By C. Ugolf. Centenary College of Louisiana. 2018.
This dependence makes being in a relationship much more important discount aciclovir 200 mg without a prescription, and therefore increases anxiety about being alone and increases fears of rejection discount 400 mg aciclovir amex. For example I have had many clients who thought they could only be happy if they get married and have a family buy aciclovir 800mg lowest price. Yet some were fearing age would overtake their ability to have children, and no partner was in sight. They developed a terror of not having their happy family dream come true and living their lives alone. They became very "needy," manipulative, and scared potential partners away. They escaped the catch by learning how to be at peace with the thoughts that they might never be married and might live alone the rest of their lives. They learned how to take care of themselves and how to be happy alone. Because now they were less fearful and "needy" and more confident and relaxed. If you have few interests that you can do alone, because you have spent most of your life either with other people or doing what others wanted you to do, then it is especially important for your own independence that you explore new potential interests. Remember this, if many other people love this activity there must be some fun in it. Many activities are difficult to enjoy until you have learned the basics about how to participate in them. Most sports are that way, but even music and the theater can take some time to appreciate. Give the new activity a chance over a reasonable period of time. Many people hate to do things alone, so they refrain from activities. A common reason is that they are afraid of what others will think about their coming alone. However, if you continue to do activities alone, you can eventually desensitize yourself to most of those fears. Career interests, sports, music and the arts, reading, entertainment events, hobbies, do-it-yourself projects, taking classes, walks, shopping, bike rides, or taking oneself out for dinner are but a few examples of activities people do to entertain themselves. Initiating activities with other people and joining organizations are examples of ways that you can create your own happiness with others without being in an exclusive relationship. Finally, if you are generally happy and enjoy life, your positiveness and happiness can help them be happier as well. And that will make you more attractive to anyone who wants to be happy themselves.. CREATING A HAPPY OTHER CREATES AN ATTRACTIVE YOUYou are attractive to another person to the degree that that person perceives you as potentially contributing to their happiness. You are not responsible for their happiness, you are only being yourself and giving gift of your presence and actions. You are only hoping these gifts will contribute to their happiness. Each person is ultimately responsible for their own happiness. PRACTICE:1) List all of the characteristics you want in another person. PRACTICE: Make a list of the labels that stop you from approaching others or being yourself. Then take each one and decide the degree to which you intend to change it or to accept it as it is. Keep in mind that there are many happily married persons who fit all of the above descriptions and realize that, you are looking for someone who would be happy with a person just like you. External events or commitments that keep you from pursuing a relationship now. The difference between an EXCUSE and a CONSCIOUS CHOICE is whether or not you are being honest with yourself about all of your underlying motives. If you are avoiding involvement primarily because of fear of rejection or failure, then that is very different from saying that you are doing it because you are too busy. It is ok not to be in a relationship or looking for one. If you want to pursue other parts of your life and develop yourself into the person you want to be, that can be very healthy for building your own self-esteem and relationship potential. When you are ready for a relationship, you will be more the person who will be attractive to the type of person you want. PRACTICE: If you are not sure whether you are being honest with yourself about doing what might be helpful to improve a relationship or meet someone, try getting in touch with underlying feelings and beliefs, exploring new creative alternatives and possible outcomes. Then make a conscious decision based upon your true underlying motives. Women often think that men are "only interested in sex or the size of my breasts," "say they want an equal relationship, but are afraid of successful women". Many men think that most women are primarily interested in money, expensive cars, restaurants, and gifts. Or, that they only want a man who is extremely good looking and charming with a good line (can make a good impression, but would make a poor partner). PRACTICE: Make a list of your stereotypes which prevent you from approaching others or being yourself. Identify ways that you try to put up a front to make a good impression based upon your stereotypes. For example you may believe that you have to constantly be clever and funny because that is what you think women/men are looking for. In fact you may be turning the other person off, because you are being "phoney" and not intimate about who you really are. You are making the mistake of underestimating the person you are with. Treat potential partners as if he/she were as mature as youand as if he/she were the kind of person you would want. A research study at the University of Oregon had single women evaluate their conversations with single men. The women evaluated the men on a number of variables including if they would like to go out with them. To their surprise low-frequency dating men performed just as well as high-frequency dating men in actual ratings by the women.
Some cutting treatment programs are still very intensive but operate on an outpatient basis discount aciclovir 400 mg on line; where the patient attends treatment during the day but continues to live at home 200 mg aciclovir otc. This type of cutting help often includes similar types of services to inpatient cutting treatment but requires greater individual responsibility over not cutting due to the lesser oversight purchase aciclovir 400mg with mastercard. When attending cutting treatment, the patient is often asked to sign a document promising they will not harm themselves while in the program. A patient may also be asked to identify alternative self-injury coping methods up-front and be expected to use these instead of self-harming. This may be in the form of group therapy or individual counseling. Therapists who are licensed and specialize in self-harm are the best choice for cutting help. This type of therapy might be found through a treatment center but can also be found in the community or through mental health organizations. Common forms of therapy for cutting treatment include:Dialectical behavior therapy (DBT)Interpersonal psychotherapyMedication is rarely prescribed for cutting treatment, when cutting or self-harm is the only problem present. Many people who cut, however, also have underlying mental illnesses and so those must be treated when undergoing treatment. These underlying illnesses, such as bipolar disorder, depression or borderline personality disorder, may require the use of psychiatric medication and other specialized treatment. End the desire to self-injure and feelings that motivate you to cut yourself. Believe and all your dreams will all come trueStopping the cutting is easier said than done. Basically what it boils down to is that you have to want to stop cutting yourself. Of course, self-injury cutting releases pain and tension. Of course, it makes you feel better immediately, but in the long run, it makes you feels worse. When you cut, you generally end up feeling ashamed that you hurt yourself and embarrassed by the scratches and self-injury scars. Here are some of my suggestions on how to stop cutting yourself:Do something creative! I have a friend that paints, one that journals, and still another that writes poetry. I have several friends that write and compose music to release their frustrations. Personally, I like to create/modify websites to get my mind off the things that are bothering me. You can do a lot of things to occupy your mind besides expelling creative energy. I would also suggest going to a theater to see a movie because it helps to get out of the house. This is probably the most obvious suggestion in the book! You can and should talk to others about your self-injury problem! I would suggest turning to a close friend or significant other first, but parents can be a good thing to fall back on. If you are not sure how to broach the issue, here are some suggestions on how to tell someone you self-injure. Yes, but not something that will hurt you or someone else. You can rip up or punch a pillow, scream your lungs off, jump up and down, or practice a combination of things. Exercise is also a good idea, since it can be good for you. Sometimes, writing can help sway your feelings and the desire to self-injure will subside. Afterwards, you can analyze your feelings and possibly avoid what triggered the desire to self-injure in you in the first place. She has a lot of tapes she has made for herself that help her when she is in the mood to self injure. They give her something to identify with, so she knows she is not alone. Another interesting thing that she does when she feels down is make collages. She has several that are very interesting, although most are painful to see. We talk about her collages, why she chooses the images she does, and I try to reinforce that she is just as intelligent, beautiful, and important as the people in her collages. For more suggestions on ways to immediately avoid self injuring, please take a look at this page on self-harm alternatives. This page offers ways to cope with self-injury based on the feelings that motivate you to self-injure. Another thing to do, after you have calmed the urge to self-injure, is to go back through your day and try to determine what pushed you to want to SI. If you can recognize what is causing the problem, you can attempt to come to terms with it or handle it differently. Here, you will find methods and suggestions to stop self-injuring permanently, as well as more spur-of-the-moment suggestions. Be prepared to make a commitment to yourself and stop the self-harm. Cutting help and professional cutting treatment are key to your recovery. If you want to get better, you have to come to terms with your problems, and the best way to do that is by getting self-injury help and support and another perspective by telling someone close to you about your problem. If someone you care for needs to go to the hospital and wants you to go with them, there are a number of things you can do to ensure they get proper treatment. Sometimes the person that has injured themselves will feel meek or vulnerable. In this situation, you must stand up for them and be their "advocate. Consider revealing your self-injury to someone you trust. Telling someone that you are a self-injurer is scary. In a way, it can be viewed as similar to coming out as gay or lesbian. Although it is very common, it may not be considered "acceptable" ?? to others. You can disclose your self-harm in a conversation, or in a letter that you present to them, or by e-mail.
The injury from physical child abuse may be the result of:Beating order aciclovir 200mg fast delivery, slapping buy 200 mg aciclovir fast delivery, or hitting quality aciclovir 200 mg. Burning with cigarettes, scalding water, or other hot objects. Physical abuse is an injury resulting from physical aggression. Physical punishment is the use of physical force with the intent of inflicting bodily pain, but not injury, for the purpose of correction or control. As you can see, physical punishment can easily get out of control and become physical abuse. Some other specific types of physical child abuse are:Shaken Baby Syndrome - Shaking a baby or toddler can cause serious head injuries. Munchausen by Proxy Syndrome - Inducing medical illness in a child or wrongly convincing others that a child is sick is both dangerous and abusive. Drug use during pregnancy - Drug and alcohol use during pregnancy or lactation can be harmful to your child, leading to problems such as Fetal Alcohol SyndromeHundreds of thousands of children are physically abused each year by someone close to them, and thousands of children die from the injuries. For those who survive, the emotional scars are deeper than the physical scars. Burns, bite marks, cuts, bruises, or welts in the shape of an object. Sexual abuse of a child is any sexual act between an adult and a child, including penetration, intercourse, incest, rape, oral sex, and sodomy. Violations of bodily privacy - Forcing a child to undress, spying on a child in the bathroom or bedroom. Exposing children to adult sexuality - Performing sexual acts in front of a child, exposing genitals, telling "dirty" stories, showing pornography to a child. Commercial exploitation - Sexual exploitation through child prostitution or child pornography. Sexual child abusers can be:Fathers, mothers, siblings, or other relatives. Foster parents or host families of foreign-exchange students. Inappropriate interest in or knowledge of sexual acts. Avoidance of things related to sexuality, or rejection of own genitals or body. Your child spends large amounts of time online, especially at night. Your child turns the computer monitor off or quickly changes the screen on the monitor when you come into the room. Your child is using an online account belonging to someone else. It can range from a simple verbal insult to an extreme form of punishment. Emotional abuse is almost always present when another form of abuse is found. Surprisingly, emotional abuse can have more long-lasting negative psychiatric effects than either physical abuse or sexual abuse. Other names for emotional abuse are:Psychological maltreatment or psychological abuseEmotional child abuse can come from adults or from other children:Teachers or athletic coachesBullies at school or elsewhereMiddle- and high-school girls in social cliques Child neglect is a very common type of child abuse. According to Child Welfare Information Gateway, more children suffer from neglect than from physical and sexual abuse combined. Yet victims are not often identified, primarily because neglect is a type of child abuse that is an act of omission - of not doing something. Some overlap exists between the definitions of emotional abuse and emotional neglect. A single act of neglect might not be considered child abuse, but repeated neglect is definitely child abuse. There are three basic types of neglect; physical neglect, educational neglect, and emotional neglect. Failure to provide food, clothing appropriate for the weather, supervision, a home that is hygienic and safe, and/or medical care, as needed. Failure to enroll a school-age child in school or to provide necessary special education. This includes allowing excessive absences from school. Failure to provide emotional support, love, and affection. Administration for Children and FamiliesNational Clearinghouse on Child Abuse and Neglect InformationNational Institutes of Health -National Library of MedicineU. Department of Health and Human Services, National Center on Child Abuse and NeglectReporting child abuse is critical in the prevention of the maltreatment of children. In the vast majority of cases, reports of child abuse are not made by the victims but rather by people around them who know of, or suspect, the abuse. How and where to report child abuse is something that every adult should know so that if needed, they can protect a child in danger. In fact, reporting of child abuse is taken so seriously that in every state child abuse laws require some professionals, and in many cases adults in general, to report suspected child abuse. In almost all states, the following professionals are required to report suspected child abuse: Law enforcement officialsChild abuse reporting laws also frequently apply to:Photograph / film processorsIn 18 states, any adult that "suspects or has reasons to believe" that a child has been abused or neglected must report the child abuse. Not reporting child abuse may not just hurt the child, but it also may hurt the non-reporter. Mandatory reporters who do not report child abuse face prosecution in the vast majority of states. Not reporting child abuse is typically considered a misdemeanor but may be upgraded to a felony in the case of not reporting serious situations or in the case of repeated non-reporting. Criminal penalties for not reporting child abuse range between 10 days to 5 years in jail and fines of between $100 and $5000. In some cases, not reporting child abuse also makes the non-reporter civilly liable. Knowing who to report child abuse to and how to report child abuse is important. Several systems are in place to make suspected child abuse reports easy to make. Reports of child abuse can be made: Through a law enforcement agency (call the non-emergency number of your local police)Child Protective Services (CPS)There is also a national child abuse hotline provided by Childhelp. Childhelp is a national organization that provides crisis assistance and other counseling and referral services. The Childhelp National Child Abuse Hotline is staffed 24 hours a day, 7 days a week, with professional crisis counselors who have access to a database of 55,000 emergency, social service, and support resources.
Sexual abuse of a ward or minor includes:Engaging in a sex act with someone over the age of 11 but under the age of 16 wherein the perpetrator is at least four years older than the victimEngaging in a sex act with another person who is in official detention under the custodial generic aciclovir 400mg free shipping, supervisory or disciplinary authority of the perpetratorSexual abuse of a minor is punishable by a fine and not more than 15 years in jail whereas sexual abuse of a ward is punishable by a fine and a jail term of not more than one year generic 400 mg aciclovir amex. This law pertains to any sexual assault defined elsewhere wherein the sexual assault results in death generic aciclovir 800 mg online. Sexual abuse resulting in death (rape resulting in death) is punishable by death, imprisonment of any number of years or life in prison. Laws against rape can also be specified at the state level. Understanding what to do if you are raped is something no one wants to know. However, the steps in reporting rape are important to know in case that worst case scenario ever happens to you. Knowing what to do if you are raped is critical in order to ensure your safety, preserve evidence and increase the likelihood that the rapist is successfully prosecuted. Even though evidence might be the last thing on your mind directly after a rape, it is something you will likely think about for a long time to come; so taking steps now can help you out in the long run. The most important thing to do after a rape is ensure your own safety and get medical attention. The first obvious step is to find a safe environment away from the attacker. Wherever you choose to go, consider calling a friend to come with you to offer moral support. What has just happened to you is not your fault and you do not need to go through it alone. Calling the National Sexual Assault Hotline at 1-800-656-HOPE can provide you with information on what to do if you have been raped. Do not brush your teeth, bathe or change clothes until medical professionals have had a chance to properly collect evidence. Once you are safe, ensure you get medical attention ??? whether you feel you have been hurt or not. Medical attention will ensure that you are physically okay and can assess the risk for things like sexual transmitted infections and pregnancy. Tell the hospital that you have been raped so that they can conduct a rape kit. This ensures that forensic evidence can be properly preserved. If you feel that you may have been drugged, make sure to give a urine sample so that a lab can analyze it for further evidence. Once your safety is assured and you receive medical attention, writing down the details of the rape is important. Write down everything that happenedWrite down everything you remember about the attackerWhile this can seem like the last thing you want to do, this can be crucial evidence in prosecuting your rapist; and bringing your attacker to justice may be one of the key steps in your rape recovery efforts. Most rape crisis centers have professionals who can help you through the rape reporting process. It is never too late to report a rape although some prosecutions are barred after a certain number of years, depending on the state. Ideally, a report will be made right after it happens and while medical attention is being given, but days or even months later a rape can still legally be reported and prosecuted. One final note, many states have victim compensation programs which provide victims money for rape therapy. However, most states require rape victims to report the crime to police in order to qualify for the funds. When ingested, date rape drugs rapidly make you become weak and disoriented. Some types of date rape drugs have an amnesic effect, so that you may not even remember being sexually assaulted. In some cases, perpetrators use the drug known as Ambien^, which has a very strong amnesic affect and slows brain activity to allow sleep. Ambien is a prescription sedative that people take to alleviate symptoms of insomnia. In recent news, authorities have found traces of the drug in the blood of women who have been date raped. Perpetrators sometimes purchase these and other prescription drugs over the Internet from companies outside of U. These drugs often contain illegal or dangerous ingredients. For example, authorities have found haloperidol (Haldol^), a powerful antipsychotic drug with dangerous side effects, in Ambien formulations purchased from overseas pharmacies. People, who abuse these drugs and those who use them to assist them in seHTTP/1. The first instance of abuse in my life occurred when I was two. I remember walking down the stairs and going in the bathroom. Teddy, my cousin, had told me not to tell, but the pain won out, and I called my mother into the bathroom. All I know is that I never saw Teddy again, except in my nightmares. Shortly after that, my brother Gary started abusing me. She tells me that she sent me to a child psychologist. But I loved the memory game so much that it was the thing that triggered my memories to come years later. So my brother would sneak into my room late at night (my mom rarely left us alone cause she was afraid he would sexually abuse me), at least three to four times a night. At least one or two of those times he would rape me. I had this teddy bear that was given to me when I was two. Anyway, my brother Gary abused me at least until the age of eight. My most vivid memory was this time when I was playing with my blocks in the basement. My brother was baby-sitting me and his friend was over. He called me over and then told me touch his thing and I did and then he made me touch his friend. And then he touched me and stuff in front of his friend. And I remember walking to him shakily when I was really young.
In postmarketing reports quality 400 mg aciclovir, hemolytic anemia has been reported in patients who did not have known G6PD deficiency cheap 200mg aciclovir with mastercard. Patients should be informed of the potential risks and advantages of Glimepiride and of alternative modes of therapy order aciclovir 800 mg without a prescription. They should also be informed about the importance of adherence to dietary instructions, of a regular exercise program, and of regular testing of blood glucose. The risks of hypoglycemia, its symptoms and treatment, and conditions that predispose to its development should be explained to patients and responsible family members. The potential for primary and secondary failure should also be explained. Fasting blood glucose should be monitored periodically to determine therapeutic response. Glycosylated hemoglobin should also be monitored, usually every 3 to 6 months, to more precisely assess long-term glycemic control. Studies in rats at doses of up to 5000 ppm in complete feed (approximately 340 times the maximum recommended human dose, based on surface area) for 30 months showed no evidence of carcinogenesis. In mice, administration of Glimepiride for 24 months resulted in an increase in benign pancreatic adenoma formation which was dose related and is thought to be the result of chronic pancreatic stimulation. The no-effect dose for adenoma formation in mice in this study was 320 ppm in complete feed, or 46 to 54 mg/kg body weight/day. This is about 35 times the maximum human recommended dose of 8 mg once daily based on surface area. Glimepiride was non-mutagenic in a battery of in vitro and in vivo mutagenicity studies (Ames test, somatic cell mutation, chromosomal aberration, unscheduled DNA synthesis, mouse micronucleus test). There was no effect of Glimepiride on male mouse fertility in animals exposed up to 2500 mg/kg body weight (> 1,700 times the maximum recommended human dose based on surface area). Glimepiride had no effect on the fertility of male and female rats administered up to 4000 mg/kg body weight (approximately 4,000 times the maximum recommended human dose based on surface area). Glimepiride did not produce teratogenic effects in rats exposed orally up to 4000 mg/kg body weight (approximately 4,000 times the maximum recommended human dose based on surface area) or in rabbits exposed up to 32 mg/kg body weight (approximately 60 times the maximum recommended human dose based on surface area). Glimepiride has been shown to be associated with intrauterine fetal death in rats when given in doses as low as 50 times the human dose based on surface area and in rabbits when given in doses as low as 0. This fetotoxicity, observed only at doses inducing maternal hypoglycemia, has been similarly noted with other sulfonylureas, and is believed to be directly related to the pharmacologic (hypoglycemic) action of Glimepiride. There are no adequate and well-controlled studies in pregnant women. On the basis of results from animal studies, Glimepiride tablets should not be used during pregnancy. Because recent information suggests that abnormal blood glucose levels during pregnancy are associated with a higher incidence of congenital abnormalities, many experts recommend that insulin be used during pregnancy to maintain glucose levels as close to normal as possible. In some studies in rats, offspring of dams exposed to high levels of Glimepiride during pregnancy and lactation developed skeletal deformities consisting of shortening, thickening, and bending of the humerus during the postnatal period. Significant concentrations of Glimepiride were observed in the serum and breast milk of the dams as well as in the serum of the pups. These skeletal deformations were determined to be the result of nursing from mothers exposed to Glimepiride. Prolonged severe hypoglycemia (4 to 10 days) has been reported in neonates born to mothers who were receiving a sulfonylurea drug at the time of delivery. This has been reported more frequently with the use of agents with prolonged half-lives. Patients who are planning a pregnancy should consult their physician, and it is recommended that they change over to insulin for the entire course of pregnancy and lactation. In rat reproduction studies, significant concentrations of Glimepiride were observed in the serum and breast milk of the dams, as well as in the serum of the pups. Although it is not known whether Glimepiride is excreted in human milk, other sulfonylureas are excreted in human milk. Because the potential for hypoglycemia in nursing infants may exist, and because of the effects on nursing animals, Glimepiride should be discontinued in nursing mothers. If Glimepiride is discontinued, and if diet and exercise alone are inadequate for controlling blood glucose, insulin therapy should be considered. Glimepiride (n = 135) was administered at 1 mg initially, and then titrated up to 2, 4 or 8 mg (mean last dose 4 mg) until the therapeutic goal of self-monitored fasting blood glucosePreviously Treated Patients *Change from baseline (mean) +Adjusted Treatment Difference **The profile of adverse reactions in pediatric patients treated with Glimepiride was similar to that observed in adults. Hypoglycemic events, as documented by blood glucose values - Safety population with on-treatment evaluation for weight (Glimepiride, n = 129; metformin, n = 126)In U. No overall differences in safety or effectiveness were observed between these subjects and younger subjects, but greater sensitivity of some older individuals cannot be ruled out. Comparison of Glimepiride pharmacokinetics in Type 2 diabetic patients ?-T 65 years (n = 49) and those > 65 years (n = 42) was performed in a study using a dosing regimen of 6 mg daily. There were no significant differences in Glimepiride pharmacokinetics between the two age groups (see CLINICAL PHARMACOLOGY, Special Populations, Geriatric). The drug is known to be substantially excreted by the kidney, and the risk of toxic reactions to this drug may be greater in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function. Elderly patients are particularly susceptible to hypoglycemic action of glucose-lowering drugs. In elderly, debilitated, or malnourished patients, or in patients with renal and hepatic insufficiency, the initial dosing, dose increments, and maintenance dosage should be conservative based upon blood glucose levels prior to and after initiation of treatment to avoid hypoglycemic reactions. Hypoglycemia may be difficult to recognize in the elderly and in people who are taking beta-adrenergic blocking drugs or other sympatholytic agents (see CLINICAL PHARMACOLOGY, Special Populations, Renal Insufficiency; PRECAUTIONS, General; and DOSAGE AND ADMINISTRATION, Special Patient Population). The incidence of hypoglycemia with Glimepiride, as documented by blood glucose valuesVomiting, gastrointestinal pain, and diarrhea have been reported, but the incidence in placebo-controlled trials was less than 1%. In rare cases, there may be an elevation of liver enzyme levels. In isolated instances, impairment of liver function (e. These may be transient and may disappear despite continued use of Glimepiride. If those hypersensitivity reactions persist or worsen, the drug should be discontinued. Porphyria cutanea tarda, photosensitivity reactions, and allergic vasculitis have been reported with sulfonylureas, including Glimepiride. Leukopenia, agranulocytosis, thrombocytopenia, hemolytic anemia, aplastic anemia, and pancytopenia have been reported with sulfonylureas, including Glimepiride. Hepatic porphyria reactions and disulfiram-like reactions have been reported with sulfonylureas, including Glimepiride.
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