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The researcher then calculates the correlation between scores at the first assessment and scores at the second assessment (a coefficient sometimes called a test-retest correlation or even a stability coefficient) symptoms congestive heart failure order residronate 35 mg fast delivery. As you know shinee symptoms mp3 purchase residronate 35 mg visa, a correlation coefficient is a numerical summary of the linear association between two variables treatment 4 hiv cheap residronate 35 mg line. Roberts and DelVecchio (2000) summarized 3 treatment 1st degree burn buy generic residronate 35 mg line,217 test-retest correlations for a wide range of personality attributes reported in 152 longitudinal studies. They used statistical methods to equate the different test-retest correlations to a common interval of about seven years. This allowed them to compare results from studies of differing lengths of time because not all studies followed participants for the same interval of time. This pattern of increasing stability with age is called the cumulative continuity principle of personality development (Caspi et al. This general pattern holds for both women and men and applies to a wide range of different personality attributes ranging from extraversion to openness and curiosity. It is important to emphasize, however, that the observed correlations are never perfect at any age. This indicates that personality changes can occur at any time in the lifespan; it just seems that greater inconsistency is observed in childhood and adolescence than in adulthood. Key Messages So Far Personality Stability and Change 947 It is useful to summarize the key ideas of this module so far. The starting point was the realization that there are several different ways to define and measure personality stability. Heterotypic stability refers to the consistency of the underlying psychological attribute that may have different behavioral manifestations at different ages. Homotypic stability, on the other hand, refers to the consistency of the same observable manifestations of a personality attribute. This type of stability is commonly studied in the current literature, and absolute and differential stability are a focus on many studies. A consideration of the broad literature on personality stability yields two major conclusions. Average levels of personality attributes seem to change in predictable ways across the lifespan in line with maturity principle of personality development. Traits that are correlated with positive outcomes (such as conscientiousness) seem to increase from adolescence to adulthood. This perspective on personality stability is gained from considering absolute stability in the form of average levels of personality attributes at different ages. Personality attributes are relatively enduring attributes that become increasingly consistent during adulthood in line with the cumulative continuity principle. This perspective on stability is gained from considering differential stability in the form of testretest correlations from longitudinal studies. In general, the picture that emerges from the literature is that personality traits are relatively enduring attributes that become more stable from childhood to adulthood. Nonetheless, the stability of personality attributes is not perfect at any period in the lifespan. This is an important conclusion because it challenges two extreme perspectives that have been influential in psychological research. More than 100 years ago, the famous psychologist William James remarked that character (personality) was "set like plaster" for most people by age 30. In contrast, other psychologists have sometimes denied there was any stability to personality at all. Their perspective is that individual thoughts and feelings are simply responses to transitory situational influences that are unlikely to show much consistency across the lifespan. As discussed so far, current research does not support either of these extreme perspectives. Nonetheless, the existence of some degree of stability raises important questions about the exact processes and mechanisms that produce personality stability (and personality change).
Understand the difference among the three main etiological theories of mental illness medicine used to treat chlamydia residronate 35mg amex. Describe specific beliefs or events in history that exemplify each of these etiological theories medicine during pregnancy order residronate in united states online. Describe the features of the "moral treatment" approach used by Chiarughi treatment plan goals purchase residronate with american express, Pinel treatment diarrhea 35 mg residronate, and Tuke. History of Mental Illness 1159 History of Mental Illness References to mental illness can be found throughout history. The evolution of mental illness, however, has not been linear or progressive but rather cyclical. Whether a behavior is considered normal or abnormal depends on the context surrounding the behavior and thus changes as a function of a particular time and culture. In the past, uncommon behavior or behavior that deviated from the sociocultural norms and expectations of a specific culture and period has been used as a way to silence or control certain individuals or groups. Throughout history there have been three general theories of the etiology of mental illness: supernatural, somatogenic, and psychogenic. Supernatural theories attribute mental illness to possession by evil or demonic spirits, displeasure of gods, eclipses, planetary gravitation, curses, and sin. Somatogenic theories identify disturbances in physical functioning resulting from either illness, genetic inheritance, or brain damage or imbalance. Psychogenic theories focus on traumatic or stressful experiences, maladaptive learned associations and cognitions, or distorted perceptions. Etiological theories of mental illness determine the care and treatment mentally ill individuals receive. As we will see below, an individual believed to be possessed by the devil will be viewed and treated differently from an individual believed to be suffering from an excess of yellow bile. Trephination is an example of the earliest supernatural explanation for mental illness. As such, a harmonious life that allowed for the proper balance of yin and yang and movement of vital air was essential (Tseng, 1973). History of Mental Illness 1160 As a result, the Egyptians, and later the Greeks, also employed a somatogenic treatment of strong smelling substances to guide the uterus back to its proper location (pleasant odors to lure and unpleasant ones to dispel). Temple attendance with religious healing ceremonies and incantations to the gods were employed to assist in the healing process. Hebrews saw madness as punishment from God, so treatment consisted of confessing sins and repenting. For example, someone who was too temperamental suffered from too much blood and thus blood-letting would be the necessary treatment. Hippocrates classified mental illness into one of four categories-epilepsy, mania, melancholia, and brain fever-and like other prominent physicians and philosophers of his time, he did not believe mental illness was shameful or that mentally ill individuals should be held accountable for their behavior. Mentally ill individuals were cared for at home by family members and the state shared no responsibility for their care. He also opened the door for psychogenic explanations for mental illness, however, by allowing for the experience of psychological stress as a potential cause of abnormality. By the late Middle Ages, economic and political turmoil threatened the power of the Roman Catholic church. Between the 11th and 15th centuries, supernatural theories of mental disorders again dominated Europe, fueled by natural disasters like plagues and famines that lay people interpreted as brought about by the devil. Superstition, astrology, and alchemy took hold, and common treatments included prayer rites, relic touching, confessions, and atonement. Beginning in the 13th century the mentally ill, especially women, began to be persecuted as witches who were possessed. At the height of the witch hunts during the 15th through 17th centuries, with the Protestant Reformation having plunged Europe into religious History of Mental Illness 1161 strife, two Dominican monks wrote the Malleus Maleficarum (1486) as the ultimate manual to guide witch hunts. Witch-hunting did not decline until the 17th and 18th centuries, after more than 100,000 presumed witches had been burned at the stake (Schoeneman, 1977; Zilboorg & Henry, 1941). Modern treatments of mental illness are most associated with the establishment of hospitals and asylums beginning in the 16th century.
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While the disease is currently incurable medications before surgery residronate 35 mg otc, treatments exist that can substantially relieve symptoms and improve quality of life medications for ptsd generic residronate 35mg otc. Therefore an effort should be made to speak to both individuals alone during the visit symptoms you need a root canal cheap 35 mg residronate with amex. Physicians are encouraged to use a team care model for treatment and refer the individual treatment 8th march safe residronate 35mg, as needed, to an occupational therapist, physical therapist, speech-language pathologist, and dietician/nutritionist who can help increase safety, functional independence and comfort in daily life. However, individuals should be encouraged to discuss therapies they are considering and not be afraid to tell their physicians that they are trying them. Each child of an affected individual has the same 50% chance of inheriting the abnormal huntingtin gene, and therefore developing the disease one day. Inheriting a normal huntingtin gene from the unaffected parent does not prevent or counteract the disease-causing effects of the abnormal gene. Huntingtin protein contains a sequence in which the amino acid glutamine is repeated a number of times. The huntingtin protein appears to be produced in equal quantities, whether it has a normal or excess number of glutamines, but the abnormally elongated protein appears to be processed aberrantly within the neurons, so that its fragments tend to accumulate over time into intranuclear inclusions. The details of this process and how it relates to the development of neurologic disease are still being studied. Some of the cases include better documentation of clinical, genetic, or pathologic features than others. This can sometimes be explained by early death of a gene-carrying parent, by adoption, or by mistaken paternity. Predictive testing of healthy people requires a different clinical approach than the one to which neurologists are accustomed. Predictive testing should be reserved for adults who have participated in a careful discussion with a genetic counselor about their genetic risks and the potential risks and benefits of the test itself. Therapy or counseling may be needed to help the caregiver cope with the test results. Care of the Person Who Has Had Predictive Testing Although predictive genetic testing is often performed in conjunction with, or by, a genetics professional, it falls to the neurologist or primary care physician to follow the person who is known to be gene positive. While most people cope well with the results of their gene test, there may be a need for ongoing counseling or support to help the individual adapt to his or her new status. If a baseline neurological examination was not performed as part of the predictive testing process, the gene-positive person should be encouraged to have a baseline exam, so that there are grounds for comparison later. Formal baseline neuropsychometric or neuropsychological assessment can also be very helpful. Some are concerned about the potential impact of genetic test results on insurability or employability (despite the recent passage of the Genetic Information Nondiscrimination Act, the intent of which is 1) to prevent health insurers from accessing genetic test information as part of their underwriting decision, and 2) to prevent employers from using genetic test results as part of employment decisions or processes). Some seem to have faith that researchers will find a treatment or cure for the disease in time for them; others may feel for one reason or another that they already "know" whether they are carriers or not, or that they could not emotionally handle the knowledge of their genetic fate. The majority of non-tested individuals, however, simply do not seem to seek this irreversible glimpse into the future. Physicians must be able to provide predictive testing in a timely, private, and sensitive manner for those who desire it, while remaining respectful of the interests and concerns of those who do not. All at-risk individuals should be made aware that predictive testing is available, so that they can access it if they wish. Some at-risk individuals need emotional support as they deal with affected parents, anniversaries of difficult family events such as suicide, or as they make major life decisions about marriage, childbearing, or career choices. Genetic counseling about reproductive options should also be offered to at-risk individuals, whether or not they have previously undergone predictive testing. The discussion of reproductive options should be performed as part of overall genetic counseling and preferably before a pregnancy occurs. In this process, the woman uses fertility drugs so that she produces several oocytes at each cycle. Chorionic villus sampling is another form of prenatal testing, which may be performed very early, at 8-10 weeks after conception. Amniocentesis may also be used to obtain a sample for genetic testing at 14-16 weeks after conception.
Sometimes staff are not sufficiently aware that people with intellectual disabilities who are getting older will experience painful conditions symptoms your dog is sick generic 35 mg residronate with mastercard, such as arthritis treatment lung cancer order 35mg residronate with amex, that can be associated with older age medicine 60 generic 35mg residronate fast delivery. Difficulties are sometimes ascribed to the dementia process rather than there being a consideration of whether people are in pain treatment plantar fasciitis 35mg residronate mastercard. Research and practice both indicate that there is inadequate training about dementia and people with intellectual disabilities of staff, at all levels and from all professional backgrounds. In addition, little attention is paid to the recognition and management of pain in this group. Guidance on their Assessment, Diagnosis, Interventions and Support 43 There is also little use of pain assessment and recognition tools. There is a range of effective pain/distress tools available for staff and carers to use to identify pain or distress in people with intellectual disabilities and dementia. Key points I I I Pain recognition and management for people with intellectual disabilities and dementia is often very poor. Diagnostic overshadowing is a frequent occurrence, and staff are often unaware of the range of painful health conditions that may present with increasing age. There are tools available to help staff and carers identify pain in people with intellectual disabilities. The sleep disturbances in dementia typically include a reversal of the sleep-wake cycle (sleeping during day time and wandering at night time) and a reduction in the slow wave sleep; which may be due to the loss of cholinergic nerve cells. Clinicians should exclude the following treatable conditions or situations before considering biological attributes (loss of cholinergic neurons): I I I I I Co-morbid psychological problems including depression, anxiety, fear and nightmares. People with intellectual disabilities and dementia should have a routine assessment of sleep hygiene. Associated factors can be easily overlooked, especially in people with intellectual disabilities who may have poor communication skills. The use of assistive technology or waking night staff has helped greatly in trying to provide some of the answers, but is not a panacea. Some effort may be required to get adequate sleep data; however, accurate information is required to inform the appropriate management strategies. Consideration should also be given to the use of, for example, the Epworth Sleepiness scale (Johns, 1991) or related scale used by local sleep apnoea clinics, in the event of daytime sleepiness in order to establish whether onward referral to a sleep clinic is warranted. If the above approaches do not produce any significant benefits and the risks continue, a pharmacological approach may be considered along with non-pharmacological approaches. Monitor results, if improvement after three weeks, treatment can be extended to 10 weeks in the first instance. Use short acting benzodiazepines (Temazepam, Loprazolam or Lormetazepam), but be careful about the long-term effects of such drugs. There are no differences in the efficacy of z-drugs and if one of them is not effective the others should not be used. Guidance on their Assessment, Diagnosis, Interventions and Support 45 I I I I I I I I I Switch from one z-drug to another only if there is an adverse effect directly related to that particular drug. Discuss the discontinuation with the person and carer, and taper/stop it very gradually. Do not use in hepatic failure, chronic respiratory diseases and people who have a history of substance misuse. Be mindful of the side effects including day time sedation, falls and sun downing (confusional state in the evening). Key points I I I I I Sleep difficulties are commonly experienced in people with intellectual disabilities as they get older and/or develop dementia. Assessment should include ruling out co-morbid mental health problems, substance misuse, physical health problems and poor sleep hygiene. The management of sleep difficulties in dementia should be based on nonpharmacological approaches including good practice of sleep hygiene. Medication should only be used if other approaches have failed or risks are significant.