By B. Tyler. The Stefan University. 2019.
Note: If criteria are met prior to the onset of Schizophrenia purchase kamagra polo line, add "Premorbid purchase kamagra polo 100mg amex," e cheap kamagra polo 100 mg mastercard. Although people with Schizoid Personality Disorder do not have Schizophrenia kamagra polo 100 mg with mastercard, it appears that many of the same risk factors in Schizophrenia also apply to Schizoid Personality Disorder. For comprehensive information on schizoid personality and other forms of personality disorders, visit the Personality Disorders Community. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Merck Manual, Home Edition for Patients and Caregivers, last revised 2006. Restructuring Personality Disorders: A Short-Term Dynamic Approach. Full description of Social Phobia (Social Anxiety Disorder, SAD). Definition, signs, symptoms, and causes of Social Anxiety Disorder, Social Phobia. Social Anxiety Disorder is the third most common psychiatric disorder in America behind depression and alcohol abuse. At some point in their life, 7-13% of American adults suffer from social anxiety disorder. It affects men and women equally and children and teens who are very "social status" conscious are especially susceptible to SAD. Some people are shy by nature and, early in life, show timidness that later develops into social phobia. Others first experience anxiety in social situations around the time of puberty. People with social phobia are concerned that their performance or actions will seem inappropriate. Often they worry that their anxiety will be obvious - that they will sweat, blush, vomit, or tremble or that their voice will quaver. They also worry that they will lose their train of thought or that they will not be able to find the words to express themselves. Some social phobias are tied to specific performance situations, producing anxiety only when the people must perform a particular activity in public. The same activity performed alone produces no anxiety. Situations that commonly trigger anxiety among people with social phobia include the following:Performing publicly, such as reading in church or playing a musical instrumentSigning a document before witnessesA more general type of social phobia is characterized by anxiety in many social situations. A marked and persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears that he or she will act in a way (or show anxiety symptoms) that will be humiliating or embarrassing. Note: In children, there must be evidence of the capacity for age-appropriate social relationships with familiar people and the anxiety must occur in peer settings, not just in interactions with adults. Exposure to the feared social situation almost invariably provokes anxiety, which may take the form of a situationally bound or situationally predisposed Panic Attack. Note: In children, the anxiety may be expressed by crying, tantrums, freezing, or shrinking from social situations with unfamiliar people. The person recognizes that the fear is excessive or unreasonable. The feared social or performance situations are avoided or else are endured with intense anxiety or distress. In individuals under age 18 years, the duration is at least 6 months. The fear or avoidance is not due to the direct physiological effects of a substance (e. If a general medical condition or another mental disorder is present, the fear in Criterion A is unrelated to it, e. At this point, there are two primary theories:Environmental Exposure: People with social phobia may acquire their fear from observing the behavior and consequences of others, a process called observational learning or social modeling. Earlier Negative Social Consequences: Being the victim of bullying, facing a particularly embarrassing situation in public, having a disability or being disfigured and being teased or extremely self-conscious about it. Other possible causes of social phobia include:an overactive amygdala, the part of the brain that controls fear responsesa brain chemical imbalancegenetics may play a relatively minor roleFor comprehensive information on social phobia and other forms of anxiety, visit the Anxiety-Panic Community. Exposure to the phobic stimulus almost invariably provokes an immediate anxiety response, which may take the form of a situationally bound or situationally predisposed Panic Attack. Note: In children, the anxiety may be expressed by crying, tantrums, freezing, or clinging. The person recognizes that the fear is excessive or unreasonable. The phobic situation(s) is avoided or else is endured with intense anxiety or distress. In individuals under age 18 years, the duration is at least 6 months. The anxiety, Panic Attacks, or phobic avoidance associated with the specific object or situation are not better accounted for by another mental disorder, such as Obsessive-Compulsive Disorder (e. Besides a familial history of anxiety disorders, it may by also true that human beings are biologically prone to acquire fear of certain animals or situations, such as rats, poisonous animals, animals with disgusting appearance, such as frogs, slugs or cockroaches, etc. Fear of certain situations or things can also be the result of learned experiences from child or adulthood. Traumatic events often trigger the development of specific phobias. For comprehensive information on specific (simple) phobia and other forms of anxiety, visit the Anxiety-Panic Community. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Merck Manual, Home Edition for Patients and Caregivers, last revised 2006. Fighting Phobias, The Things That Go Bump in the Mind. In the past 20 years especially, psychiatric research has made great strides in the precise diagnosis and successful treatment of many mental illnesses. Where once mentally ill people were warehoused in public institutions because they were disruptive or feared to be harmful to themselves or others, today most people who suffer from a mental illness--including those that can be extremely debilitating, such as schizophrenia --can be treated effectively and lead full lives. Recognized mental illnesses are described and categorized in the book Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. This book is compiled by the American Psychiatric Association and updated periodically. It can be purchased through the American Psychiatric Press Inc. For comprehensive information on mental illness, here is the Mental Illness Table of Contents with all the information you need to know. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Overview of depression, anxiety, schizophrenia and substance abuse. When people hear the phrase "mental illnesses," often they will conjure up the images of a person tortured by the demons only he or she sees, or by the voices no one else hears. This, of course, is the version of mental illnesses that most of us have developed from movies and literature. Films and books trying to create dramatic effect often rely on the extraordinary symptoms of psychotic illnesses like schizophrenia, or they draw on outmoded descriptions of mental illnesses that were evolved during a time when no one had any idea what caused them. Few who have seen these characterizations ever realize that people suffering even from the most severe mental illnesses actually are in touch with reality as often as they are disabled by their illnesses. Moreover, few mental illnesses have hallucinations as symptoms.
According to the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) discount kamagra polo 100 mg amex, episodes must last a minimum length of time:Two weeks for depressionWhile those are minimum lengths of time safe 100mg kamagra polo, many people with bipolar disorder spend more order 100mg kamagra polo, sometimes considerably more time in an episode purchase kamagra polo visa. Between episodes, there may be periods of normalcy (without an elevated or depressed mood). Rapid cycling bipolar disorder is the dramatic speeding up of these cycles. While the DSM-IV-TR only defines one type of rapid cycling, particularly short cycles are also known to occur. Ultra-rapid cycling denotes episodes only lasting days and ultradian indicates multiple episodes per day. Rapid cycling bipolar disorder can be more difficult to detect than standard bipolar disorder as patients, particularHTTP/1. Manic symptoms are some of the most devastating in bipolar disorder and often land patients in the hospital. Bipolar mania is associated with bipolar I, where the person experiences both the highs and depressed lows. Bipolar manic symptoms include:expansiveness (acting in a larger-than-life manner)Other manic symptoms required for diagnosis include at least three of the following: A large sense of self; overwhelming and unrealistic self-esteemRapid, incessant, excessive talkingRapid and rapidly changing thoughtsBeing easily distractedExcessively engaging in pleasurable activities like sex, spending sprees, gambling; often with negative consequencesIncreasein goal-focused activity at home, at work, or sexuallyIn order to be diagnosed with bipolar disorder mania, these symptoms cannot otherwise be explained by substance abuse or another illness. Some manic symptoms sound pleasurable and can even be perceived that way by the person with bipolar disorder. However, the problem with bipolar disorder mania is that the behaviors and thoughts are taken too far to the extreme and result in dangerous consequences. It is common for bipolar manic symptoms to include the feeling of god-like power. The person feels that they can control everything around them or have a direct line to god. The person may start preaching his perceived powers or do things to prove his powers such as attempt to fly by jumping from a roof. Gambling and spending sprees, as a result of bipolar mania, often leave a person with huge bills and no way to pay them. Manic episodes are a period of extremely elevated mood and are required for a diagnosis of bipolar disorder type 1. Bipolar manic episodes are not just feeling "good" or "high," they are moods that are beyond reason and cause major distress and life impairment. Some of the symptoms of a manic episode include:Extreme, grandiose self-esteem; a perceived connection with god; belief in god-like powersExtreme elation or irritabilitySpending or gambling sprees, drug use, dramatic increase in sexual behaviorA rapid stream of ideas thought to be brilliantEither behavior with extreme focus on goals or complete distractibilityNot sleeping, or sleeping very littleThis mood must be present for at least one week and not be explainable by drug abuse or any other illness in order to be diagnosed as a manic episode. Manic episodes may be brought on by stressful life events, lack of sleep, drug use, medication changes or nothing at all. Because manic episodes can cause great elation or great irritability, manic episodes can be perceived as pleasant or unpleasant. For some with a grandiose, elated mood, a manic episode is a pleasurable experience. They feel very good about themselves and engage in pleasurable behavior, like spending money or having sex. They believe they are extremely creative and intelligent and can constantly create with no need for sleep. For some though, and sometimes within the same manic episode, a person feels extremely irritable with all those around them. They may feel special and brilliant but be extremely annoyed with others for not understanding their genius. Someone in a manic episode may be particularly angry if their goal-directed behavior is interrupted. The longer someone is in a manic episode, the more likely they are to become irritable. This irritability feels uncontrollable and can increase to rage. Those in a bipolar manic episode often endanger themselves because of these behaviors and require emergency intervention. The energy felt inside a manic episode is seen on the outside too. People in bipolar manic episodes are often "buzzing" about the room, moving and talking quickly, often going from one idea, or one person, to another. They can be seen laughing and smiling without cause. Three-quarters of manic episodes involve delusions wherein the person truly believes in ideas beyond reason or logic. This is often seen as they brag about impossible abilities, god-like power or creative genius. They may defend themselves violently if they feel threatened. Manic episodes may even, very rarely, result in homicide. Other outward cues of a manic episode include:Clothes put on in haste, disheveledUnusual clothing that attracts attentionMay be openly combative and aggressive with no tolerance for anyoneMaking bad decisions in all aspects of life; no insightHTTP/1. A cycling mood disorder has been written about as a clear mental illness since early Chinese authors and was described by the encyclopedist Gao Lian in the late 16th century. German psychiatrist Emil Kraepelin developed the term "manic depressive psychosis" in the early 20th century. This term made the most sense at the time as the illness has episodes of mania and episodes of depression. Manic depressive disorder was defined in the mid-20th century as cycling periods of mania, depression and normal functioning. Around 1957, the term "bipolar" was first used and subclassifications of the illness began to appear combining these states:Mania ??? a state of abnormally elevated or irritable mood, arousal and/or energy levels. Hypomania ??? a state of abnormally elevated or irritable mood, arousal and/or energy levels. Depression ??? a state of abnormally low mood, arousal and/or energy levels. Manic depressive illness is sometimes still preferred, particularly over bipolar type 1, as it indicates the constantly changing mood present in the illness. Bipolar type 2 consists of periods of depression and hypomania, rather than mania. Where once there were average periods of happiness and sadness common through life, there now is mania and depression for the manic depressive. During a manic state, life may appear to be perfect to a manic depressive. The patient feels like they are on top of the world, can talk to god or perhaps even have godlike powers themselves. The manic depressive feels no need to sleep or eat and never gets tired. The patient feels brilliant and talks non-stop in a steady stream of ever-changing ideas. A manic depressive may even become paranoid and psychotic and think they are being communicated to through inanimate objects. This manic state spirals out of control often leading to drinking, gambling and sex binges and puts the manic depressive and those around them in danger as the patient engages in risky behavior like driving while intoxicated or believing they can fly. Manic depressive symptoms include heavy sadness, constant crying, worrying, guilt and shame. A patient may not want to get out of bed and may sleep for most of the day. The manic depressive looses all ability to feel pleasure, retreats from life and those around them. The depression may include psychosis where the manic depressive believes people are out to get him or her and they may cease leaving their house entirely. Either mania or depression can impact a manic depressive life to the point where they lose their job, friends and even family. In very severe cases of manic depressive disorder the patient may be hospitalized due to the concern that they may harm themselves or others.
Given the 24 hour elimination half-life of ZOLOFT purchase kamagra polo toronto, dose changes should not occur at intervals of less than 1 week discount 100mg kamagra polo overnight delivery. Maintenance/Continuation/Extended Treatment Major Depressive Disorder -It is generally agreed that acute episodes of major depressive disorder require several months or longer of sustained pharmacologic therapy beyond response to the acute episode buy kamagra polo 100mg free shipping. Systematic evaluation of ZOLOFT has demonstrated that its antidepressant efficacy is maintained for periods of up to 44 weeks following 8 weeks of initial treatment at a dose of 50-200 mg/day (mean dose of 70 mg/day) (see Clinical Trials under CLINICAL PHARMACOLOGY ) purchase discount kamagra polo on line. It is not known whether the dose of ZOLOFT needed for maintenance treatment is identical to the dose needed to achieve an initial response. Patients should be periodically reassessed to determine the need for maintenance treatment. Posttraumatic Stress Disorder -It is generally agreed that PTSD requires several months or longer of sustained pharmacological therapy beyond response to initial treatment. Systematic evaluation of ZOLOFT has demonstrated that its efficacy in PTSD is maintained for periods of up to 28 weeks following 24 weeks of treatment at a dose of 50-200 mg/day (see Clinical Trials under CLINICAL PHARMACOLOGY ). It is not known whether the dose of ZOLOFT needed for maintenance treatment is identical to the dose needed to achieve an initial response. Patients should be periodically reassessed to determine the need for maintenance treatment. Social Anxiety Disorder -Social anxiety disorder is a chronic condition that may require several months or longer of sustained pharmacological therapy beyond response to initial treatment. Systematic evaluation of ZOLOFT has demonstrated that its efficacy in social anxiety disorder is maintained for periods of up to 24 weeks following 20 weeks of treatment at a dose of 50-200 mg/day (see Clinical Trials under CLINICAL PHARMACOLOGY ). Dosage adjustments should be made to maintain patients on the lowest effective dose and patients should be periodically reassessed to determine the need for long-term treatment. Obsessive-Compulsive Disorder and Panic Disorder -It is generally agreed that OCD and Panic Disorder require several months or longer of sustained pharmacological therapy beyond response to initial treatment. Systematic evaluation of continuing ZOLOFT for periods of up to 28 weeks in patients with OCD and Panic Disorder who have responded while taking ZOLOFT during initial treatment phases of 24 to 52 weeks of treatment at a dose range of 50-200 mg/day has demonstrated a benefit of such maintenance treatment (see Clinical Trials under CLINICAL PHARMACOLOGY ). It is not known whether the dose of ZOLOFT needed for maintenance treatment is identical to the dose needed to achieve an initial response. Nevertheless, patients should be periodically reassessed to determine the need for maintenance treatment. Premenstrual Dysphoric Disorder -The effectiveness of ZOLOFT in long-term use, that is, for more than 3 menstrual cycles, has not been systematically evaluated in controlled trials. However, as women commonly report that symptoms worsen with age until relieved by the onset of menopause, it is reasonable to consider continuation of a responding patient. Dosage adjustments, which may include changes between dosage regimens (e. Switching Patients to or from a Monoamine Oxidase Inhibitor -At least 14 days should elapse between discontinuation of an MAOI and initiation of therapy with ZOLOFT. In addition, at least 14 days should be allowed after stopping ZOLOFT before starting an MAOI (see CONTRAINDICATIONS and WARNINGS ). Dosage for Hepatically Impaired Patients -The use of sertraline in patients with liver disease should be approached with caution. The effects of sertraline in patients with moderate and severe hepatic impairment have not been studied. If sertraline is administered to patients with liver impairment, a lower or less frequent dose should be used (see CLINICAL PHARMACOLOGY and PRECAUTIONS ). Treatment of Pregnant Women During the Third Trimester -Neonates exposed to ZOLOFT and other SSRIs or SNRIs, late in the third trimester have developed complications requiring prolonged hospitalization, respiratory support, and tube feeding (see PRECAUTIONS ). When treating pregnant women with ZOLOFT during the third trimester, the physician should carefully consider the potential risks and benefits of treatment. The physician may consider tapering ZOLOFT in the third trimester. Discontinuation of Treatment with Zoloft Symptoms associated with discontinuation of ZOLOFT and other SSRIs and SNRIs, have been reported (see PRECAUTIONS ). Patients should be monitored for these symptoms when discontinuing treatment. A gradual reduction in the dose rather than abrupt cessation is recommended whenever possible. If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, then resuming the previously prescribed dose may be considered. Subsequently, the physician may continue decreasing the dose but at a more gradual rate. ZOLOFT Oral Concentrate contains 20 mg/mL of sertraline (as the hydrochloride) as the active ingredient and 12% alcohol. Just before taking, use the dropper provided to remove the required amount of ZOLOFT Oral Concentrate and mix with 4 oz (1/2 cup) of water, ginger ale, lemon/lime soda, lemonade or orange juice ONLY. Do not mix ZOLOFT Oral Concentrate with anything other than the liquids listed. At times, a slight haze may appear after mixing; this is normal. Note that caution should be exercised for patients with latex sensitivity, as the dropper dispenser contains dry natural rubber. ZOLOFT Oral Concentrate is contraindicated with ANTABUSE (disulfiram) due to the alcohol content of the concentrate. ZOLOFT^ (sertraline hydrochloride) capsular-shaped scored tablets, containing sertraline hydrochloride equivalent to 25, 50 and 100 mg of sertraline, are packaged in bottlesZOLOFT^ 25 mg Tablets: light green film coated tablets engraved on one side with ZOLOFT and on the other side scored and engraved with 25 mg. ZOLOFT^ 50 mg Tablets: light blue film coated tablets engraved on one side with ZOLOFT and on the other side scored and engraved with 50 mg. Unit Dose Packages of 100ZOLOFT^ 100 mg Tablets: light yellow film coated tablets engraved on one side with ZOLOFT and on the other side scored and engraved with 100 mg. Store at 25`C (77`F); excursions permitted to 15` - 30`C (59` - 86`F)[see USP Controlled Room Temperature]. ZOLOFT - Oral Concentrate: ZOLOFT Oral Concentrate is a clear, colorless solution with a menthol scent containing sertraline hydrochloride equivalent to 20 mg of sertraline per mL and 12% alcohol. It is supplied as a 60 mL bottle with an accompanying calibrated dropper. Store at 25`C (77`F); excursions permitted to 15` - 30`C (59` - 86`F) [see USP Controlled Room Temperature]. Panic attack treatment varies from person to person, but usually includes panic attack medication for prevention and immediate relief of symptoms; and therapy to help the patient learn to cope with triggers and relax the body and mind. Treatment strategies have the most success when patients are given both medication and therapy for panic attacks together. Anti-anxiety medications and antidepressants are used as treatment for panic attacks. Physicians prescribe sedatives and anti-anxiety medications for immediate relief of symptoms during the middle of an attack. During a full-blown attack, anti-anxiety drugs provide relatively rapid relief of symptoms and have a calming effect. Because of the danger of dependence and severity of withdrawal symptoms, doctors usually only prescribe these for the short-term at the beginning of panic attack treatment. Antidepressants, on the other hand, do not carry a risk of dependence; therefore, act as a first line panic attack medication that patients can use for the long term. These work to reduce severity and frequency of your panic attacks as well as prevent the anxieties and fears that trigger your attacks. Common antidepressants used for panic attack medication include those from the class of drugs called selective serotonin reuptake inhibitors (SSRIs). These include: paroxetine (Paxil^) fluoxetine (Prozac^), setraline (Zoloft^), citalopram (Celexa^), and escitalopram oxalate (Lexapro^). In many cases, panic attack therapy can clear up the disorder without the use of drugs. Psychotherapy works well for preventing attacks and maintaining coping skills that work to stave them off. Cognitive-behavioral therapy helps you learn to cope with symptoms of a panic attack. This highly effective method of panic attack therapy teaches you techniques, such as meditative breathing, muscle relaxation, and how to use relaxing thought processes. Another effective panic attack therapy is called exposure therapy. With exposure therapy, the therapist exposes you to the very situations that you avoid for fear of having another panic attack. With exposure therapy, your therapist may eventually ask you to go to the grocery store and confront your fears, or she may tell you to imagine going there and describe all of your feelings.
Moderate to large amounts of alcohol may increase the risk of hypoglycemia (ref cheap kamagra polo uk. Certain drugs tend to produce hyperglycemia and may lead to loss of control purchase kamagra polo from india. These drugs include the thiazides and other diuretics cheap 100mg kamagra polo fast delivery, corticosteroids purchase kamagra polo canada, phenothiazines, thyroid products, estrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics, calcium channel blocking drugs, and isoniazid. When such drugs are administered to a patient receiving Diabinese, the patient should be closely observed for loss of control. When such drugs are withdrawn from a patient receiving Diabinese, the patient should be observed closely for hypoglycemia. Since animal studies suggest that the action of barbiturates may be prolonged by therapy with chlorpropamide, barbiturates should be employed with caution. Studies with Diabinese have not been conducted to evaluate carcinogenic or mutagenic potential. Rats treated with continuous Diabinese therapy for 6 to 12 months showed varying degrees of suppression of spermatogenesis at a dose level of 250 mg/kg (five times the human dose based on body surface area). The extent of suppression seemed to follow that of growth retardation associated with chronic administration of high-dose Diabinese in rats. The human dose of chlorpropamide is 500 mg/day (300 mg/M2). Six- and 12-month toxicity work in the dog and rat, respectively, indicates the 150 mg/kg is well tolerated. Therefore, the safety margins based upon body-surface-area comparisons are three times human exposure in the rat and 10 times human exposure in the dog. Animal reproductive studies have not been conducted with Diabinese. It is also not known whether Diabinese can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. Diabinese should be given to a pregnant woman only if the potential benefits justify the potential risk to the patient and fetus. Because data suggest that abnormal blood glucose levels during pregnancy are associated with a higher incidence of congenital abnormalities, many experts recommend that insulin be used during pregnancy to maintain blood glucose levels as close to normal as possible. Prolonged severe hypoglycemia (4 to 10 days) has been reported in neonates born to mothers who were receiving a sulfonylurea drug at the time of delivery. This has been reported more frequently with the use of agents with prolonged half-lives. If Diabinese is used during pregnancy, it should be discontinued at least one month before the expected delivery date and other therapies instituted to maintain blood glucose levels as close to normal as possible. An analysis of a composite of two samples of human breast milk, each taken five hours after ingestion of 500 mg of chlorpropamide by a patient, revealed a concentration of 5 mcg/mL. For reference, the normal peak blood level of chlorpropamide after a single 250 mg dose is 30 mcg/mL. Therefore, it is not recommended that a woman breast feed while taking this medication. The effect of Diabinese on the ability to drive or operate machinery has not been studied. However, there is no evidence to suggest that Diabinese may affect these abilities. Patients should be aware of the symptoms of hypoglycemia and take caution while driving and operating machinery. Disulfiram-like reactions have rarely been reported with Diabinese (see DRUG INTERACTIONS ). Gastrointestinal disturbances are the most common reactions; nausea has been reported in less than 5% of patients, and diarrhea, vomiting, anorexia, and hunger in less than 2%. Other gastrointestinal disturbances have occurred in less than 1% of patients including proctocolitis. They tend to be dose-related and may disappear when dosage is reduced. Cholestatic jaundice may occur rarely; Diabinese should be discontinued if this occurs. Hepatic porphyria and disulfiram-like reactions have been reported with Diabinese. Pruritus has been reported in less than 3% of patients. These may be transient and may disappear despite continued use of Diabinese; if skin reactions persist the drug should be discontinued. As with other sulfonylureas, porphyria cutanea tarda and photosensitivity reactions have been reported. Skin eruptions rarely progressing to erythema multiforme and exfoliative dermatitis have also been reported. Leukopenia, agranulocytosis, thrombocytopenia, hemolytic anemia (see PRECAUTIONS ), aplastic anemia, pancytopenia, and eosinophilia have been reported with sulfonylureas. Hypoglycemia (see PRECAUTIONS and OVERDOSAGE sections). Hepatic porphyria and disulfiram-like reactions have been reported with Diabinese. On rare occasions, chlorpropamide has caused a reaction identical to the syndrome of inappropriate antidiuretic hormone (ADH) secretion. The features of this syndrome result from excessive water retention and include hyponatremia, low serum osmolality, and high urine osmolality. This reaction has also been reported for other sulfonylureas. Overdosage of sulfonylureas including Diabinese can produce hypoglycemia. Mild hypoglycemic symptoms without loss of consciousness or neurologic findings should be treated aggressively with oral glucose and adjustments in drug dosage and/or meal patterns. Close monitoring should continue until the physician is assured that the patient is out of danger. Severe hypoglycemic reactions with coma, seizure, or other neurological impairment occur infrequently, but constitute medical emergencies requiring immediate hospitalization. If hypoglycemic coma is diagnosed or suspected, the patient should be given a rapid intravenous injection of concentrated (50%) glucose solution. This should be followed by a continuous infusion of a more dilute (10%) glucose solution at a rate that will maintain the blood glucose at a level above 100 mg/dL. Patients should be closely monitored for a minimum of 24 to 48 hours since hypoglycemia may recur after apparent clinical recovery. There is no fixed dosage regimen for the management of type 2 diabetes with Diabinese or any other hypoglycemic agent. Short-term administration of Diabinese may be sufficient during periods of transient loss of control in patients usually controlled well on diet. The total daily dosage is generally taken at a single time each morning with breakfast. Occasionally cases of gastrointestinal intolerance may be relieved by dividing the daily dosage. A LOADING OR PRIMING DOSE IS NOT NECESSARY AND SHOULD NOT BE USED. The mild to moderately severe, middle-aged, stable type 2 diabetes patient should be started on 250 mg daily. In elderly patients, debilitated or malnourished patients, and patients with impaired renal or hepatic function, the initial and maintenance dosing should be conservative to avoid hypoglycemic reactions (see PRECAUTIONS section). Older patients should be started on smaller amounts of Diabinese, in the range of 100 to 125 mg daily. No transition period is necessary when transferring patients from other oral hypoglycemic agents to Diabinese. The other agent may be discontinued abruptly and chlorpropamide started at once. In prescribing chlorpropamide, due consideration must be given to its greater potency.