body of scientific literature on pediatric injuries is simplifying the process of differ- Bandura has also focused on the human capacity for entiating between intentional and accidental injuries. For symbolization, which can be considered a type of inverse instance, a 1991 study found that a child needs to fall modeling. Using their symbolic capacities, people con- from a height of 10 ft (3m) or more to sustain the life- struct internal models of the world which provide an threatening injuries that accompany physical abuse. Med- arena for planning, problem-solving, and reflection and ical professionals have also learned to recognize a spiral can even facilitate communication with others. Another pattern on x rays of broken bones, indicating that the in- area of social cognition theory explored by Bandura is jury was the result of twisting a child’s limb. He has studied Once diagnosed, the treatment for battered children is the effects of beliefs people have about themselves on based on their age and the potential for the parents or their thoughts, choices, motivation levels, perseverance, guardians to benefit from therapy. Bandura is parents are to entering therapy themselves, the more likely the author of many books, including Adolescent Aggres- the child is to remain in the home. For infants, the treat- sion (1959), Social Learning and Personality (1963), ment ranges from direct intervention and hospital care to Principles of Behavior Modification (1969), Aggression foster care to home monitoring by a social service worker (1973), Social Learning Theory (1977), and Social Foun- or visiting nurse. For the preschool child, treatment usually takes place outside the home, whether in See also Modeling a day care situation, a therapeutic preschool, or through individual therapy. The treatment includes speech and lan- Further Reading guage therapy, physical therapy, play therapy, behavior Decker, Philip J. By the time the child enters school, the physical signs of abuse are less visible. Because these children may not yet realize that their lives are different from those of other children, very few will report that their Battered child syndrome mothers or fathers are subjecting them to gross physical A group of physical and mental symptoms arising injury. It is at this stage that psychiatric and behavioral from long-term physical violence against a child. The treatment, Battered child syndrome occurs as the result of administered through either group or individual therapy, long-term physical violence against a child or adoles- focuses on establishing trust, restoring self-esteem,ex- cent. An estimated 2,000 children die each year in the pressing emotions, and improving cognitive and prob- United States from confirmed cases of physical abuse lem-solving skills. The battering Recognizing and treating physical abuse in the ado- takes many forms, including lacerations, bruises, burns, lescent is by far the most difficult. She devoted her life to documenting and alertness to danger, and/or frequent mood swings. Detec- measuring intellectual and motor development in infants, tion is exacerbated by the fact that all teenagers exhibit children, and adults. Her “Bayley Abused teens do not evoke as much sympathy as Scales of Mental and Motor Development” are used younger victims, for society assumes that they are old throughout the world as standardized measurements of enough to protect themselves or seek help on their own. The abused teen is often resistant to therapy, which may take the form of individual psy- The third of five children of Prudence Cooper and chotherapy, group therapy, or residential treatment. She and her siblings were deliv- While reporting child abuse is essential, false accu- ered by her aunt who had become a country physician sations can also cause great harm. Bayley’s father was head of the anyone who suspects that a child is being physically grocery in a department store in The Dalles. Childhood abused to seek confirmation from another adult, prefer- illness prevented Bayley from attending school until she ably a non-relative but one who is familiar with the fami- was eight, but she quickly made up the missed grades ly. If the second observer concurs, the local child protec- and completed high school in The Dalles. The agency has the authority to verify reports of child abuse and make decisions about protection and intervention. Defines her niche in developmental Unlike many other medical conditions, child abuse psychology is preventable. Family support programs can provide parenting information and training, develop family Although she entered the University of Washington skills, offer social support, and provide psychotherapeu- in Seattle with plans to become an English teacher, Bay- tic assistance before abuse occurs.

The events included employment buy clonidine from india, financial safe 0.1 mg clonidine, housing clonidine 0.1mg free shipping, health, and relationship stressors. The dependent measure in the study was the level of depression reported by the participant, as [18] assessed using a structured interview test (Robins, Cottler, Bucholtz, & Compton, 1995). But for the participants who did not have a short allele, increasing stress did not increase depression (bottom panel). Furthermore, for the participants who experienced 4 stressors over the past 5 years, 33% of the participants who carried the short version of the gene became depressed, whereas only 17% of participants who did not have the short version did. This important study provides an excellent example of how genes and environment work together: An individual‘s response to environmental stress was influenced by his or her genetic makeup. But psychological and social determinants are also important in creating mood disorders and depression. In terms of psychological characteristics, mood states are influenced in large part by our cognitions. Negative thoughts about ourselves and our relationships to others create negative moods, and a goal of cognitive therapy for mood disorders is to attempt to change people‘s Attributed to Charles Stangor Saylor. Negative moods also create negative behaviors toward others, such as acting sad, slouching, and avoiding others, which may lead those others to respond negatively to the person, for instance by isolating that person, which then creates even more depression (Figure 12. You can see how it might become difficult for people to break out of this “cycle of depression. These differences seem to be due to discrepancies between individual feelings and cultural expectations about what one should feel. People from European and American cultures report that it is important to experience emotions such as happiness and excitement, whereas the Chinese report that it is more important to be stable and calm. If the depression continues and becomes even more severe, the diagnosis may become that of major depressive disorder. Give a specific example of the negative cognitions, behaviors, and responses of others that might contribute to a cycle of depression like that shown inFigure 12. Given the discussion about the causes of negative moods and depression, what might people do to try to feel better on days that they are experiencing negative moods? Aspinall, Apsychology of human strengths: Fundamental questions and future directions for a positive psychology (pp. Hedonic tone and activation level in the mood-creativity link: Toward a dual pathway to creativity model. Hippocampal neurogenesis: Opposing effects of stress and antidepressant treatment. Identify the biological and social factors that increase the likelihood that a person will develop schizophrenia. The term schizophrenia, which in Greek means “split mind,‖ was first used to describe a psychological disorder by Eugen Bleuler (1857–1939), a Swiss psychiatrist who was studying patients who had very severe thought disorders. Schizophrenia is a serious psychological disorder marked by delusions, hallucinations, loss of contact with reality, inappropriate affect, disorganized speech, social withdrawal, and deterioration of adaptive behavior. Schizophrenia is the most chronic and debilitating of all psychological disorders. It affects men and women equally, occurs in similar rates across ethnicities and across cultures, and affects at any one time approximately 3 million people in the United States (National Institute of Mental [1] Health, 2010). Onset of schizophrenia is usually between the ages of 16 and 30 and rarely Attributed to Charles Stangor Saylor. Symptoms of Schizophrenia Schizophrenia is accompanied by a variety of symptoms, but not all patients have all of them (Lindenmayer & Khan, 2006). Finally, cognitive symptoms are the changes in cognitive processes that accompany schizophrenia (Skrabalo, 2000). Auditory hallucinations are the most common and are reported by approximately three quarters [6] of patients (Nicolson, Mayberg, Pennell, & Nemeroff, 2006). Schizophrenic patients frequently report hearing imaginary voices that curse them, comment on their behavior, order them to do [7] things, or warn them of danger (National Institute of Mental Health, 2009). Visual hallucinations are less common and frequently involve seeing God or the devil (De Sousa, [8] 2007). Schizophrenic people also commonly experience delusions, which are false beliefs not commonly shared by others within one’s culture, and maintained even though they are obviously out of touch with reality. People with delusions of grandeur believe that they are important, famous, or powerful. They often become convinced that they are someone else, such as the president or God, or that they have some special talent or ability. Some claim to have been assigned to a [9] special covert mission (Buchanan & Carpenter, 2005). People with delusions of persecution believe that a person or group seeks to harm them. They may think that people are [10] able to read their minds and control their thoughts (Maher, 2001). If a person suffers from delusions of persecution, there is a good chance that he or she will become violent, and this [11] violence is typically directed at family members (Buchanan & Carpenter, 2005). People suffering from schizophrenia also often suffer from the positive symptom of derailment—the shifting from one subject to another, without following any one line of thought to conclusion—and may exhibit grossly disorganized behavior including inappropriate sexual behavior, peculiar appearance and dress, unusual agitation (e. Movement disorders typically appear as agitated movements, such as repeating a certain motion again and again, but can in some cases include catatonia, a state in which a person does not move and is unresponsive to others (Janno, Holi, Tuisku, & Wahlbeck, [12] 2004; Rosebush & Mazurek, 2010). Patients often suffer from flat affect, which means that they express almost no emotional response (e. Another negative symptom is the tendency toward incoherent language, for instance, to repeat the speech of others (“echo speech‖). Some schizophrenics experience motor disturbances, ranging from complete catatonia and apparent obliviousness to their environment to random and frenzied motor activity during which they become hyperactive [15] and incoherent (Kirkpatrick & Tek, 2005). Not all schizophrenic patients exhibit negative symptoms, but those who do also tend to have the [16] poorest outcomes (Fenton & McGlashan, 1994). Negative symptoms are predictors of deteriorated functioning in everyday life and often make it impossible for sufferers to work or to care for themselves. Cognitive symptoms of schizophrenia are typically difficult for outsiders to recognize but make it extremely difficult for the sufferer to lead a normal life. These symptoms include difficulty comprehending information and using it to make decisions (the lack of executive control), difficulty maintaining focus and attention, and problems with working memory (the ability to use information immediately after it is learned). Rather, a variety of biological and environmental risk factors interact in a complex way to increase the likelihood that someone might develop [17] schizophrenia (Walker, Kestler, Bollini, & Hochman, 2004). Studies in molecular genetics have not yet identified the particular genes responsible for schizophrenia, but it is evident from research using family, twin, and adoption studies that [18] genetics are important (Walker & Tessner, 2008). Neuroimaging studies have found some differences in brain structure between schizophrenic and normal patients. In some people with schizophrenia, the cerebral ventricles (fluid-filled spaces in [19] the brain) are enlarged (Suddath, Christison, Torrey, Casanova, & Weinberger, 1990). People with schizophrenia also frequently show an overall loss of neurons in the cerebral cortex, and some show less activity in the frontal and temporal lobes, which are the areas of the brain involved in language, attention, and memory. This would explain the deterioration of functioning Attributed to Charles Stangor Saylor.

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