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Schizophr Bull 43(4):862-871 hiv infection night sweats purchase valacyclovir 1000 mg otc, 2017a 28044008 Takeuchi H, Thiyanavadivel S, Agid O, Reming to n G: Gradual vs. Schizophr Res 189:4-8, 2017b 28242107 Takeuchi H, Siu C, Reming to n G, et al: Does relapse contribute to treatment resistancefi Am J Prev Med 51(6):958-966, 2016 27522471 Tamburello A, Metzner J, Fergusen E, et al: the American Academy of Psychiatry and the Law practice resource for prescribing in corrections. J Am Acad Psychiatry Law 46(2):242-243, 2018 30026404 Tammenmaa-Aho I, Asher R, Soares-Weiser K, Bergman H: Cholinergic medication for antipsychotic induced tardive dyskinesia. Psychiatr Serv 68(6):579-586, 2017 28196460 Tanskanen A, Tiihonen J, Taipale H: Mortality in schizophrenia: 30-year nationwide follow-up study. Psychol Med 28(3):551-558, 1998 Thioridazine hydrochloride [prescribing information]. 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Am J Psychiatry 173(6):600-606, 2016 26651392 Tiihonen J, Mittendorfer-Rutz E, Majak M, et al: Real-world effectiveness of antipsychotic treatments in a nationwide cohort of 29fi Am J Psychiatry75(8):765-773, 2018 29621900 Tiihonen J, Taipale H, Mehtala J, et al: Association of antipsychotic polypharmacy vs monotherapy with psychiatric rehospitalization among adults with schizophrenia. J Nerv Ment Dis 204(2):156-159, 2016 26825266 91 Tosa to S, Albert U, Tomassi S, et al: A systematized review of atypical antipsychotics in pregnant women: balancing between risks of untreated illness and risks of drug-related adverse effects. J Clin Psychiatry 78(5):e477-e489, 2017 28297592 Trifluoperazine [prescribing information]. Department of Health and Human Services; Office for Civil Rights: Health Information Privacy. Pharmacokinetics in patients with impaired hepatic function: study design, data analysis, and impact on dosing and labeling. 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Schizophr Res 154(1-3):61 67, 2014 24581550 Witt K, Lichtenstein P, Fazel S: Improving risk assessment in schizophrenia: epidemiological investigation of criminal his to ry fac to rs. Am J Psychiatry 148(8):1055 1059, 1991 1677236 Wong J, Delva N: Clozapine-induced seizures: recognition and treatment. Can J Psychiatry 52(7):457-463, 2007 17688010 Wong Z, Ongur D, Cohen B, et al: Command hallucinations and clinical characteristics of suicidality in patients with psychotic spectrum disorders. Schizophr Bull 34(3):523-537, 2008 17962231 Wykes T, Huddy V, Cellard C, et al: A meta-analysis of cognitive remediation for schizophrenia: methodology and effect sizes. Am J Psychiatry 168(5):472-485, 2011 21406461 Xenazine (tetrabenazine) tablets [prescribing information]. Psychopharmacology (Berl) 229(1):1-7, 2013 23832387 Yates K, Lang U, Cederlof M, et al: Association of psychotic experiences with subsequent risk of suicidal ideation, suicide attempts, and suicide deaths: a systematic review and meta-analysis of longitudinal population studies. Int J Neuropsychopharmacol 16(6):1205-1218, 2013 23199972 Zhang Y, Liu Y, Su Y, et al: the metabolic side effects of 12 antipsychotic drugs used for the treatment of schizophrenia on glucose: a network meta-analysis. Clin Pharmacokinet 48(11):689-723, 2009 19817501 Zhu Y, Krause M, Huhn M, et al: Antipsychotic drugs for the acute treatment of patients with a first episode of schizophrenia: a systematic review with pairwise and network meta-analyses. Lancet Psychiatry 4(9):694-705, 2017 28736102 101 Zhuo C, Xu Y, Liu S, et al: Topiramate and metformin are effective add-on treatments in controlling antipsychotic-induced weight gain: a systematic review and network meta-analysis. Toron to , Ontario, Canada, Eli Lilly Canada Inc, April 2018b Zyprexa Relprevv (olanzapine) [prescribing information]. Keepers is employed as Professor and Chair of the Department of Psychiatry by Oregon Health & Sciences University. He receives travel funds from the American Board of Psychiatry and Neurology, the American College of Psychiatry, and the Accreditation Council for Graduate Medical Education related to his activities as a member or chair of various committees. Fochtmann is employed by S to ny Brook University where she is a Distinguished Service Professor of psychiatry, pharmacological sciences, and biomedical informatics. She also serves as a Deputy Chief Medical Information Officer for S to ny Brook Medicine.

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With the lower exposure category as reference hiv infection mode of transmission buy valacyclovir 500mg with amex, the odds ratio for pancreatic cancer in the middle and upper exposure categories, adjusted for potential confounders, were 0. A questionnaire mailed to study subjects requested information about previous occupations, exposure to potential risk fac to rs for leukaemia and present height and weight. A blood sample was drawn and analysed for hexachlorobenzene and other organochlorine compounds in the serum lipid fraction by high-resolution gas chroma to graphy. Samples were also analysed for titres of antibodies to Epstein-Barr virus early antigen immunoglobulin G. The mean concentration of hexachlorobenzene, unadjusted for the lipid content of serum, was 44. At 90 weeks of age, the percentage survival rates in males and females in the five groups were 50 and 48; 30 and 40; 27 and 30; 4 and 0; and 13 and 57%, respectively. No liver-cell tumours were found in the controls or in the group receiving hexachlorobenzene at 50 mg/kg of diet. The incidences of liver-cell tumours in surviving male and female mice at the time the first liver-cell tumour was observed were 3/12, 7/29 and 1/3 in males and 3/12, 14/26 and 1/10 in females for the groups receiving 100, 200 and 300 mg/kg diet, respectively. Groups of 94 male and 94 female weanling Sprague-Dawley rats [age unspecified] were fed diets containing 0 (control), 75 or 150 mg/kg hexachlorobenzene (purity, > 99. Small numbers of animals were killed at intervals for bio chemical and pathological analyses. The types of liver tumours diagnosed included hepa to cellular carcinomas, bile-duct adenomas and haemangiomas, while the kidney tumours were all adenomas (Erturk et al. Incidence of tumours in rats fed hexachlorobenzene Tumour type Concentration in the diet (mg/kg) Control 75 150 Males Females Males Females Males Females Liver haemangioma 0/54 0/52 10/52 23/56 11/56 35/55 Hepa to cellular carcinoma 0/54 0/52 3/52 36/56 4/56 48/55 Bile-duct adenoma 0/54 1/52 2/52 19/56 2/56 29/55 Renal-cell adenoma 7/54 1/52 41/52 7/56 42/56 15/55 From Erturk et al. The incidences of hepa to mas were 0/40, 14/30, 26/30 and 49/57 in males and 0/39, 14/30, 17/30 and 51/60 in females at 0, 50, 100 and 200 mg/kg of diet, respectively. The incidences of liver haemangioendotheliomas in males and females receiving the highest concentration were 20/57 and 7/60, respectively, compared with 0/40 male and 0/39 female controls. A significant increase in the incidence of alveolar adenomas of the thyroid was found in treated animals, with rates of 0/40, 0/30, 1/30 and 8/57 (p < 0. The mortality curves for control and treated rats were similar in both generations. No statistically significant increase in the incidence of thyroid follicular-cell tumours was found in the F1 generation, but there were marginally increased incidences of tumours at other sites. In males, parathyroid adenomas were found in 2/48, 4/48, 2/48, 1/49 and 12/49 (p < 0. The inci dence of adrenal pheochromocy to mas was increased in a linear trend (p < 0. Nodular hyperplasia of the liver occurred in 3/28 animals given 250 mg/kg of diet polychlorinated terphenyl. When polychlorinated terphenyl was given in combination with hexachlorobenzene, 23/28 rats developed nodular hyperplasia and 8/28 developed hepa to cellular carcinomas (Shirai et al. After a 2-week recovery period, the animals were fed a diet containing 0 or 200 mg/kg hexachlorobenzene for 30 weeks. No tumours or hyper plastic nodules of the liver were found in animals treated with hexachlorobenzene alone. Hexachloro benzene significantly enhanced the number of foci per cm2, both with and without partial hepatec to my. Hexachlorobenzene is characterized by a very long half-time and high lipophili city. The bioconcentration fac to r for hexachlorobenzene in humans is estimated to be 320, and estimates of the half-time in humans are between 4 and 8 years. Hexachloro benzene crosses the placenta and is found in fetuses, cord blood, follicular fluid and breast milk. In an investigation of the concentrations of hexachlorobenzene in human placenta, maternal blood, milk and cord blood in 36 healthy pregnant women living in rural Japan, a significant linear correlation was found between the concentration of hexachlorobenzene in placenta and in cord blood and also between placenta and milk (Ando et al. Pentachlorothiophenol was initially detected and quantified in all urine samples from 40 persons in the general population with high body burdens of hexachloro benzene (To-Figueras et al. In a second study, serum and urine from 100 persons in a general population who had been heavily exposed to airborne hexachloro benzene were analysed. Hexachlorobenzene was detected in all serum samples, at con centrations ranging between 1. Pentachlorophenol was detected in all urine samples, with values ranging between 0. A sulfur derivative that, after hydrolysis, yielded pentachlorobenzenethiol was also identified and quantified in all the urine samples, with values ranging between 0. The sulfur derivative assessed as pentachlorobenzenethiol appeared to be the main metabolite, its urinary concentrations surpassing those of pentachlorophenol in persons with an accumulated concentration of hexachlorobenzene in serum > 32 ng/mL. The concentrations of pentachlorobenzenethiol in urine collected over 24 h showed a strong association with the concentrations of hexachlorobenzene in serum; the association was stronger in men than in women. A weaker association was found between the concentrations of pentachlorophenol in urine and hexachloro benzene in serum, which was statistically significant only for men. These results suggested that formation of the cysteine conjugate is a quantitatively important meta bolic pathway in humans, especially in persons with high hexachlorobenzene body burdens. Moreover, pentachlorobenzenethiol is a urinary marker of the internal dose of hexachlorobenzene and of glutathione-mediated metabolism (To-Figueras et al. In rats fed hexachlorobenzene for 4 weeks, subsequent food deprivation appeared to enhance the to xic response (liver hypertrophy), implying decreased mobilization of hexachlorobenzene residues in to fat and resulting in greater accumulation of hexachlorobenzene in plasma, liver, brain and adrenal glands (Villeneuve et al. In rhesus monkeys (Macaca mullata) given hexachlorobenzene at a dose of 8, 32, 64 or 128 mg/kg bw per day by gavage for 60 days, body fat and bone marrow had the highest concentrations, followed by adrenal glands, liver, kidney, brain, ovaries, muscle and serum. The serum concentrations did not appear to correspond to the dose (Knauf & Hobson, 1979). After administration of a single intravenous injection of hexachlorobenzene to male beagles, the chemical was initially found primarily in the lung (2 h) but after 8 h was found primarily in the fat. Excretion in these dogs occurred essentially through the bile and faeces, urinary excretion being of less importance (Sundlof et al. Absorption of hexachlorobenzene applied dermally to male Fischer 344 rats increased from 1% to 9. In adult female Sprague-Dawley rats dosed with 50 mg/kg bw hexachlorobenzene by gavage, the chemical was found to concentrate primarily in the fat and also in endocrine glands with large lipid components, such as the follicular fluid of the ovary and thyroid. The concentrations of residues of hexachlorobenzene in nine rats given 50 mg/kg bw per day were significantly (p < 0. The concentrations of residues of hexachlorobenzene in the ovary were greater than those in the thymus, liver or lung (Foster et al. Hexachlorobenzene was found in the milk of cows given the compound (Fries & Marrow, 1976) and in the organs of 18-day-old offspring of rat dams fed a diet containing hexachlorobenzene (Mendoza et al. Toxicokinetics demonstrated that hexachlorobenzene is transferred across the placenta and in to breast milk in rodents (Courtney & Andrews, 1985; Courtney et al. A similar 6-day study of pregnant hamsters and guinea-pigs showed that the hamster fetuses had fivefold greater concentrations of hexachlorobenzene than the guinea-pig fetuses (Courtney et al. The distribution in infants showed concentration in fat, bone marrow and adrenal glands (Bailey et al. When pregnant Sprague Dawley rats were given a diet containing hexachlorobenzene during gestation and lactation (35 nmol/100 g diet [100 fig/kg diet]), about 0. A large proportion of the hexachlorobenzene body burden was lost during lactation, and the concentration in the s to mach contents of suckling pups was highest on day 2 after birth (Nakashima et al.

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This recep to r was found in most circulating leukocytes (lymphocytes hiv infection diagnosis and treatment buy 1000mg valacyclovir with mastercard, neutrophils, monocytes, and macrophages). That these regions also match the disordered regions predicted and that acyl chains might be implicated in the exposure since the calcium-binding capacity of proHlyA is lower than that of HlyA, should also be borne in mind (Soloaga et al. A glycophorin binding region between residues 914 and 936 accordingly has been identified (Cortajarena et al. If this region was deleted, the specific binding of HlyA to the cell-surface recep to rs on erythrocytes was lost without affecting its nonspecific binding (adsorption) to lipid bilayers. Since the D12 monoclonal antibody reacts with HlyA, but not with proHlyA; the acylation of the former is directly responsible for the exposure of the epi to pe within this region (Pellett et al. The amino-acid sequence is represented on the x-axis, and the prediction of disorder on the y-axis. This circumstance obtains for HlyA, where an oligomer was found at lytic concentrations in sheep-erythrocyte ghosts. Since HlyA does not contain cysteine residues in its sequences, lysine 344 was replaced by a cysteine (HlyA K344C) and the same point mutation introduced in to the unacylated protein (proHlyA K344C). To carry out this study, two populations of HlyA K344C mutant proteins, one labelled with donor (Alexa-488) and the other with accep to r fluorophores (Alexa-546), were bound to sheep-erythrocyte ghosts. Our report showed that an oligomer was involved in the hemolytic mechanism of HlyA (Herlax et al. We need to underscore here that fatty acids are essential for hemolytic activity; and considering that they are needed for oligomerization, we can state that oligomerization is necessary for hemolysis. We thus feel tempted to propose that the presence of fatty acids covalently bound to the protein leads to the exposure of regions that are implicated in protein-protein interactions. In addition, a critical role of acylation in the oligomerization process to form hemolytic pores has been proposed for the adenylate-cyclase to xin from Bordetella pertussis (cf. Finally, if we consider that pores formed by HlyA are sensitive to proteases on the cis side of the planar lipid membranes (Menestrina et al. Right inset: the same emission spectrum as in the left inset but measured for ProHlyA K344C. These microdomains are enriched in cholesterol and sphingolipids and probably exist in a liquid-ordered phase, in which lipid acyl chains are extended and ordered (Brown & London, 1998). Many proteins are targeted to these membrane microdomains by their favorable association with ordered lipids. Interestingly, such proteins are linked to saturated acyl chains, which species partition well in to those domains (Pike, 2003). Although covalently bound fatty acids had not been implicated in the targeting of HlyA to membranes, their involvement in the targeting to membrane microdomains was studied (Herlax et al. The hemolysis rate of the cholesterol-poor erythrocytes was lower than that of the control erythrocytes at each HlyA concentration tested, thus pointing to the participation of cholesterol-enriched microdomains in the oligomerization process. For cholesterol-depleted erythrocytes, at low to xin concentrations, the kinetics of hemolysis seemed to be more complex, suggesting that to xin diffusion in membranes is the rate limiting step. This result indicated that cholesterol enriched microdomains played a significant role in the oligomerization process. The concentration of the small oligomers was favored by the cholesterol-enriched microdomains, where the diffusion time in the membrane became diminished. Measurement of accep to r fluorescence at 570 nm as a function of time in a mixture composed of HlyA K344C labelled with fluorescent donor and accep to r plus either control erythrocytes (black line) or cholesterol-depleted erythrocytes (light gray line). The excitation and emission monochroma to rs were set at 480 nm and 570 nm, respectively. The curves represent the average value of three independent experiments containing five replicates each. An extension of this reasoning suggested that at high doses a progressive oligomerization of HlyA leads to the fusion of the pore and rapid destruction of the cell membrane with little time for activation of the central apop to tic pathway. By contrast, at lower concentrations, the pores would be smaller and fewer in number so that the cells, though injured, would survive long enough for apop to sis to be observed (Lally et al. In conclusion, the fusion of oligomers may be the rate-limiting step in pore formation, and the integrity of the cholesterol-enriched microdomains is necessary for the concentration of HlyA to induce hemolysis. This notion agrees with the findings of Moayeri and Welch (Moayeri & Welch, 1994), who observed that the degree of osmotic protection of erythrocytes afforded by protectants of varying sizes depended on the amount of to xin applied and the duration of the assay. These authors suggested that HlyA creates a lesion with a very small initial size that then increases in apparent diameter over time. This technique takes advantage of the selective solubilization of different lipids that occurs when a biomembrane is submitted to the action of a nonionic detergent such as Tri to n X-100. A key feature of cholesterol-enriched microdomains is the tight packing of lipid acyl chains in the liquid-ordered phase, where the lipid acyl chains are extended and ordered (Brown & London, 1998). Because of the difficulty in packing membrane-spanning helices in to the ordered lipid environment, some proteins are linked to saturated acyl chains and partition well in to those microdomains (de Planque & Killian, 2003). To conclude, we propose that fatty acids covalently bound to HlyA and membrane microdomains are implicated in the hemolysis process. Fatty acids are essential because they 122 Biochemistry induce the exposure of intrinsic disordered regions in the to xin so as to enhance protein protein interactions in order to form the oligomer, while the membrane microdomains act as platforms for the concentration of the to xin during the oligomerization process. Cells were lysed with 1% (v/v) Tri to n X-100 and insoluble cell components separated by sucrose-density-gradient centrifugation. Gradient fractions were also analyzed by immunoblotting with anti-Flotillin-1 antibodies. Fatty acids expose specific regions that induce protein-protein interaction in the oligomerization process that takes place within the membrane microdomains of erythrocytes. Toxin-based theraphy Bacterial to xins have been defined as "soluble substances that alter the normal metabolism of host cells with deleterious effects on the host" (Schlessinger & Schaechter, 1993). Nonetheless, during the last decade, taking advantage of advances in to xin research, E. In the present section we will discuss these to xin-based therapies and the possible relevant use of HlyA. These considerations have prompted the development of many new approaches for the treatment of cancer. The term "immuno to xin" classically refers to chimeric proteins with a cell-selective ligand chemically linked or genetically fused to a to xin moiety that can target cancer cells overexpressing tumor-associated antigens, membrane recep to rs, or carbohydrate antigens. In the 1970s the first therapeutic agents composed of to xins conjugated to antibodies against cell-surface antigens started to emerge as tumor-cell killers (Moolten & Cooperband, 1970), (Moolten et al. Since then, many hybrid molecules consisting of a to xin coupled to a specific targeting antibody or ligand were developed, with most of these hybrids being directed against tumor cells (Pastan et al. First-generation immuno to xins were prepared by chemically conjugating antibodies to natural intact to xin units or to to xins with attenuated cell-binding capability. These constructs, however, were heterogeneous and nonspecific both because multiplicities of potential sites were available for chemical conjugation and since the presence of the cell binding domain on the to xin led to an in to xication of nontumor cells as well. Immuno to xins of the second generation were also based on chemical conjugation between the targeting moiety and the to xin. Nevertheless, accumulated knowledge on the structure and function of the to xins enabled the removal of their native nonspecific cell-binding domain, thus generating immuno to xins that were much more target-specific when conjugated to monoclonal antibodies.

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Familial forms antiviral vitamin c buy cheap valacyclovir 500 mg on-line, following an au to somal dominant pattern of inheritance, represent 5% to 15% of cases. Patients show a very rapid cognitive deteri oration, myoclonic jerks, rigidity, and ataxia. Pseudodementia is the term used for patients with major depression, who exhibit impaired attention, perception, problem solving, or memory. Although the actual memory impairment is modest in these patients, the subjective complaint is great. His wife states that this kind of behavior is not new for this patient, making any of the more acute disor ders unlikely. Patients with narcissistic personality disorder, in the face of some narcissistic insult (in this case, the myocardial infarction, reminding the patient that he is, indeed just human), often react with an exaggerated 112 Psychiatry denial of the problem. Dizziness, dere alization, and light-headedness are caused by the cerebral vasoconstriction, while circumoral tingling, carpopedal spasm, and paresthesias are symp to ms of hypocalcemia. Hyperventilation is a central feature of panic disor der and acute anxiety attacks, though more symp to ms are required (beyond just hyperventilation) to make those diagnoses. Panic disorder is characterized by recurring, spontaneous, unexpected anxiety attacks with rapid onset and short duration. The symp to ms of an attack climb to maxi mum intensity within 10 minutes, but can peak within a few seconds. Typ ical symp to ms include shortness of breath, tachypnea, tachycardia, tremor, dizziness, hot or cold sensations, chest discomfort, and feelings of deper sonalization or derealization. Generalized anxiety disorder is charac terized by excessive anxiety and worry, occurring more days than not for at least 6 months, about a number of events or activities. The anxiety and worry are associated with three or more of six symp to ms: (1) restlessness or feeling keyed up or on edge, (2) becoming easily fatigued, (3) difficulty concentrating, (4) irritability, (5) muscle tension, and (6) sleep distur bance. There are insufficient criteria to meet any one of the diagnoses, but perhaps a number of symp to ms for sev eral. Anxiety disorder secondary to a general medical condition is charac terized by symp to ms of anxiety, but these symp to ms must be related to (and caused by) a medical illness, such as hyperthyroidism, angina, hypo glycemia, and so on. In doing so, the hypocapnia is reversed, as is the respira to ry alkalosis, Cognitive Disorders Answers 113 which in turn leads to a return of normal cerebral blood flow and a nor malization of the ionized serum calcium. After the hyperventilation episodes are s to pped, it might be advisable for the patient to learn relaxation techniques (perhaps through biofeedback or hypnosis) so that the episodes will not recur. Wernicke-Korsakoff syndrome is a neurologic condition manifested by confusion, ataxia, and nystagmus; thiamine deficiency is its direct cause. If thiamine is given during the acute stage of Wernicke encephalopathy, Korsakoff syndrome can be prevented. This syndrome is characterized by a severe anterograde learning defect associated with confabulations. Although Wernicke-Korsakoff can be caused by malnutrition alone, it is usually associated with alcohol abuse and dependence. Pick disease is a form of frontal lobe dementia in which Pick cells and bodies (irregularly shaped, silver-staining, intracy to plasmic inclusion bodies that displace the nucleus to ward the periphery) are present in the brain. There is an insidious onset and gradual progression, with early decline in social interpersonal conduct. There is a marked decline in personal hygiene and significant distractibility and mo to r impersistence. It is caused by a direct effect of the virus on the brain and is always accompanied by some brain atrophy. Common features include impaired attention and concentration, psychomo to r slowing, for getfulness, slow reaction time, and mood changes. Wernicke encephalopathy is a medical emergency and can rapidly resolve with immediate supplementation of thiamine. This diagnosis should be considered in any patient brought in to the emergency room unresponsive. The dementia displays frontal-subcortical dysfunction features, such as impaired attention, visuospatial deficits, and poor judgment. These patients will often mutilate them selves repeatedly in a frantic effort to be cared for by the hospital system. Malingering is similar to fac titious disorder in that symp to ms are faked, but the motive for malingering is some secondary gain, such as getting out of jail. Somatization disorder is characterized by the recurrent physical complaints that are not explained by physical fac to rs and that cause significant impairment or result in seek ing medical attention. Somatization disorder usually emerges in adolescence or the early twenties and follows a chronic course. Somatization disorder is diagnosed predominantly in women, with a prevalence of 0. Borderline personality disorder patients may mutilate themselves, but the object is generally to get attention or relieve stress. Hyperprolactinemia with neuroleptic use is secondary to the blockade of dopamine recep to rs with these drugs. Other causes of hyperprolactinemia include severe systemic illness such as cir rhosis or renal failure, pituitary tumors, idiopathic sources, and pregnancy. Symp to ms include nausea, vomiting, diarrhea, abdominal pain, delirium, coma, and seizures. Arsenic is found in herbal and homeopathic remedies, insecticides, rodenticides, and wood preservatives, and it has a variety of other industrial applications. Despite medical evaluation and reassurance, the patient continues to fear that the disease is present. Often, after reassurance is given (usually because a negative test result is received) the patient is temporarily relieved, but this relief does not last. The symp to ms must cause clinically significant distress, and be present for longer than 6 months. New complaints or fears about an illness should be dealt with by the primary 116 Psychiatry care physician, using a limited evaluation (his to ry or physical examination) to ensure that no organic disease has developed, since even patients with hypochondriasis can become physically ill. Since these patients do not believe that their disorder is psychiatric, referral for psychotherapy is likely to be unsuccessful. The patient in this question reports no other signs of depression, and thus an antidepressant is not warranted. Presuming the patient has already had a work-up for ovarian cancer, which it appears by his to ry that she has, fur ther work-up for this disease is unwarranted. Consequently, the only conclusion that can be reached about the man described in the question is that he responds to placebos. Patients cannot form new memories, and they have difficulties recalling past personal events, with the poorest recall for events that to ok place closest to the onset of the amnesia. It presents with weight loss, abdominal pain, apathy, decreased energy, lethargy, anhe donia, and depression. This test is less reliable with partial complex seizures, and it is not useful in status epilepticus and simple partial seizures. Drug abuse and drug withdrawal are more commonly seen in young and middle-aged adults. Accidental poi soning and hypoxia (eg, from drowning) are more frequent in children. Among the identified causes of this syn drome have been drug effects, especially from opioids and anticholinergic medications; subclinical brain injury; complement activation; poor nutri tional status; and embolism. Stable vital signs help in the differential diag nosis with delirium tremens, which is accompanied by hypertension, tachycardia, and elevated temperature. The addition of medications to this picture usually does not help, and may worsen the condition.

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In the literature hiv infection methods buy valacyclovir visa, more studies can be found describing changes in biological activities of flavonoids after their acylation with aliphatic acids. The aliphatic acylation of anthocyanins with malonic acid is important for enhancing the pigment solubility in water, protecting glycosides from enzymatic degradation and stabilizing anthocyanin structures (Nakayama et al. Several in vitro observations suggest that acylation with malonic acid or sinapic acid is crucial for efficient flavonoid accumulation in plants. Fatty acid esters of catechins were reported to display antitumor, antibacterial and 5-fi reductase inhibiting activity (Fukami et al. Acylation of the flavonoid molecule with polyunsaturated fatty acids introduces potential antitumor and antiangiogenic properties (Mellou et al. Anticarcinogenic effects were observed also in silybin esters acylated with butyric and lauric acid (Xanthakis et al. Recently, we found that acylation of rutin with unsaturated fatty acids, such as oleic, fi linoleic and linolenic, increased the antioxidant potential of the initial compound (Viskupicova et al. In the field of fatty acid ester synthesis, information on the pho to protective effectiveness of new quercetin derivatives acylated with acetic, propionic and palmitic acids, has been reported. The authors found that esterification with a short side-chain (such as acetate or propionate) may improve migration through the aqueous environment and interaction with or penetration in to phospholipid membranes (Saija et al. Enzyme-Mediated Preparation of Flavonoid Esters and Their Applications 275 Recent experimental findings indicate that acylation of flavonoid may increase enzyme inhibi to ry activity. We presume that there might be a general mechanism involved in the enhanced inhibi to ry activity of the acylated flavonoids on structurally diverse classes of enzymes which seems to be donated by the medium to long fatty acid chains. Application perspectives the following section provides a summary of patented inventions available in the commercial sphere. Furthermore, selectively acylated flavonoids may cause significant changes in their bioavailability and bioactivity, and when consumed, may thus play a role in preventing diseases. Flavonoid acylation is a useful to ol for modification of sensory properties of food. While flavonoids provide a variety of health benefits, flavonoid-containing food often suffers from bitter and astringent taste. Both the taste intensity and the taste profile perception are improved by the novel compounds. Another particular advantage obtained by these modified flavonoids is the bifunctional character of their molecule with higher biological activity. Free unsaturated fatty acids represent a potential risk because they are highly reactive and by creating free radicals they cause undesirable damage in food. Enzymatic synthesis of flavonoids with unsaturated fatty acids was found to be a useful solution for the stabilization of these highly oxidizable acids (Viskupicova et al. Another important benefit of acylated anthocyanins lies in the use as food colorants which can serve as a useful alternative to synthetic additives (Giusti & Wrolstad, 2003; Fox, 2000; Asen et al. The discovery of acylated anthocyanins with increased stability has shown that these pigments may provide food products with the desirable color and stability at a wide pH range. Examples of suitable acylated anthocyanin sources may be radishes, red 276 Biochemistry pota to es, red cabbage, black carrots, and purple sweet pota to es (reviewed in Giusti & Wrolstad, 2003). It relates to an anthocyanin isolated from the Heavenly Blue Morning Glory (Ipomoea tricolor Cav cv), peonidin 3-(dicaffeylsophoroside)-5-glucoside, which is characterized by the stability of colors ranging from purplish-red to blue produced in food and beverage products at pH values from about 2. Fox (2000) reported the invention referring to a stable, ruby red natural colorant (anthocyanins acylated with chlorogenic acid) derived from purple sunflower hulls, useful as a coloring agent in food products, cosmetics, pharmaceuticals and other materials. Novel acylated flavanone derivatives are effective in the treatment or prevention of elevated blood lipid level-related diseases. In spite of their potent efficacies, the flavanone derivatives exhibited no to xicity or mi to genicity in tests using mice (Bok et al. The 6'-O-esterification of kaempferol-3-O-glucoside (astragalin) with p-coumaric acid was found to increase its anti-inflamma to ry activity eight times compared to the initial flavonoid, while addition of another p-coumaroyl group at 2' position gave an activity 30 times greater than that of astragalin (Harborne & Williams, 2000). Another kaempferol derivative, kaempferol 3-(2',3'-di-E-p-coumaroylrhamnoside), was found to possess a cy to to xic effect. Enzyme-Mediated Preparation of Flavonoid Esters and Their Applications 277 Parejo et al. They found that these compounds exhibited a high radical scavenging activity in comparison with reference compounds. Fatty acid derivatives of catechins are described as having antitumorigenesis promoting activity or 5-fi reductase inhibiting activity, as well as antibacterial activity (Fukami et al. Since these acylated catechin compounds have a greatly superior solubility in fats and oils than any catechins previously known, they may be used as a highly effective antioxidative agents (Sakai et al. A different catechin derivative, 3-O-octanoyl-(+)-catechin, was synthesized by Aoshima et al. This ester was found to be more efficient than catechin in inhibiting the response of ionotropic gamma-aminobutyric acid recep to rs and Na+/glucose cotransporters expressed in Xenopus oocytes in a noncompetitive manner. Moreover, it induced a nonspecific membrane current and decreased the membrane potential of the oocyte. This newly synthesized catechin derivative possibly binds to the lipid membrane more strongly than do catechin, (-)-epicatechin gallate, or (-)-epigallocatechin-3-gallate, and as a result it perturbs the membrane structure (Aoshima et al. The consequence of this oxidation is to profoundly modify the properties, which makes them unusable after a variable time period. By virtue of the skin-protecting and skin cleansing properties of flavonoids and their effects against aging, against skin discoloration and on the appearance of the skin, they have been used as constituents of cosmetic or dermopharmaceutical compositions. Conclusions Flavonoids, having a wide spectrum of health-beneficial activities, seem to be applicable in various areas of national management from food additivization to pharmaceutical preparations with the purpose of prevention and/or treatment of important civilization diseases. Their chemical structure determines not only biological effects on human health but also their solubility, stability and bioavailability. Recently, selective enzyme-mediated acylation of flavonoids has been introduced to confer improved biological properties to the novel compounds including both biological activity of initial flavonoid and other parameters determined by the chemical structure of an acyl donor. In the past, proteases, esterases and acyltransferases were used for the preparation of acylated flavonoids. In light of our review, immobilized lipases, especially Candida antarctica B lipase, are suitable for this purpose. Not only the given enzyme but also the reaction conditions have a distinct influence on the performance of acylation. This aspect must be considered when producing acylated flavonoids in technology scale for potential uses in the food, pharmaceutical and cosmetic industry. Acylated flavone glucosides: synthesis, conformational investigation, and complexation properties. Acylation of natural flavonoids using lipase of Candida antarctica as biocatalyst. Enzyme-Mediated Preparation of Flavonoid Esters and Their Applications 279 Ardhaoui, M. Effect of acyl donor chain length and substitutions pattern on the enzymatic acylation of flavonoids. Enzymatic synthesis of new aromatic and aliphatic esters of flavonoids using Candida antarctica as biocatalyst. Thermal stabilization of immobilized lipase B from Candida antarctica on different supports: Effect of water activity on enzymatic activity in organic media. Stable foods and beverages containing the anthocyanin, peonidin-3-(dicaffeylsophoroside)-5-glucosid. Enzymatic synthesis of sugar esters and oligosaccharides from renewable resources. Flavanone derivatives and composition for preventing or treating blood lipid level-related diseases comprising same. Microbial carboxyl esterases: classification, properties and application in biocatalysis. Enzymatic acylation of flavonoids: Effect of the nature of the substrate, origin of lipase, and operating conditions on conversion yield and regioselectivity. Biotransformations and bioconversions in New Zealand: Past endeavours and future potential. Lipase catalysed formation of macrocycles by the ring opening polymerisation of fi-caprolac to ne. Detection of galangin-induced cy to plasmic membrane damage in Staphylococcus aureus by measuring potassium loss.

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For example antiviral drip proven valacyclovir 500mg, through the introjection of a loved object, the painful awareness of separateness or the threat of loss may be avoided. Acting out implies the expression of an impulse through action to avoid experiencing the accom panying emotion related to that impulse at a conscious level. Intellectual ization is the excessive use of intellectual processes to avoid affective expression or experience. In this case, the man avoids his guilty feelings through the meticu lous explanation, over and over, of the events leading up to his car accident. Through sublimation, satisfaction of an objectionable impulse is obtained by using socially acceptable means. Repression refers to expelling or withholding from consciousness an idea or feeling. Acting out implies the expression of an impulse through action to avoid experiencing the accompanying effect at a conscious level. Rationalization is the process of offering rational explanations in an attempt to justify attitudes, beliefs, or behavior that may otherwise be unacceptable. The clue here is that her previous functioning, as described by her husband, was normal in both the cognitive and the emotional realms, making a pre viously undiagnosed personality disorder unlikely. Delirium would be accompanied by waxing and waning of consciousness, which is not described in this case. A mood disorder secondary to an organic cause is likewise unlikely, since the patient is not described as depressed or manic in behavior. Although the fear is irrational, because the impulse is only a thought or fear and not an actual action, the compulsive nature of the act causes the person to perform it repeatedly regardless. Undoing is one of the three main psychological defense systems used in obsessive-compulsive disorder. The protest phase is charac terized by crying, calling, and searching for the parent. This can be seen by the child refusing affec tion from the parent, turning his or her head away, and wanting to remain with the alternate caregiver. If the separation continues, the child enters the detachment phase, when the bond with the parent has been irreparably severed. Prior to the achievement of this level, the child is unable to maintain a mental image of an object, so when it disappears from view, it, in effect, no longer exists. Once the child recognizes object perma nence, he or she understands that objects can be hidden, thus making the game of hide-and-seek a rewarding one for a child of this age. They can exact revenge, modify the outcome of any situation, or otherwise improve their condition in life through this play. In this particular case, it is likely that the boy is engaging in this play because 52 Psychiatry someone at day care (named Johnny) has been difficult for the child to to lerate. Whether this is because Johnny is verbally, physically, or sexually abusive or just dominant on the playground is unknown. He should, by the age of 27 months, be able to understand small body parts (elbow, chin), family name categories (sister, father), and size, as well as most adjectives. He should be intelligible 50% to 80% of the time, and be able to use real sentences. Children cannot appropriately react to the feelings of others until the ages of 7 to 11. Children like attention and approval at the ages of 1 to 2, and should be able to show sensitivity to criticism and care about the feelings of others by the age of 5. In each stage, pleasure (not necessarily sexual) is derived from specific areas of the body. In the first 18 months of life, infants go through the oral stage, during which oral sensations (feeding, sucking, biting, etc. In the anal stage, between 18 and 36 months of age, the child is much more indepen dent and active than during the previous stage. Erotic stimulation of the Human Behavior Answers 53 anal mucosa through the excretion or retention of feces is the main source of pleasure. Battles over to ilet training are common in the attempts to achieve au to nomy from the parents. The phallic stage, which starts at age 3, is characterized by a concentration of erotic pleasure in the penis and the cli to ris areas. During the phallic stage, the child starts looking outside himself or herself for an erotic object, thus heralding the advent of the oedipal stage. Freud theorized that between the ages of 3 and 5, the male child, like Oedipus in Greek mythology, falls in love with the mother and perceives the father as a murderous rival. During the oedipal stage, girls experience an equivalent attraction for their fathers and perceive their mothers as rivals. How girls resolve their oedipal conflicts and come to identify with their mothers is less clearly explained. During latency, between 5 and 11 to 13 years of age, the sexual drive is relatively quiescent and the child becomes focused on learning new skills and social interactions with peers. The genital stage begins with puberty and ends with young adulthood and is characterized by a reintensification of sexual drives. The key developmental tasks associ ated with this stage are mastery over instinctual drives, separation from parents, and the establishment of a genital sexuality with an appropriate partner. Infantile sexuality is a Freudian developmental theory of childhood sexuality that delineates the vicissitudes of erotic activity from birth through puberty. Primary process refers to thinking that is dereistic, illogical, or magical; it is nor mally found in dreams and abnormally in psychosis. The onset of puberty and the devel opment of an overt interest in the opposite sex typically occur later, in ado lescence (ages 12-15). The consolidation of personality and a growing concern with cultural values and ideologies occur in late adolescence, typ ically defined as 17 to 20 years of age. Dream work is the process through which the latent content of the dream is transformed in to the more acceptable manifest content. Condensation, displacement, and symbolic representation are primary processes and can make the manifest content of the dream quite bizarre. Secondary revision, a process guided by the ego, intervenes at the end of the dream work to make the manifest content more rational and acceptable to the dreamer. An 18-year-old man is admitted to the psychiatric unit after his par ents find him in his room muttering to himself and convinced that people are going to hurt him. During his stay in the hospital, the patient is fre quently found standing in the center of his room with both arms over his head, immobile. Benzodiazepines, barbiturates, and many anticonvulsants exert their influence through which of the following types of recep to rsfi The observation that levodopa (a drug used to treat Parkinson disease) can cause mania and psychosis in some patients supports which neuro chemical theory of psychiatric behaviorfi A 24-year-old man with Tourette disorder comes to his psychiatrist because he has just gotten engaged.

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It is important to convey to health staff during training that anyone can experience sexual violence hiv primo infection symptoms purchase valacyclovir 500 mg amex. Public health guide for emergencies I 191 4 Implementing gender-based violence programmes in the health sec to r Gender-based violence is a sensitive issue. It is important to ensure that a gender-based violence programme is culturally appropriate and sensitive to the different needs of men and women and different age groups. It must be accessible and available to those who may be especially vulnerable, such as widows, older women, and adolescents. All individuals who are actual victims or potential victims of sexual violence are entitled to the protection of, and respect for, their human rights. Rape in war is considered a war crime and crime against humanity and is characterized as a form of to rture. Table 4-16: Rights health care providers should respect Right Description Right to health Survivors of gender-based violence have a right to receive quality health services that include reproductive healthcare to manage physical and psychological consequences of the abuse. Right to human Treatment should be consistent with the dignity and respect the victim dignity is owed as a human being. Right to non Laws, policies and practices related to healthcare access should not discrimination discriminate against a person who has suffered gender-based violence on any grounds (race, sex, colour or national origin). Right to self Healthcare providers should not force or pressure examinations or determination treatment. All decisions regarding care are to be made by the survivor after receiving appropriate information that allows informed choices. Survivors have the right to decide whether they want to receive information, be examined, or get treated, as well as whom they want to accompany them. Right to information Information about treatment options should be individualized. The full range of choices must be presented regardless of the individual beliefs of the healthcare provider. Right to privacy Conditions for examination and treatment should be created to ensure privacy. Only people whose involvement is necessary in order to deliver medical care should be present during exams and treatment. In the case of a charge filed with the police or other authorities, relevant information from the exam will need to be conveyed. Confidentiality It is critical that field staff ensure strict confidentiality about any specific incidents of sexual or gender-based violence. The possible consequences of inadequate confidentiality about these issues include the stigmatization of victims, violent revenge against those 192 I the Johns Hopkins and the International Federation of Red Cross and Red Crescent Societies 4 committing the violent acts, and the reluctance of other victims to seek assistance. The role of the health sec to r, in collaboration with other assistance mechanisms, is to reach out to and identify survivors, provide examinations and treatment, collect medical evidence, document as appropriate, and refer to other needed care. At a minimum, care should include treatment and referral for complications of the effects of the sexual violence, including wounds, treatment or prevention of sexually transmitted infections, emergency contraception, counselling, referral to social services and psychological counselling and support services, as well as documentation and basic moni to ring and evaluation. When the situation becomes more stable, pro to cols for rape management should be established, and provision of services should be coordinated with more development oriented activities, such as skills training and income generation for survivors. Moni to ring and evaluation of gender-based violence programmes in the health sec to r Moni to ring and Evaluation (M&E) is an important process to meet the requirements of donors and other stakeholders and to maximize efficient and effective use of limited resources. In order to moni to r progress and evaluate whether a programme has achieved the intended results, data must be gathered. Moni to ring Regular moni to ring is necessary for reviewing the progress of a gender-based violence programme activity in reaching the set objectives, as well as analyzing the prevention of sexual violence and response to incidents. Various to ols, such as clinic registers, forms, and internal reports, may be used for both moni to ring and programme management (especially supervision and decision-making). The involved sec to rs, frequency and methods used for moni to ring should be decided by an established, multi-sec to ral gender based violence working group. For example, when a programme is established, you can expect to have increased reporting, but this does not mean there is more violence. The goal of such a programme is to encourage higher reporting and, therefore, better treatment and identification. Possible indica to rs include: fi Incidence of sexual violence; Moni to r the number of cases of sexual violence reported to health services, protection and security officers; fi Supplies for universal precautions; Moni to r the availability of supplies for universal precautions, such as gloves, protective clothing and disposal of sharp objects; fi Estimate of condom coverage Calculate the number of condoms available for distribution to the population; Public health guide for emergencies I 193 4 fi Estimate of coverage of clean delivery kits Calculate the number of clean delivery kits available to cover the estimated births in a 71 given period of time. Table 4-17: Indica to rs for moni to ring gender-based violence messages disseminated through drama, community dialogues, etc. Performance indica to r Measure Number of sensitization Number of drama shows depicting manifestations of gender sessions /dissemination based violence and its effects that were conducted during the activities conducted during reporting period in settlements (Programme Coordina to rs to the quarter through drama, identify technically skilled persons to encourage the social community dialogue, forums to develop drama scripts that communicate gender-based impromptu discussions and violence messages effectively. The drama scripts will focus on 4 booklet clubs types of gender-based violence, incidents and referral. Evaluation Most programmes to prevent and respond to gender-based violence in peaceful and emergency settings have not been appropriately evaluated. This increases the likelihood that resources will be wasted and unsuccessful programmes replicated, with potential harm to intended beneficiaries. While evaluations are discussed in more detail in the management chapter of this book, it is important to look at a few specific items in evaluations as they relate to gender-based violence programmes. The table below outlines some sample questions for various gender-based violence issues that need to be evaluated. Table 4-18: Sample questions for various gender-based violence issues Issues Sample questions Coordination fi What multi-sec to r and interagency procedures, practices and reporting forms are in place in the current emergencyfi Do regular working group meetings include local community groups, local advocacy groups, local government or authoritiesfi Water and sanitation fi Are there adequate numbers of latrines for each sex in the communityfi Shelter, site planning, non fi Is there a community-based plan for providing safe shelter for food items victims/survivorsfi Health and community fi Are victims of sexual violence receiving timely and services appropriate carefi Evidence-based evaluation In many situations, the absence of quantitative generalisable baseline data impedes the ability of service providers to plan for, obtain funding for, and implement essential health and psychosocial services for sexual violence survivors. Given the sheer magnitude and range of problems competing for gender-based violence funding and programmes in many countries, quantitative data can be essential to ensure that limited resources are directed to wards the physical and mental needs of women who have experienced rape and sexual violence, as well as other forms of gender-based violence. An evidence-based survey can be applied to any situation (conflict or post-conflict) and any country. The evidence-based needs depend on the situation (internally displaced Public health guide for emergencies I 195 4 person, refugee, host population, etc. The goals of a quantitative study are to credibly document the full scope of abuses and to understand patterns and predic to rs of abuse. Good quantitative work often reveals previously hidden patterns and underlying issues and can identify targets for intervention. If done properly, the findings can be generalized to larger populations, which case documentation does not permit. Solid quantitative research also can be a source of future leads for case documentation efforts and provide essential information for programme planning and funding requirements. They go door- to -door and hold group discussions, community dialogues, and booklet clubs. Performed in English, French and Swahili, the plays are dramatic reflections of current circumstances. For example, one play depicted the theme of early marriage through a true s to ry about a 14-year-old girl whose parents allowed a 65-year-old man to kidnap and force her in to marriage in exchange for money. Unfortunately, you will note that note that Red Cross/Red Crescent National Society or other humanitarian staff can sometimes be the victims of sexual violence, but can also be the perpetra to rs of sexual violence. Refugee settlements can be unsafe and women may be forced to use sex as a means of securing food, shelter, and protection. The following are a few examples of sexual violence that has occurred in disaster settings: fi Sexual violence increases during crisis. In East Timor, 23% of women reported sexual violence by men outside their family during the crisis period.

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Abnormal personality: A personality with traits which deviate markedly from what is generally accepted as normal diferencia entre antiviral y vacuna cheap valacyclovir 500mg free shipping. This term has largely been replaced by clinical psychology when referring to the professional practice of abnormal psychology. Above and below: Adler used this term to imply the unconscious notion existing in every psyche, male or female, of femaleness as a degradation and maleness as an ideal. Abreaction: A process, used in some forms of psycho therapy, especially psychoanalytically oriented ones, by which repressed material, particularly a painful experience or a conflict, is brought back to consciousness. A therapeutic effect sometimes occurs through partial discharge or desensitization of the painful emotions and increased insight and also, by the development of new coping strategies, See also catharsis. Abreaction, mo to r: the living-out of an unconscious impulse through muscular or mo to r expression. Absence: A temporary loss of consciousness due to epilepsy without any convulsive phenomenon. Abstinence: the act of refraining voluntarily from some activity or from the use of certain substances such as food or drugs. Abstinence syndrome: In the area of alcohol or drug dependence, being without the substance on which the subject is dependent. It is equivalent to 4 Dictionary of Psychology & Allied Sciences withdrawal symp to ms and its appearance suggests the presence of physiological dependence or addiction. Abstract attitude: Cognitive functioning that includes assuming a mental set voluntarily; shifting volun tarily from one aspect of a situation to another, keeping in mind simultaneously various aspects of a situation; grasping the essentials of a whole breaking it in to its parts and solating them voluntarily, planning ahead ideationally, and/ or thinking or performing symbolically. A char acteristic of many psychiatric disorders in the inability to assume the abstract attitude or shift readily from the concrete to the abstract and back again as demanded by circumstance. Abstracting disabilities: Difficulties in organizing and understanding the inputs once information has been recorded in the brain. Abstraction: the process whereby thoughts or ideas are generalized and dissociated from particular concrete instances or material objects. Concrete ness in proverb interpretation suggests an impair ment of abstration, as in schizophrenia. Abstract thought: Thought which uses concepts which do not have an immediate material correspondence such as justice or freedom. Absurdity: In psychoanalysis, anything that is contra dic to ry or incoherent or meaningless in a train of thought or a constellation of ideas. Dictionary of Psychology & Allied Sciences 5 Abulia: Lack of will or motivation, often expressed as inability to make decisions. Abuse: (1) of substance, using them inappropriately in a way that is harmful to the individuals. See, addiction (2) inappropriate and harmful treatment of another person (child, elder, sexual, spouse). Acalculia: Loss of previously possessed faculty with arithmetic calculation: may follow parietal lobe damage. Acanthesthesia: A type of paresthesia in which the patient experiences a sensation of pinpricks. Acarophobia: Fear of small objects such as insect, worms, pins and needles seen in patients with alcoholism. Acatalepsia: A mental deficiency characterized by the inability to reason or comprehend. Acataphasia: A form of disordered speech in which statements are incorrectly formulated. The patient may express himself with words that sound like the ones he means to use but are not appropriate to his thoughts or he may use to tally inappropriate expressions. Accessible and inaccessible: A patient is said to be accessible if the psychiatrist or analyst succeeds in making rapport with him, and inaccessible if he fails. The term is pseudo-objective, since it implies that the capacity for rapport is a constant, identical in every examining physician. Accident proneness: Susceptibility to accidents based on psychological cause or motivations. Acetylcholine: A neuro-transmitter which is particularly found at the mo to r end plate and is therefore involved in muscle action. Achievement motivation: the motivation to accomplish valued goals and to avoid failure. This concept became important as motivation theory became less dominated by physiological drives. Achievement test: Tests used to measure present knowledge or skills especially knowledge or skills developed through specific learning. Acquisition: (1) A term used to indicate that a particular skill or ability has been gained by an animal or human being. When applied to language, this term is used to avoid drawing inferences about whether language has been learned or inherited. Acquisition curve: the graphic representation of learning which shows that the strength of the learned response gradually increases with more and more learning trials. Acting out: To express a wish, need or motivation particularly when it is unrecognized or unconscious in overt behaviour rather than words. Often the behaviour is aggressive and self-destructive and may be very unchar acteristic for the persons who may have no idea, why they behave in that way. In psychoanalysis, the essence of Dictionary of Psychology & Allied Sciences 7 concept is the replacement of thought by action and it implies that (a) the impulse being acted out has never acquired verbal representation, or (b) the impulse is to o intense to be dischargeable in words, or (c) that the patient lacks the capacity for inhibition. Since psychoanalysis is a talking cure carried out in a state of reflection acting out is antitherapeutic. Acting out is characteristic of psychopathy and behaviour disorders and reduces the accessibility of these conditions to psychoanalysis. Action theory: A theory concerned with the study of human goal directed behaviour and its social basis. Active and passive: Friend made extensive use of the idea that there exists a polarity between activity and passivity; Masculinity, aggression, sadism and voyeurism being active and feminity, sub missiveness, masochism and exhibitionism being passive. The situation is, however complicated by a further assumption that instincts can undergo reversal in to their opposite, in particular that active instincts can become passive, sadism and voyeurism being usually cited as the examples of instincts capable of this reversal. Active group therapy: A type of group therapy introduced and developed by S R Slavon and designed for children and young adolescents, with emphasis on emotional and active interaction is a permissive, non-threatening atmosphere. The therapist stresses on reality testing, ego strengthe ning and active interpretation. Active therapist: Type of therapist, who makes no effort to remain anonymous but is forceful and expresses his personality definitively in the therapy setting. It asserts that mind could not be reduced to a set of elements 8 Dictionary of Psychology & Allied Sciences found in consciousness. Actual neurosis: Friend, in his early writing, distin guished between psychoneuroses and actual neuroses, the former being due to psychological conflicts and past events the latter being the physiological consequences of present distur bances in sexual functioning. He further distin guished two forms of actual neurosis; neurasthenia, the result of sexual excess and anxiety neurosis, the result of unrelieved sexual stimulation. Actualizing tendency: A term coined by Rogers (1954) to describe the process by which people seek to develop their various potentials and maximize their personal growth. Acute confusional state: (1) A form of delirium in which the most prominent symp to ms are disorders of memory deficit and both retrograde and antero grade amnesia and clouding of consciousness (reduced clarity of awareness of environment and reduced capacity to shift, focus and sustain attention to environmental stimuli). The reaction is characterized by frustration; rage, inability to concentrate and feeling or estrangement, depersonalization, and loneliness; it is generally self-limited and subsides and the person adjusts to his situation. Dictionary of Psychology & Allied Sciences 9 Acute reaction to stress: Very transient disorders of any severity and nature which occur in individuals without any apparent pre-existing mental disorder in response to exceptional physical or mental stress such as natural battle and which usually subside within hours or days. The acute reaction to stress may manifest a predominant disturbance of emotions.