By E. Campa. Colorado State University.

Encourage verbalization of feelings related to this inability in an effort to deal with unresolved issues and accept what cannot be changed generic sustiva 200mg online. Encourage par- ticipation in these activities generic 200mg sustiva overnight delivery, and provide positive reinforce- ment for participation sustiva 200 mg overnight delivery, as well as for achievement. Client verbalizes choices made in a plan to maintain control over his or her life situation. Client verbalizes honest feelings about life situations over which he or she has no control. Client is able to verbalize system for problem-solving as required for adequate role performance. Possible Etiologies (“related to”) [Panic level of anxiety] [Past experiences of difficulty in interactions with others] [Need to engage in ritualistic behavior in order to keep anxiety under control] [Repressed fears] Defining Characteristics (“evidenced by”) [Stays alone in room] Uncommunicative Withdrawn No eye contact Developmentally [or culturally] inappropriate behaviors Preoccupation with own thoughts; repetitive, meaningless actions Expression of feelings of rejection or of aloneness imposed by others Experiences feelings of differences from others Insecurity in public Goals/Objectives Short-term Goal Client will willingly attend therapy activities accompanied by trusted support person within 1 week. Long-term Goal Client will voluntarily spend time with other clients and staff members in group activities by time of discharge from treatment. Be with the client to offer support during group activities that may be frightening or difficult for him or her. The pres- ence of a trusted individual provides emotional security for the client. Short-term use of antianxiety medications, such as diaze- pam, chlordiazepoxide, or alprazolam, helps to reduce level of anxiety in most individuals, thereby facilitating interactions with others. Discuss with client the signs of increasing anxiety and techniques for interrupting the response (e. Maladaptive behaviors, such as withdrawal and sus- piciousness, are manifested during times of increased anxiety. Give recognition and positive reinforcement for client’s volun- tary interactions with others. Positive reinforcement enhances self-esteem and encourages repetition of acceptable behaviors. When anxiety is high, client may require simple, concrete demonstrations of activities that would be performed without difficulty under normal conditions. Client may be unable to tolerate large amounts of food at mealtimes and may therefore require additional nourishment at other times during the day to receive adequate nutrition. Assist client to bathroom on hourly or bihourly schedule, as need is determined, until he or she is able to fulfill this need without assistance. Client maintains optimal level of personal hygiene by bathing daily and carrying out essential toileting procedures without assistance. They are classified as mental disorders because patho- physiological processes are not demonstrable or understandable by existing laboratory procedures, and there is either evidence or strong presumption that psychological factors are the major cause of the symptoms. It is now well documented that a large proportion of clients in general medical outpatient clinics and private medical offices do not have organic disease requiring medical treatment. It is likely that many of these clients have somatoform disorders, but they do not perceive themselves as having a psychiatric problem and thus do not seek treat- ment from psychiatrists. Symptoms can represent virtu- ally any organ system but commonly are expressed as neuro- logical, gastrointestinal, psychosexual, or cardiopulmonary dis- orders. Onset of the disorder is usually in adolescence or early adulthood and is more common in women than in men. The disorder usually runs a fluctuating course, with periods of re- mission and exacerbation. This diagnosis is made when psychological factors have been judged to have a major role in the onset, severity, ex- acerbation, or maintenance of the pain, even when the physical examination reveals pathology that is associated with the pain. Hypochondriasis Hypochondriasis is an unrealistic preoccupation with the fear of having a serious illness. Occasionally medical disease may be pres- ent, but in the hypochondriacal individual, the symptoms are grossly disproportionate to the degree of pathology. Individu- als with hypochondriasis often have a long history of “doctor shopping” and are convinced that they are not receiving the proper care. Conversion Disorder Conversion disorder is a loss of or change in body function re- sulting from a psychological conflict, the physical symptoms of which cannot be explained by any known medical disorder or pathophysiological mechanism. The most common conversion symptoms are those that suggest neurological disease such as paralysis, aphonia, seizures, coordination disturbance, akinesia, dyskinesia, blindness, tunnel vision, anosmia, anesthesia, and paresthesia. Body Dysmorphic Disorder This disorder, formerly called dysmorphophobia, is charac- terized by the exaggerated belief that the body is deformed or defective in some specific way. Studies have shown an increased incidence of somatization disorder, conversion disorder, and hypo- chondriasis in first-degree relatives, implying a possible inheritable predisposition (Sadock & Sadock, 2007; Soares & Grossman, 2007; Yutzy, 2003). Decreased levels of serotonin and endor- phins may play a role in the etiology of pain disorder. They hypothesize that physical complaints are the expression of low self- esteem and feelings of worthlessness and that the individual believes it is easier to feel something is wrong with the body than to feel something is wrong with the self. The psychodynamic theory of conversion disorder pro- poses that emotions associated with a traumatic event that the individual cannot express because of moral or ethical unacceptability are “converted” into physical symptoms. The unacceptable emotions are repressed and converted to a somatic hysterical symptom that is symbolic in some way of the original emotional trauma. Some families have difficulty expressing emotions openly and resolving conflicts verbally. When this occurs, the child may become ill, and a shift in focus is made from the open conflict to the child’s illness, leaving unre- solved the underlying issues that the family cannot confront openly. Thus, somatization by the child brings some stabil- ity to the family, as harmony replaces discord and the child’s welfare becomes the common concern. Somatic complaints are often reinforced when the sick role relieves the individual from the need to deal with a stressful situation, whether it be within society or within the family. When the sick per- son is allowed to avoid stressful obligations and postpone unwelcome challenges, is excused from troublesome du- ties, or becomes the prominent focus of attention because of the illness, positive reinforcement virtually guarantees repetition of the response. Personal experi- ence, or the experience of close family members, with seri- ous or life-threatening illness can predispose an individual to hypochondriasis. Once an individual has experienced a threat to biological integrity, he or she may develop a fear of recurrence. The fear of recurring illness generates an exaggerated response to minor physical changes, leading to hypochondriacal behaviors. Some cultures and religions carry implicit sanctions against verbalizing or directly expressing emotional states, thereby indirectly encouraging “more acceptable” somatic behaviors. Cross- cultural studies have shown that the somatization symp- toms associated with depression are relatively similar, but the “cognitive” or emotional symptoms such as guilt Somatoform Disorders ● 179 are predominantly seen in Western societies. In Middle Eastern and Asian cultures, depression is almost exclusively manifested by somatic or vegetative symptoms. Environmental influences may be significant in the predisposition to somatization disorder. Some studies have suggested that a tendency toward somatization appears to be more common in individuals who have low socioeconomic, occupational, and educational status. Any physical symptom for which there is no organic basis but for which evidence exists for the implication of psycho- logical factors.

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The stimulated endolymph fluid in turn stimulates the hair cells of the organ of Corti order sustiva 200mg visa, which transmit the impulses to the brain over the auditory nerve cheap sustiva 200 mg with mastercard. Three semicircular canals buy generic sustiva 200 mg, each with an ampulla (or small, dilated por- tion) at each end, lie at right angles to each other. The ampullae connect to a fluid-filled sac called a utricle, which in turn connects to another fluid-filled sac called a saccule. Both sacs contain regions called maculae that are lined with sensitive hairs and contain concretions (solid masses) of calcium carbonate called otoliths (or otoconia). When linear acceleration pulls at them, the otoliths press on the hair cells and initiate an impulse to the brain through basal sensory nerve fibers. When the head changes posi- tion, it causes a change in the direction of force on the hairs. Movement of the hairs stimulates dendrites of the vestibulocochlear nerve (the eighth cranial nerve) to carry impulses to the brain. Use the terms that follow to identify the internal structures of the eye shown in Figure 15-7. The structure in the eye that responds to the ciliary muscles during focusing is the a. The structure that contains the receptor cells for the perception of sound is the a. The small bone in the ear that strikes against the oval window of the vestibular canal, setting into motion the perilymph fluid in the vestibular and tympanic canals of the cochlea, is the a. Use the terms that follow to identify the structures of the ear shown in Figure 15-8. Stapes Chapter 15: Feeling Jumpy: The Nervous System 261 Answers to Questions on the Nervous System The following are answer to the practice questions presented in this chapter. Sense organs’ capacity to generate nerve impulse to stimulation d Coordination: b. Ability to receive impulses and direct them to channels for favorable response e Conceptual thought: e. Capacity to record, store, and relate information to be used to deter- mine future action f The brain and spinal cord are called the a. Some of the other answer options are parts of a neuron, but the neuron is the central unit. The nodes of Ranvier are gaps along the myelin sheath, so one of them can’t be found at the end of the line. When present, this fiber actually wraps around the myelin sheath, so it’s always on the outside. Cells that contribute to the repair process of the central nervous system l Microgliacytes: d. Cytoplasmic projections carrying impulses to the cell body p The neuroglia cells are important as b. With all that acetylcholine and cholinesterase floating around, it must be a chemical transmission. Outer thin membrane around an axon fiber Part V: Mission Control: All Systems Go 262 u Schwann cell: c. Negatively charged ion on the inner surface of the cell membrane B Polarization: a. Reshuffling of cell membrane ions; permeability of cell membrane D Cholinesterase: b. To remember, use the word “occipital” to bring to mind the word “optic,” which of course is related to visual activity. Controls motor coordination and refinement of muscular movement Chapter 15: Feeling Jumpy: The Nervous System 263 U Medulla oblongata: b. Contains the centers that control cardiac, respiratory, and vasomotor functions V Cerebrum: e. Contains the corpora quadrigemina and nuclei for the oculomotor and trochlear nerves X The largest quantity of cerebrospinal fluid originates from the c. Y The part of the brain that contains the thalamus, pituitary gland, and the optic chiasm is the a. Count them: 8 cervical, 12 thoracic, 5 lumbar, 5 sacral — plus 1 tailbone (coccygeal). It has two divisions that are antagonistic to each other, meaning that one counteracts the effects of the other one. Lens : The area of the eyeball that contains cells that are sensitive to light is the b. They reshape the lens by contracting and relaxing as needed to bring things into focus. The structure in the eye that responds to the ciliary muscles during focusing is the b. Otherwise known as the eardrum, this membrane sometimes bursts or tears as a result of infection or trauma. Hairs in this structure are what ultimately send the signal down the auditory nerve. These little endolymph- filled sacs have hairs and chunks of calcium carbonate that detect changes in gravitational forces. Pinna Chapter 16 Raging Hormones: The Endocrine System In This Chapter Absorbing what endocrine glands do Checking out the ringmasters: Pituitary and hypothalamus glands Surveying the supporting glands Understanding how the body balances under stress he human body has two separate command and control systems that work in harmony Tmost of the time but also work in very different ways. Designed for instant response, the nervous system cracks its cellular whip using electrical signals that make entire systems hop to their tasks with no delay (refer to Chapter 15). By contrast, the endocrine system’s glands use chemical signals called hormones that behave like the steering mechanism on a large, fully loaded ocean tanker; small changes can have big impacts, but it takes quite a bit of time for any evidence of the change to make itself known. At times, parts of the nervous system stimulate or inhibit the secretion of hormones, and some hormones are capable of stimulating or inhibiting the flow of nerve impulses. The word “hormone” originates from the Greek word hormao, which literally translates as “I excite. Each chemical signal stimulates some specific part of the body, known as target tissues or target cells. The body needs a constant supply of hormonal signals to grow, maintain homeostasis, reproduce, and conduct myriad processes. In this chapter, we go over which glands do what and where, as well as review the types of chemical signals that play various roles in the body. You also get to practice discerning what the endocrine system does, how it does it, and why the body responds like it does. No Bland Glands Technically, there are ten or so primary endocrine glands with various other hormone- secreting tissues scattered throughout the body.

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