By O. Bengerd. Atlantic Union College.

Nicotine chewing gum (Nicorette order 25 mg persantine fast delivery, others) is one medication approved by the Food and Drug Administration (FDA) for the treatment of nicotine dependence persantine 100 mg lowest price. Nicotine in this form acts as a nicotine replacement to help smokers quit smoking discount 25mg persantine otc. The success rates for smoking cessation treatment with nicotine chewing gum vary considerably across studies cheap persantine 100mg mastercard, but evidence suggests that it is a safe means of facilitating smoking cessation if chewed according to instructions and restricted to patients who are under medical supervision. Nicotine lozenge (Commit) is a tablet that dissolves in your mouth and, like nicotine gum, delivers nicotine through the lining of your mouth. The lozenges are also available in 2- and 4-milligram doses. The recommended dose is one lozenge every couple of hours for six weeks, then gradually increasing the intervals between lozenges over the next six weeks. Another approach to smoking cessation is the nicotine transdermal patch (Nicoderm CQ, Nicotrol, Habitrol, others), a skin patch that delivers a relatively constant amount of nicotine to the person wearing it. Both nicotine gum and the nicotine patch, as well as other nicotine replacements such as sprays and inhalers, are used to help people fully quit smoking by reducing withdrawal symptoms and preventing relapse while undergoing behavioral treatment. The nicotine in this product, sprayed directly into each nostril, is absorbed through your nasal membranes into veins, transported to your heart and then sent to your brain. This device is shaped something like a cigarette holder. You puff on it, and it gives off nicotine vapors in your mouth. You absorb the nicotine through the lining in your mouth, where it then enters your bloodstream and goes to your brain, relieving nicotine withdrawal symptoms. There are other medications to help you in your efforts to quit smoking, but they should be used in conjunction with a behavior modification program. One tool in treating tobacco and nicotine addiction is the antidepressant medication bupropion, that goes by the trade name Zyban. This is not a nicotine replacement, as are the gum and patch. Rather, this works on other areas of the brain, and its effectiveness is in helping to make nicotine craving, or thoughts about cigarette use, more controllable in people who are trying to quit. As with many medications, bupropion (Zyban) has side effects, including sleep disturbance and dry mouth. Another antidepressant that may help is nortriptyline (Aventyl, Pamelor ). Potential side effects include headache, nausea, an altered sense of taste and strange dreams. The nicotine conjugate vaccine (NicVax) is under investigation in clinical trials. This vaccine causes the immune system to develop antibodies to nicotine. These antibodies then catch nicotine as it enters the bloodstream and prevent the nicotine from reaching the brain, effectively blocking the effects of nicotine. Your doctor may also be able to recommend local support groups or smoking cessation programs. Additionally, some people find that a form of counseling called behavior therapy can help them come up with productive ways to change the behaviors and thoughts associated with smoking. These are the nicotine articles on the HealthyPlace website. These articles on nicotine addiction are designed to help you understand the problem and treat it. In-depth information on prescription drug abuse and addiction. Signs and symptoms of addiction to painkillers and other medications. Treatments for addiction to prescription medications. Recent news stories have highlighted the increasing number of teens and adults abusing prescription drugs, particularly painkillers. While overall youth drug use is down by 23 percent since 2001, approximately 6. New abusers of prescription drugs have caught up with the number of new people that use marijuana. Much of this abuse appears to be fueled by the relative ease of access to prescription drugs. Approximately 60 percent of people who abuse prescription pain killers indicate that they got their prescription drugs from a friend or relative for free. These same medications when taken inappropriately can cause addiction (characterized by compulsive drug seeking and use) as they act on the same places in the brain as heroin does. Prescription drugs that are abused or used for nonmedical reasons can alter brain activity and lead to dependence. Commonly abused classes of prescription drugs include:opioids (often prescribed to treat pain)central nervous system depressants (often prescribed to treat anxiety and sleep disorders)stimulants (prescribed to treat narcolepsy, ADHD, and obesity)hydromorphone (Dilaudid)Common central nervous system depressants include barbiturates such as pentobarbital sodium (Nembutal), and benzodiazepines such as: diazepam ( Valium ) and alprazolam ( Xanax ). Long-term use of opioids or central nervous system depressants can lead to physical dependence and addiction. Taken in high doses, stimulants can lead to compulsive use, paranoia, dangerously high body temperatures, and irregular heartbeat. Some people mistakenly think that prescription drugs are more powerful because you need a prescription for them. For example, dextromethorphan (DXM) is found in some OTC cough medicines. When someone takes the number of teaspoons or tablets that are recommended, everything is fine. But high doses can cause problems with the senses (especially vision and hearing) and can lead to confusion, stomach pain, numbness, and even hallucinations. National Institute on Drug Abuse, Prescription Drugs: Abuse and Addiction, August 2005The White House Office of National Drug Control Policy, Press Release dated Feb. One of the main signs of a prescription drug addiction is that the user develops an increased tolerance for the drug. When a person increases their tolerance for a prescription drug, more and more of the drug is required to get the desired effects. Physical dependence is another primary symptom of prescription drug addiction. Physical dependence is when a person needs a certain amount of the prescription drug in their system in order to function normally. The body adapts to the drug and needs it to perform. Withdrawal symptoms often occur when an addict quits using the prescription drug. Here are some other common symptoms of prescription drug abuse or addiction:Hyperactive, increased alertnessExcessive sweating, urination or thirstUncontrollable diarrheaDrowsiness, dizziness and insomniaUnpleasant or painful symptoms when substance is withdrawnJust like illegal drugs, prescription drugs also have numerous side effects and toxicity from these drugs is common. Like all individuals who abuse illicit drugs, individuals who abuse prescription drugs also deny that they have a problem. The majority of these individuals have medical conditions which are obvious but the prescription drug problem is hidden. The majority of these individuals may have social, emotional problems, stress, depression, anxiety, financial woes or familial problems. A gradual change in these individuals may give a hint to their problem of prescription drug abuse. These changes include:declining interest in healthdecreased interest in schoolisolation from family and old friendswithdraws from social activitiesThe health risks associated with prescription drug abuse vary depending on the agent. Each class of drugs has its own particular set of side effects but in general the majority of prescription drugs can cause the following side effects:Side effects of Opioids (respiratory depression, low BP, nausea, vomiting)Side effects of Benzodiazepines (sedation, coma, decreased respiration, lethargy, mental confusion)Side effects of Stimulants (fever, fast heart rate, increased BP, seizures)Substance Abuse and Mental Health Services Administration, National Survey on Drug Use and Health: Nonmedical Users of Pain Relievers: Characteristics of Recent Initiates (PDF), 2006Substance Abuse and Mental Health Services Administration, Results from the 2005 National Survey on Drug Use and Health: National Findings, September 2006National Institute on Drug Abuse and University of Michigan, 2006 Monitoring the Future Drug Data Tables, December 200620 questions to help determine if you have a problem with prescription drug abuse or addiction. If you are unsure whether you have a problem with prescription drugs, here are 20 questions that will help you decide whether to seek professional help for prescription medication abuse or addiction:Has your doctor, spouse or anyone else expressed concern about your use of medications? Have you ever decided to stop taking pills only to find yourself taking them again contrary to your previous decision? Have you ever felt remorse or concern about taking pills? Has your efficiency or ambition decreased since taking pills? Have you established a supply for your purse or pocket or to hide away in case of emergency?

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One theory suggests that people with Dependent Personality Disorder have a biological tendency toward anxiety and pessimistic expectations and that purchase 25mg persantine free shipping, as a young child proven persantine 100 mg, their parents or primary caretaker encouraged reliance on others and cautioned against independent thinking and behavior purchase persantine 100mg without prescription. Caretakers may foster dependence in the child to meet their own dependency needs generic persantine 25mg overnight delivery, and may reward extreme loyalty but reject attempts the child makes towards independence. Families of those with dependent personality disorder often do not express their emotions and are controlling; they demonstrate poorly defined relational roles within the family unit. For comprehensive information on dependent and other personality disorders, visit the Personality Disorders Community. Full description of Dissociative Identity Disorder (DID). Definition, signs, symptoms, causes of Dissociative Identity Disorder. People with this disorder are prone to injuring themselves. Some personalities appear to know and interact with one another in an elaborate inner world. Other personalities may or may not be aware of personality B, and personality B may or may not be aware of them. Because the personalities often interact with each other, people with dissociative personality disorder report hearing inner conversations and the voices of other personalities commenting on their behavior or addressing them. They experience distortion of time, with time lapses and amnesia. They often have concern with issues of control, both self-control and the control of others. In addition, people with dissociative identity disorder tend to develop severe headaches or other bodily pain and may experience sexual dysfunction. Different clusters of symptoms occur at different times. The presence of two or more distinct identities or personality states (each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self). Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness. The disturbance is not due to the direct physiological effects of a substance (e. Note: In children, the symptoms are not attributable to imaginary playmates or other fantasy play. According to the Merck Manual, Dissociative Identity Disorder appears to be caused by the interaction of several factors. About 97 to 98% of adults with dissociative identity disorder report having been abused during childhood. For comprehensive information on dissociative identity disorder (DID), visit the Dissociative Disorders Center in the Abuse Community. Definition, signs, symptoms, and causes of Dysthymia. Dysthymia is a chronic form of depression, but is milder in severity than major depression. People who suffer from dysthymia have a persistent underlying depression. Dysthymia (dysthymic disorder) usually sets in during early adulthood, and the disorder can last for years or even decades. Later onset is usually associated with bereavement or obvious stress, and often follows on the heels of a more extreme depressive episode. Women are twice as likely as men to suffer from dysthymia, similar to that seen with major depression. About 3% of the population is affected by dysthymic disorder, with three-quarters of individuals displaying signs of other psychiatric or medical disorders as well. Depressed mood for most of the day, for more days than not, as indicated either by subjective account or observation by others, for at least 2 years. Note: In children and adolescents, mood can be irritable and duration must be at least 1 year. Presence, while depressed, of two (or more) of the following:poor appetite or overeatinginsomnia or hypersomniapoor concentration or difficulty making decisionsfeelings of hopelessnessC. During the 2-year period (1 year for children or adolescents) of the disturbance, the person has never been without the symptoms in Criteria A and B for more than 2 months at a time. No Major Depressive Episode has been present during the first 2 years of the disturbance (1 year for children and adolescents); i. Note: There may have been a previous Major Depressive Episode provided there was a full remission (no significant signs or symptoms for 2 months) before development of the Dysthymic Disorder. In addition, after the initial 2 years (1 year in children or adolescents) of Dysthymic Disorder, there may be superimposed episodes of Major Depressive Disorder, in which case both diagnoses may be given when the criteria are met for a Major Depressive Episode. There has never been a Manic Episode, a Mixed Episode, or a Hypomanic Episode, and criteria have never been met for Cyclothymic Disorder. The disturbance does not occur exclusively during the course of a chronic Psychotic Disorder, such as Schizophrenia or Delusional Disorder. The symptoms are not due to the direct physiological effects of a substance (e. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. This may increase the likelihood of developing later major depressive episodes. Major life stressors, chronic illness, medications, and relationship or work problems may also increase the chances of dysthymia. Genetics-heredity may also play a role in the development of dysthymia. Most people with dysthymia will have a family history of mood or affective disordersAlthough it can occur at any age, dysthymia often begins earlier than major depression - in childhood, adolescence, or early adult life. People who have dysthymia have been thought to have a "depressive personality" or "depressive neurosis. Definition, signs, symptoms, and causes of Histrionic Personality Disorder. Histrionic Personality Disorder is a condition in which a person acts very emotional and overly dramatic in order to call attention to themselves. People with this disorder are also intensely expressive, egocentric, highly reactive, and excitable. Other features of Histrionic Personality Disorder may include emotional and interpersonal superficiality as well as socially inappropriate interpersonal behavior. People with a histrionic personality are prone to sexually provocative behavior or to sexualizing nonsexual relationships. However, they may not really want a sexual relationship; rather, their seductive behavior often masks their wish to be dependent and protected. Some people with a histrionic personality also are hypochondriacal and exaggerate their physical problems to get the attention they need. A pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:is uncomfortable in situations in which he or she is not the center of attentioninteraction with others is often characterized by inappropriate sexually seductive or provocative behaviordisplays rapidly shifting and shallow expression of emotionsconsistently uses physical appearance to draw attention to selfhas a style of speech that is excessively impressionistic and lacking in detailshows self-dramatization, theatricality, and exaggerated expression of emotionis suggestible, i. Psychoanalysts suggest that a traumatic childhood contributes towards the development of HPD. For comprehensive information on histrionic and other personality disorders, visit the Personality Disorders Community. Full description of major depression (clinical depression, major depressive disorder). Definition, signs, symptoms, and causes of major depression. Major depression is also known as clinical depression and major depressive disorder. This serious medical illness affects some 15 million American adults every year or about 5-8% of the adult population. Severe sadness, along with feeling worthless, hopeless, and helpless over a prolonged period of time are some of the hallmark symptoms of major depression. Major depression is disabling and prevents a person from functioning normally.

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This latter program cheap 100mg persantine otc, funded by the NICHD and the NIDCD Network on the Neurobiology and Genetics of Autism discount persantine 100mg without a prescription, consists of 10 sites order persantine 25 mg fast delivery. The CPEA centers are located at:University of California buy persantine 100mg online, DavisUniversity of California, IrvineUniversity of Texas, HoustonUniversity of Pittsburgh, PennsylvaniaUniversity of Utah, Salt Lake CityCenter for Childhood Neurotoxicology and Assessment, University of Medicine & Dentistry, New JerseyThe Center for the Study of Environmental Factors in the Etiology of Autism, University of California, DavisThis addendum to the booklet Autism Spectrum Disorders was prepared to clarify information contained in the booklet; and to provide updated information on the prevalence of autism spectrum disorders. In 2007 - the most recent government survey on the rate of autism - the Centers for Disease Control (CDC) found that the rate is higher than the rates found from studies conducted in the United States during the 1980s and early 1990s (survey based on data from 2000 and 2002). The CDC survey assigned a diagnosis of autism spectrum disorder based on health and school records of 8 year olds in 14 communities throughout the U. Debate continues about whether this represents a true increase in the prevalence of autism. Changes in the criteria used to diagnose autism, along with increased recognition of the disorder by professionals and the public may all be contributing factors. Nonetheless, the CDC report confirms other recent epidemiologic studies documenting that more children are being diagnosed with an ASD than ever before. Summarizing this and several other major studies on autism prevalence, CDC estimates that 2-6 per 1,000 (from 1 in 500 to 1 in 150) children have an ASD. Compared to the prevalence of other childhood conditions, this rate is lower than the rate of mental retardation (9. For additional data, please visit the autism section of the CDC Web site. Other members of the family who may be contemplating having a child may also wish to be checked for the syndrome. Because both males (XY) and females (XX) have at least one X chromosome, both can pass on the mutated gene to their children. A father with the altered gene for Fragile X on his X chromosome will only pass that gene on to his daughters. Because mothers pass on only X chromosomes to their children, if the mother has the altered gene for Fragile X, she can pass that gene to either her sons or her daughters. If the mother has the mutated gene on one X chromosome and has one normal X chromosome, and the father has no genetic mutations, all the children have a 50-50 chance of inheriting the mutated gene. The odds noted here apply to each child the parents have. In terms of prevalence, the latest statistics are consistent in showing that 5% of people with autism are affected by fragile X and 10% to 15% of those with fragile X show autistic traits. Food and Drug Administration (FDA) approved risperidone (generic name) or Risperdal (brand name) for the symptomatic treatment of irritability in autistic children and adolescents ages 5 to 16. The approval is the first for the use of a drug to treat behaviors associated with autism in children. These behaviors are included under the general heading of irritability, and include aggression, deliberate self-injury and temper tantrums. Olanzapine (Zyprexa) and other antipsychotic medications are used "off-label" for the treatment of aggression and other serious behavioral disturbances in children, including children with autism. Off-label means a doctor will prescribe a medication to treat a disorder or in an age group that is not included among those approved by the FDA. Other medications are used to address symptoms or other disorders in children with autism. Fluoxetine (Prozac) and sertraline (Zoloft) are approved by the FDA for children age 7 and older with obsessive-compulsive disorder. Fluoxetine is also approved for children age 8 and older for the treatment of depression. Fluoxetine and sertraline are antidepressants known as selective serotonin reuptake inhibitors (SSRIs). Despite the relative safety and popularity of SSRIs and other antidepressants, some studies have suggested that they may have unintentional effects on some people, especially adolescents and young adults. In 2004, after a thorough review of data, the Food and Drug Administration (FDA) adopted a "black box" warning label on all antidepressant medications to alert the public about the potential increased risk of suicidal thinking or attempts in children and adolescents taking antidepressants. In 2007, the agency extended the warning to include young adults up to age 25. A "black box" warning is the most serious type of warning on prescription drug labeling. The warning emphasizes that children, adolescents and young adults taking antidepressants should be closely monitored, especially during the initial weeks of treatment, for any worsening depression, suicidal thinking or behavior, or any unusual changes in behavior such as sleeplessness, agitation, or withdrawal from normal social situations. The Institute of Medicine (IOM) conducted a thorough review on the issue of a link between thimerosal (a mercury based preservative that is no longer used in vaccinations) and autism. The final report from IOM, Immunization Safety Review: Vaccines and Autism, released in May 2004, stated that the committee did not find a link. Until 1999, vaccines given to infants to protect them against diphtheria, tetanus, pertussis, Haemophilus influenzae type b (Hib), and Hepatitis B contained thimerosal as a preservative. Today, with the exception of some flu vaccines, none of the vaccines used in the U. The MMR vaccine does not and never did contain thimerosal. Varicella (chickenpox), inactivated polio (IPV), and pneumococcal conjugate vaccines have also never contained thimerosal. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Child Health and Human Development. Diagnostic and statistical manual of mental disorders: DSM-IV-TR (fourth edition, text revision). Washington DC: American Psychiatric Association, 2000. EH, Dawson G, Gordon B, Gravel JS, Johnson CP, Kellen RJ, Levy SE, Minshew NJ, Prizant BM, Rapin I, Rogers SJ, Stone WL, Teplin S, Tuchman RF, Volkmar FR. The screening and diagnosis of autism spectrum disorders. Journal of Autism and Developmental Disorders, 1999; 29(2): 439-484. Yeargin-Allsopp M, Rice C, Karapurkar T, Doernberg N, Boyle C, Murphy C. Autism Among Us: Rising Concerns and the Public Health Response [Video on the Internet]. Journal of Autism and Developmental Disorders, 1998; 28(5): 407-414. EH, Dawson G, Gordon B, Gravel JS, Johnson CP, Kallen RJ, Levy SE, Minshew NJ, Ozonoff S, Prizant BM, Rapin I, Rogers SJ, Stone WL, Teplin SW, Tuchman RF, Volkmar FR. Practice parameter: screening and diagnosis of autism. A screening instrument for autism at 18 months of age: A 6-year follow-up study. Journal of the American Academy of Child and Adolescent Psychiatry, 2000; 39: 694-702. The modified checklist for autism in toddlers: an initial study investigating the early detection of autism and pervasive developmental disorders. Journal of Autism and Developmental Disorders, 2001; 31(2): 149-151. Brief report: screening tool for autism in two-year-olds (STAT): development and preliminary data. Journal of Autism and Developmental Disorders, 2000; 30(6): 607-612. A screening questionnaire for Asperger syndrome and other high-functioning autism spectrum disorders in school age children. Journal of Autism and Developmental Disorders, 1999; 29(2): 129-141. The Cast (Childhood Asperger Syndrome Test): preliminary development of a UK screen for mainstream primary-school-age children. A principal components analysis of the autism diagnostic interview-revised. Journal of the American Academy of Child and Adolescent Psychiatry, 2003; 42(7): 864-872. The autism diagnostic observation schedule-generic: a standard measure of social and communication deficits associated with the spectrum of autism. Journal of Autism and Developmental Disorders, 2000; 30(3): 205-230. Comparison of DSM-III-R and childhood autism rating scale diagnoses of autism.

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The child becomes a reflection of the parent cheap persantine 100 mg amex, a conduit through which the parent experiences and realises himself for better (hopes buy generic persantine 100mg online, aspirations discount 25mg persantine fast delivery, ambition persantine 25mg low cost, life goals) and for worse (weaknesses, "undesirable" emotions, "negative" traits). Relationships between such parents and their progeny easily deteriorate to sexual or other modes of abuse because there are no functioning boundaries between them. The child accommodates, idealises and internalises (introjects) the narcissistic and abusive Primary Object successfully. The child tries to comply with its directives and with its explicit and perceived wishes. The child, in short, becomes the ultimate extension. We must not neglect the abusive aspect of such a relationship. The narcissistic parent always alternates between idealisation and devaluation of his offspring. The child is likely to internalise the devaluing, abusive, critical, demeaning, berating, diminishing, minimising, upbraiding, chastising voices. The parent (or caregiver) goes on to survive inside the child-turned-adult (as part of a sadistic and ideal Superego and an unrealistic Ego Ideal). The child-turned-adult keeps looking for narcissists in order to feel whole, alive and wanted. He craves to be treated by a narcissist narcissistically. What others call abuse is, to him or her, familiar territory and constitutes Narcissistic Supply. To the Inverted Narcissist, the classic narcissist is a Source of Supply (primary or secondary) and his narcissistic behaviours constitute Narcissistic Supply. The IN feels dissatisfied, empty and unwanted when not "loved" by a narcissist. The roles of Primary Source of Narcissistic Supply (PSNS) and Secondary Source of Narcissistic Supply (SSNS) are reversed. To the inverted narcissist, her narcissistic spouse is a Source of PRIMARY Narcissistic Supply. The child can also reject the narcissistic parent rather than accommodate her or him. The child may react to the narcissism of the Primary Object with a peculiar type of rejection. He develops his own narcissistic personality, replete with grandiosity and lack of empathy - but his personality is antithetical to that of the narcissistic parent. If the parent were a somatic narcissist, the child is likely to grow up to be a cerebral one. If his father prided himself being virtuous, the son turns out sinful. If his narcissistic mother bragged about her frugality, he is bound to profligately flaunt his wealth. The two are, in many ways, two sides of the same coin, or "the mould and the moulded" - hence the neologisms "mirror narcissist" or "inverted narcissist". The narcissist tries to merge with an idealised but badly internalised object. He does so by "digesting" the meaningful others in his life and transforming them into extensions of his self. To the "digested", this is the crux of the harrowing experience called "life with a narcissist". The "inverted narcissist" (IN), on the other hand, does not attempt, except in fantasy or in dangerous, masochistic sexual practice, to merge with an idealised external object. This is because he so successfully internalised the narcissistic Primary Object to the exclusion of all else. The IN feels ill at ease in his relationships with non-narcissists because it is unconsciously perceived by him to constitute "betrayal", "cheating", an abrogation of the exclusivity clause he has with the narcissistic Primary Object. This is the big difference between narcissists and their inverted version. Classic narcissists of all stripes reject the Primary Object in particular (and object relations in general) in favour of a handy substitute: themselves. Inverted Narcissists accept the (narcissist) Primary Object and internalise it - to the exclusion of all others (unless they are perceived to be faithful renditions, replicas of the narcissistic Primary Object). The classic narcissist has a badly regulated sense of self-worth. He goes through cycles of self-devaluation (and experiences them as dysphorias). Whereas the narcissist devalues others - the IN devalues himself as an offering, a sacrifice to the narcissist. The IN pre-empts the narcissist by devaluing himself, by actively berating his own achievements, or talents. The IN is exceedingly distressed when singled out because of actual accomplishments or a demonstration of superior skills. The inverted narcissist is compelled to filter all of her narcissistic needs through the primary narcissist in her life. Independence or personal autonomy are not permitted. Pre-occupied with fantasies of unlimited success, power, brilliance and beauty or of an ideal of love. This is the same as the DSM-IV-TR criterion for Narcissistic Personality Disorder but, with the IN, it manifests absolutely differently, i. With the narcissist, the dissonance exists on two levels:Between the unconscious feeling of lack of stable self-worth and the grandiose fantasiesAND between the grandiose fantasies and reality (the Grandiosity Gap). In comparison, the Inverted Narcissist can only vacillate between lack of self-worth and reality. No grandiosity is permitted, except in dangerous, forbidden fantasy. This shows that the Invert is psychologically incapable of fully realising her inherent potentials without a primary narcissist to filter the praise, adulation or accomplishments through. She must have someone to whom praise can be redirected. Believes that she is absolutely un-unique and un-special (i. The IN becomes very agitated the more one tries to understand her because that also offends against her righteous sense of being properly excluded from the human race. A sense of worthlessness is typical of many other PDs (as well as the feeling that no one could ever understand them). The narcissist himself endures prolonged periods of self-devaluation, self-deprecation and self-effacement. In this sense, the inverted narcissist is a partial narcissist. She is permanently fixated in a part of the narcissistic cycle, never to experience its complementary half: the narcissistic grandiosity and sense of entitlement. The "righteous sense of being properly excluded" comes from the sadistic Superego in concert with the "overbearing, externally reinforced, conscienceDemands anonymity (in the sense of seeking to remain excluded at all costs) and is intensely irritated and uncomfortable with any attention being paid to her - similar to the Schizoid PD. Feels that she is inferior to others, lacking, insubstantial, unworthy, unlikable, unappealing, unlovable, someone to scorn and dismiss, or to ignore. Is extinguishingly selfless, sacrificial, even unctuous in her interpersonal relationships and avoids the assistance of others at all costs. Can only interact with others when she can be seen to be giving, supportive, and expending an unusual effort to assist. Some narcissists behave the same way but only as a means to obtain Narcissistic Supply (praise, adulation, affirmation, attention). This must not be confused with the behaviour of the IN. They are intermittently attuned to others only in order to optimise the extraction of Narcissistic Supply from them. Cannot conceive of being envied and becomes extremely agitated and uncomfortable if even brought into a situation where comparison might occur. Loathes competition and avoids competition at all costs, if there is any chance of actually winning the competition, or being singled out.

It is not known whether Prandin passes into breast milk or if it could be harmful to a nursing baby buy 25mg persantine. Do not take Prandin without telling your doctor if you are breast-feeding a baby generic 100 mg persantine visa. Do not take the medication in larger or smaller amounts generic 100 mg persantine with amex, or take it for longer than recommended by your doctor purchase persantine 100 mg mastercard. Your dose needs may change if you are ill, if you have a fever or infection, or if you have surgery or a medical emergency. Do not change your dose of Prandin without first talking to your doctor. Prandin is usually taken 2 to 4 times daily, within 30 minutes before eating a meal. If you skip a meal, do not take your dose of Prandin. Store Prandin at room temperature away from moisture and heat. Take the missed dose as soon as you remember, but only if you are getting ready to eat a meal. If it is almost time for your next dose, wait until then to take the medicine and skip the missed dose. Do not take extra medicine to make up the missed dose. Seek emergency medical attention if you think you have used too much of this medicine. Overdose symptoms may include hunger, nausea, anxiety, cold sweats, weakness, drowsiness, loss of consciousness, and coma. Before you take Prandin, tell your doctor if you also take gemfibrozil (Lopid) or itraconazole (Sporanox). You may be more likely to have hyperglycemia (high blood sugar) if you are taking Prandin with other drugs that raise blood sugar. Drugs that can raise blood sugar include:You may be more likely to have hypoglycemia (low blood sugar) if you are taking Prandin with other drugs that lower blood sugar. Drugs that can lower blood sugar include:some nonsteroidal anti-inflammatory drugs (NSAIDs);sulfa drugs (Bactrim, Gantanol, Septra, and others);a monoamine oxidase inhibitor (MAOI); orbeta-blockers (Tenormin and others). This list is not complete and there may be other drugs that can interact with Prandin. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor. Your pharmacist can provide more information about Prandin. Generic Name: pramlintide acetateSymlin is used with insulin and has been associated with an increased risk of insulin-induced severe hypoglycemia, particularly in patients with type 1 diabetes. When severe hypoglycemia associated with Symlin use occurs, it is seen within 3 hours following a Symlin injection. If severe hypoglycemia occurs while operating a motor vehicle, heavy machinery, or while engaging in other high-risk activities, serious injuries may occur. Appropriate patient selection, careful patient instruction, and insulin dose adjustments are critical elements for reducing this risk. Symlin? (pramlintide acetate) injection is an antihyperglycemic drug for use in patients with diabetes treated with insulin. Pramlintide is a synthetic analog of human amylin, a naturally occurring neuroendocrine hormone synthesized by pancreatic beta cells that contributes to glucose control during the postprandial period. Pramlintide is provided as an acetate salt of the synthetic 37-amino acid polypeptide, which differs in amino acid sequence from human amylin by replacement with proline at positions 25 (alanine), 28 (serine), and 29 (serine). The structural formula of pramlintide acetate is as shown:Pramlintide acetate is a white powder that has a molecular formula of C171H267N51O53S2- x C2H4O2 (3?-Tx?-T8); the molecular weight is 3949. Symlin is formulated as a clear, isotonic, sterile solution for subcutaneous (SC) administration. The disposable multidose SymlinPen? pen-injector contains 1000 mcg/mL of pramlintide (as acetate); Symlin vials contain 600 mcg/mL of pramlintide (as acetate). Amylin is co-located with insulin in secretory granules and co-secreted with insulin by pancreatic beta cells in response to food intake. Amylin and insulin show similar fasting and postprandial patterns in healthy individuals (Figure 1). Figure 1: Secretion Profile of Amylin and Insulin in Healthy AdultsAmylin affects the rate of postprandial glucose appearance through a variety of mechanisms. In addition, amylin suppresses glucagon secretion (not normalized by insulin alone), which leads to suppression of endogenous glucose output from the liver. Amylin also regulates food intake due to centrally-mediated modulation of appetite. In patients with insulin-using type 2 or type 1 diabetes, the pancreatic beta cells are dysfunctional or damaged, resulting in reduced secretion of both insulin and amylin in response to food. Symlin, by acting as an amylinomimetic agent, has the following effects: 1) modulation of gastric emptying; 2) prevention of the postprandial rise in plasma glucagon; and 3) satiety leading to decreased caloric intake and potential weight loss. The gastric-emptying rate is an important determinant of the postprandial rise in plasma glucose. Symlin slows the rate at which food is released from the stomach to the small intestine following a meal and, thus, it reduces the initial postprandial increase in plasma glucose. This effect lasts for approximately 3 hours following Symlin administration. Symlin does not alter the net absorption of ingested carbohydrate or other nutrients. Postprandial Glucagon SecretionIn patients with diabetes, glucagon concentrations are abnormally elevated during the postprandial period, contributing to hyperglycemia. Symlin has been shown to decrease postprandial glucagon concentrations in insulin-using patients with diabetes. Symlin administered prior to a meal has been shown to reduce total caloric intake. This effect appears to be independent of the nausea that can accompany Symlin treatment. The absolute bioavailability of a single SC dose of Symlin is approximately 30 to 40%. Subcutaneous administration of different doses of Symlin into the abdominal area or thigh of healthy subjects resulted in dose-proportionate maximum plasma concentrations (C) and overall exposure (expressed as area under the plasma concentration curve or (AUC)) (Table 1). Table 1: Mean Pharmacokinetic Parameters Following Administration of Single SC Doses of SymlinInjection of Symlin into the arm showed higher exposure with greater variability, compared with exposure after injection of Symlin into the abdominal area or thigh. There was no strong correlation between the degree of adiposity as assessed by BMI or skin fold thickness measurements and relative bioavailability. In healthy subjects, the half-life of Symlin is approximately 48 minutes. Des-lys1 pramlintide (2-37 pramlintide), the primary metabolite, has a similar half-life and is biologically active both in vitro and in vivo in rats. AUC values are relatively constant with repeat dosing, indicating no bioaccumulation. Patients with moderate or severe renal impairment (ClCr>20 to ?-T50 mL/min) did not show increased Symlin exposure or reduced Symlin clearance, compared to subjects with normal renal function. Pharmacokinetic studies have not been conducted in patients with hepatic insufficiency. However, based on the large degree of renal metabolism (see Metabolism and Elimination), hepatic dysfunction is not expected to affect blood concentrations of Symlin. Pharmacokinetic studies have not been conducted in the geriatric population.

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This is happening to me right NOW and things are NOT all right! I want to be cured more than anything and if there is a legitimate cure out there generic persantine 25mg fast delivery, my personal doctor will let me know order persantine 100 mg on line. When your friend or loved one suffers from bipolar disorder buy generic persantine 25mg on line, what are the best things you can tell them? Being depressed is not the same thing as just being sad about something generic 25 mg persantine otc. This list, compiled from a Usenet group, offers some useful statements you can make to a friend or loved one who is depressed. It is most tempting, when you find out someone is depressed, to attempt to immediately fix the problem. However, until the depressed person has given you permission to be their therapist, (as a friend or professional), the following responses are more likely to help. Acknowledge the depression for what it is, and give permission for them to feel depressed. Mood disorders are biochemical in nature, just like diabetes, and are just as treatable. Chances are he/she has already told him or herself everything you can tell them. He/she will take just so much and shut out the rest. You may only increase their feeling of isolation or force one to make promises that cannot possibly be kept. It is possible to create this impression without saying a word. Since persons with mood disorders are not in control of their affliction, this approach only increases guilt. It is like saying, "If you loved me, you would not have diabetes! There may be times, of course, when a specific action is necessary to protect children. Usually this only pushes the person into a state of desperation and/or depression. In the end, he/she will simply find new ways of getting more drugs or alcohol if he/she wants them badly enough. Besides, when you condone the use of drugs or alcohol, it is likely to cause the person to put off seeking necessary help. The tendency is to think that love of home and family is enough incentive to get well, and that outside therapy should not be needed. Frequently the motivation of regaining self-respect is more compelling for the person than resumption of family responsibilities. You may feel left out when the person turns to other people for mutual support. There may be relapses and times of tension and resentment. One of the quickest ways to push someone with a mood disorder away from you is to make them feel like you want them to be dependent on you. Each person must learn for themselves what works best for them, especially in social situations. If, for example, you try to shush people who ask questions about the disorder, treatment, medications, etc. Do offer love, support and understanding in the recovery, regardless of the method chosen. For example, some people choose to take medications, some choose not to. Each has advantages and disadvantages (more side-effect versus higher instances of relapse, for example). Learn about the causes and effects of guilt and how to deal with guilt. Although it may never completely disappear, the feeling can be significantly reduced. Acknowledge and express your guilt with an understanding listenerExamine the beliefs underlying your guilt. There are 3 major mental health organizations that provide bipolar support groups for families. Because these are national organizations, many have local chapters and hopefully there is one near you. These groups are designed not only to provide support to bipolar family members, but also to educate people about the details of the illness. Below, you find links to the bipolar family support groups that have local chapters that hold face-to-face support meetings. These organizations also offer support groups for your bipolar family member. If there is no local chapter, you might contact one of the above organizations to discuss starting one yourself. You can also contact your county mental health agency to see if there are other local support groups in your area. These organizations also offer online bipolar family support. You have every right to ask for information and help from the facilities of your state Department of Mental Health. Tax dollars are meant to support the truly disabled. Both the afflicted one and the other family members will benefit from a proper diet, regular exercise routines, and a clean, orderly living environment. Put on the brakes when you feel yourself sliding into an untenable situation, when your nerves start to jump. A game of solitaire, an hour watching an interesting television program, a hot, luxurious bath, meditation, a walk around the block, digging and weeding in the garden - anything that stops or changes the direction of your thoughts can be helpful. Learning how to cope with it is the key to making and keeping a life of your own. A walk on the beach or in the woods, a movie, a play, a good book, a painting, a conversation with a dear friend, a prayer. The point is to let yourself go, to relax, to let your body and mind renew itself, thus recharging your energy. An effort to maintain social contacts is imperative. If a family member becomes ill with a debilitating physical illness - heart disease or cancer, for instance - neighbors, friends and peripheral family members are often very supportive. If the illness is mental, the family involved usually feels stigmatized. The family unit often withdraws with their sick relative from the community at large. It is much better if they continue to circulate in as normal a way as possible. Such families are in a unique position to break down the walls of prejudice and fear that surround mental illness. If communication exists between afflicted families and their neighbors, there is often a great deal of compassion and understanding expressed. Seek out and join a support group formed by families of people with mental illness. There is much comfort and knowledge shared in such groups. If you enjoy woodworking, if you job, if you are an active club member, continue to do those things that give you pleasure and make your life fulfilling.

Exposure to the feared social situation almost always provokes anxiety and feared social or performance situations are avoided or else are endured with intense anxiety or distress buy cheap persantine 100mg online. In addition order persantine 25mg, patients recognize that the fear is excessive or unreasonable and the avoidance and anticipatory anxiety of the feared situation is associated with functional impairment or marked distress persantine 25 mg amex. The efficacy of ZOLOFT in maintaining a response in adult patients with social anxiety disorder for up to 24 weeks following 20 weeks of ZOLOFT treatment was demonstrated in a placebo-controlled trial generic persantine 25 mg on-line. Physicians who prescribe ZOLOFT for extended periods should periodically re-evaluate the long-term usefulness of the drug for the individual patient (see Clinical Trials under CLINICAL PHARMACOLOGY ). All Dosage Forms of ZOLOFT:Concomitant use in patients taking monoamine oxidase inhibitors (MAOIs) is contraindicated (see WARNINGS ). Concomitant use in patients taking pimozide is contraindicated (see PRECAUTIONS ). ZOLOFT is contraindicated in patients with a hypersensitivity to sertraline or any of the inactive ingredients in ZOLOFT. ZOLOFT oral concentrate is contraindicated with ANTABUSE (disulfiram) due to the alcohol content of the concentrate. Clinical Worsening and Suicide RiskIncreases Compared to PlaceboDecreases Compared to PlaceboThe following symptoms, anxiety, agitation, panic attacks, insomnia, irritability, hostility aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, and mania, have been reported in adult and pediatric patients being treated with antidepressants for major depressive disorder as well as for other indications, both psychiatric and nonpsychiatric. Although a causal link between the emergence of such symptoms and either the worsening of depression and/or the emergence of suicidal impulses has not been established, there is concern that such symptoms may represent precursors to emerging suicidality. If the decision has been made to discontinue treatment, medication should be tapered, as rapidly as is feasible, but with recognition that abrupt discontinuation can be associated with certain symptoms (see PRECAUTIONS and DOSAGE AND ADMINISTRATION-Discontinuation of Treatment with ZOLOFT, for a description of the risks of discontinuation of ZOLOFT). Families and caregivers of patients being treated with antidepressants for major depressive disorder or other indications, both psychiatric and nonpsychiatric, should be alerted about the need to monitor patients for the emergence of agitation, irritability, unusual changes in behavior, and the other symptoms described above, as well as the emergence of suicidality, and to report such symptoms immediately to health care providers. Such monitoring should include daily observation by families and caregivers. Prescriptions for ZOLOFT should be written for the smallest quantity of tablets consistent with good patient management, in order to reduce the risk of overdose. Screening Patients for Bipolar Disorder: A major depressive episode may be the initial presentation of bipolar disorder. It is generally believed (though not established in controlled trials) that treating such an episode with an antidepressant alone may increase the likelihood of precipitation of a mixed/manic episode in patients at risk for bipolar disorder. Whether any of the symptoms described above represent such a conversion is unknown. However, prior to initiating treatment with an antidepressant, patients with depressive symptoms should be adequately screened to determine if they are at risk for bipolar disorder; such screening should include a detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression. It should be noted that ZOLOFT is not approved for use in treating bipolar depression. Cases of serious sometimes fatal reactions have been reported in patients receiving ZOLOFT^ (sertraline hydrochloride), a selective serotonin reuptake inhibitor (SSRI), in combination with a monoamine oxidase inhibitor (MAOI). Symptoms of a drug interaction between an SSRI and an MAOI include: hyperthermia, rigidity, myoclonus, autonomic instability with possible rapid fluctuations of vital signs, mental status changes that include confusion, irritability, and extreme agitation progressing to delirium and coma. These reactions have also been reported in patients who have recently discontinued an SSRI and have been started on an MAOI. Some cases presented with features resembling neuroleptic malignant syndrome. Therefore, ZOLOFT should not be used in combination with an MAOI, or within 14 days of discontinuing treatment with an MAOI. Similarly, at least 14 days should be allowed after stopping ZOLOFT before starting an MAOI. The concomitant use of Zoloft with MAOIs intended to treat depression is contraindicated (see CONTRAINDICATIONS and WARNINGS - Potential for Interaction with Monoamine Oxidase Inhibitors. Serotonin syndrome symptoms may include mental status changes (e. If concomitant treatment of SNRIs and SSRIs, including Zoloft, with a 5-hydroxytryptamine receptor agonist (triptan) is clinically warranted, careful observation of the patient is advised, particularly during treatment initiation and dose increases (see PRECAUTIONS - Drug Interactions). The concomitant use of SNRIs and SSRIs, including Zoloft, with serotonin precursors (such as tryptophan) is not recommended (see PRECAUTIONS - Drug Interactions). Activation of Mania/Hypomania -During premarketing testing, hypomania or mania occurred in approximately 0. Weight Loss -Significant weight loss may be an undesirable result of treatment with sertraline for some patients, but on average, patients in controlled trials had minimal, 1 to 2 pound weight loss, versus smaller changes on placebo. Only rarely have sertraline patients been discontinued for weight loss. Seizure -ZOLOFT has not been evaluated in patients with a seizure disorder. No seizures were observed among approximately 3000 patients treated with ZOLOFT in the development program for major depressive disorder. However, 4 patients out of approximately 1800 (220<18 years of age) exposed during the development program for obsessive-compulsive disorder experienced seizures, representing a crude incidence of 0. Three of these patients were adolescents, two with a seizure disorder and one with a family history of seizure disorder, none of whom were receiving anticonvulsant medication. Accordingly, ZOLOFT should be introduced with care in patients with a seizure disorder. Discontinuation of Treatment with ZoloftDuring marketing of Zoloft and other SSRIs and SNRIs (Serotonin and Norepinephrine Reuptake Inhibitors), there have been spontaneous reports of adverse events occurring upon discontinuation of these drugs, particularly when abrupt, including the following: dysphoric mood, irritability, agitation, dizziness, sensory disturbances (e. While these events are generally self-limiting, there have been reports of serious discontinuation symptoms. Patients should be monitored for these symptoms when discontinuing treatment with Zoloft. 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 (see DOSAGE AND ADMINISTRATION ). Published case reports have documented the occurrence of bleeding episodes in patients treated with psychotropic drugs that interfere with serotonin reuptake. Subsequent epidemiological studies, both of the case-control and cohort design, have demonstrated an association between use of psychotropic drugs that interfere with serotonin reuptake and the occurrence of upper gastrointestinal bleeding. In two studies, concurrent use of a non-selective nonsteroidal anti-inflammatory drug (i. Although these studies focused on upper gastrointestinal bleeding, there is reason to believe that bleeding at other sites may be similarly potentiated. Patients should be cautioned regarding the risk of bleeding associated with the concomitant use of ZOLOFT with non-selective NSAIDs (i. Weak Uricosuric Effect -ZOLOFT^ (sertraline hydrochloride) is associated with a mean decrease in serum uric acid of approximately 7%. The clinical significance of this weak uricosuric effect is unknown. Use in Patients with Concomitant Illness -Clinical experience with ZOLOFT in patients with certain concomitant systemic illness is limited. Caution is advisable in using ZOLOFT in patients with diseases or conditions that could affect metabolism or hemodynamic responses. However, the electrocardiograms of 774 patients who received ZOLOFT in double-blind trials were evaluated and the data indicate that ZOLOFT is not associated with the development of significant ECG abnormalities. ZOLOFT administered in a flexible dose range of 50 to 200 mg/day (mean dose of 89 mg/day) was evaluated in a post-marketing, placebo-controlled trial of 372 randomized subjects with a DSM-IV diagnosis of major depressive disorder and recent history of myocardial infarction or unstable angina requiring hospitalization. Exclusions from this trial included, among others, patients with uncontrolled hypertension, need for cardiac surgery, history of CABG within 3 months of index event, severe or symptomatic bradycardia, non-atherosclerotic cause of angina, clinically significant renal impairment (creatinine > 2. ZOLOFT treatment initiated during the acute phase of recovery (within 30 days post-MI or post-hospitalization for unstable angina) was indistinguishable from placebo in this study on the following week 16 treatment endpoints: left ventricular ejection fraction, total cardiovascular events (angina, chest pain, edema, palpitations, syncope, postural dizziness, CHF, MI, tachycardia, bradycardia, and changes in BP), and major cardiovascular events involving death or requiring hospitalization (for MI, CHF, stroke, or angina). In patients with chronic mild liver impairment, sertraline clearance was reduced, resulting in increased AUC, Cmax and elimination half-life. The effects of sertraline in patients with moderate and severe hepatic impairment have not been studied. The use of sertraline in patients with liver disease must be approached with caution. If sertraline is administered to patients with liver impairment, a lower or less frequent dose should be used (see CLINICAL PHARMACOLOGY and DOSAGE AND ADMINISTRATION ).

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