By D. Silvio. Morningside College.
Like batterers hyzaar 50 mg on-line, battered wives often come from a history of abuse generic hyzaar 12.5 mg amex. In fact buy 12.5mg hyzaar with mastercard, many battered wives initially got married to escape the abuse present at home and may have been married young order 50 mg hyzaar overnight delivery, very quickly and with no engagement period. Those suffering from battered woman syndrome also tend to have a uniform response to violence including:Agitation and anxiety verging on panicApprehension of imminent doomThe inability to relax or sleepNightmares of violence or dangerFeelings of hopelessness and despairDue to these extreme reactions to violence in the relationship, those suffering from battered woman syndrome react to any perceived danger (real or not) by pacing, increased activity, screaming and crying. Battered wives seek medical help far more often than non-battered women and so it would be natural to assume that doctors would diagnose battered wife syndrome frequently; however, they do not. Doctors often fail to ask about domestic violence even when a woman repeatedly sees them. Battered wives are often from homes where they are taught to be compliant and not voice their concerns and this leads them into a similar adult relationship. Men who have been in homes where wife battering occurred as children, are more likely to grow up into wife batterers themselves. A battered wife can be of any race, socioeconomic status or educational background ??? anyone can be a victim of wife beating. No wife or any situation can cause a person to beat another. Within a relationship, though, there is typically a pattern to wife battering (read Cycle of Violence and Abuse ). The phases are typically: A tension building phaseA wife battering episodeA "honeymoon" phase where there is a respiteDuring the tension building phase, the wife often "walks on eggshells" around her batterer and is aware of the fact that the tension is building. These minor infractions produce unreasonable tension in the relationship. This tension eventually explodes in an acute wife battering episode. The battering may be a more minor push or slap or may be a major beating leading to broken bones or worse. The batterer may prevent the victim from receiving healthcare for their injuries and threaten the victim or others if the victim threatens to tell anyone about the abuse. Once the acute battering is over, the batterer often tries to charm his way out of what has happened; promising to never to do it again and attempting to make amends by doing things like buying flowers and being extra attentive. Often convincing a battered wife to leave their batterer is about convincing them that their false thoughts about the abuse are wrong. Taking care of the needs and safety of the wife as well as any children, and sometimes pets (which may also be abused), involved in the situation can help a woman decide to leave her batterer. This may make them even more reluctant to leave their wife batterer. Battered women generally need help to leave an abusive relationship. This is because battered women tend to by financially, psychologically and sometimes physically dependent on their abuser. Sources of help for battered woman can be found through healthcare professionals, community organizations, faith organizations and websites. While some services are specific to women, many services help men too as men can be the victims of battering just like women can. For the purposes of this article, the victim of battery is considered to be a woman and the perpetrator a man. It can be very difficult for a battered woman to leave a relationship. Battered women tend to fear their abuser and fear what will happen to them and their children if they try to leave; this makes even the thought of leaving painful and frightening. Battered women need to understand that they cannot help their batterer and they cannot make the abuser stop on their own. When you choose to leave an abusive relationship, you are protecting your children from this possible future.
A study evaluating the QT/QTc prolonging effect of intramuscular ziprasidone buy hyzaar 12.5mg, with intramuscular haloperidol as a control generic 50 mg hyzaar, was conducted in patient volunteers purchase hyzaar 12.5 mg amex. In the trial cheap hyzaar 12.5 mg on-line, ECGs were obtained at the time of maximum plasma concentration following two injections of ziprasidone (20 mg then 30 mg) or haloperidol (7. Note that a 30 mg dose of intramuscular ziprasidone is 50% higher than the recommended therapeutic dose. The mean change in QTc from baseline was calculated for each drug, using a sample-based correction that removes the effect of heart rate on the QT interval. The mean increase in QTc from baseline for ziprasidone was 4. The mean increase in QTc from baseline for haloperidol was 6. In this study, no patients had a QTc interval exceeding 500 msec. As with other antipsychotic drugs and placebo, sudden unexplained deaths have been reported in patients taking ziprasidone at recommended doses. The premarketing experience for ziprasidone did not reveal an excess risk of mortality for ziprasidone compared to other antipsychotic drugs or placebo, but the extent of exposure was limited, especially for the drugs used as active controls and placebo. This possibility needs to be considered in deciding among alternative drug products (see INDICATIONS AND USAGE ). Certain circumstances may increase the risk of the occurrence of torsade de pointes and/or sudden death in association with the use of drugs that prolong the QTc interval, including (1) bradycardia; (2) hypokalemia or hypomagnesemia; (3) concomitant use of other drugs that prolong the QTc interval; and (4) presence of congenital prolongation of the QT interval. It is recommended that patients being considered for ziprasidone treatment who are at risk for significant electrolyte disturbances, hypokalemia in particular, have baseline serum potassium and magnesium measurements. Hypokalemia (and/or hypomagnesemia) may increase the risk of QT prolongation and arrhythmia. Hypokalemia may result from diuretic therapy, diarrhea, and other causes. Patients with low serum potassium and/or magnesium should be repleted with those electrolytes before proceeding with treatment. It is essential to periodically monitor serum electrolytes in patients for whom diuretic therapy is introduced during ziprasidone treatment. Persistently prolonged QTc intervals may also increase the risk of further prolongation and arrhythmia, but it is not clear that routine screening ECG measures are effective in detecting such patients. Rather, ziprasidone should be avoided in patients with histories of significant cardiovascular illness, e. Ziprasidone should be discontinued in patients who are found to have persistent QTc measurements >500 msec. For patients taking ziprasidone who experience symptoms that could indicate the occurrence of torsade de pointes, e. A potentially fatal symptom complex sometimes referred to as Neuroleptic Malignant Syndrome (NMS) has been reported in association with administration of antipsychotic drugs. Clinical manifestations of NMS are hyperpyrexia, muscle rigidity, altered mental status and evidence of autonomic instability (irregular pulse or blood pressure, tachycardia, diaphoresis, and cardiac dysrhythmia). Additional signs may include elevated creatinine phosphokinase, myoglobinuria (rhabdomyolysis), and acute renal failure. The diagnostic evaluation of patients with this syndrome is complicated. In arriving at a diagnosis, it is important to exclude cases where the clinical presentation includes both serious medical illness (e. Other important considerations in the differential diagnosis include central anticholinergic toxicity, heat stroke, drug fever, and primary central nervous system (CNS) pathology. The management of NMS should include: (1) immediate discontinuation of antipsychotic drugs and other drugs not essential to concurrent therapy; (2) intensive symptomatic treatment and medical monitoring; and (3) treatment of any concomitant serious medical problems for which specific treatments are available. There is no general agreement about specific pharmacological treatment regimens for NMS.
Prescriptions for Prozac should be written for the smallest quantity of capsules discount 50 mg hyzaar, tablets discount hyzaar 12.5mg, or liquid consistent with good patient management order hyzaar 12.5mg without a prescription, in order to reduce the risk of overdose buy hyzaar 50 mg mastercard. Families and caregivers of adults being treated for depression should be similarly advised. It should be noted that Prozac is approved in the pediatric population only for major depressive disorder and obsessive compulsive disorder. Screening Patients for Bipolar Disorder - A major depressive episode may be the initial presentation of bipolar disorder. It is generally believed (though not established in controlled trials) that treating such an episode with an antidepressant alone may increase the likelihood of precipitation of a mixed/manic episode in patients at risk for bipolar disorder. Whether any of the symptoms described above represent such a conversion is unknown. However, prior to initiating treatment with an antidepressant, patients with depressive symptoms should be adequately screened to determine if they are at risk for bipolar disorder; such screening should include a detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression. It should be noted that Prozac is not approved for use in treating bipolar depression. Rash and Possibly Allergic Events - In US fluoxetine clinical trials as of May 8, 1995, 7% of 10,782 patients developed various types of rashes and/or urticaria. Among the cases of rash and/or urticaria reported in premarketing clinical trials, almost a third were withdrawn from treatment because of the rash and/or systemic signs or symptoms associated with the rash. Clinical findings reported in association with rash include fever, leukocytosis, arthralgias, edema, carpal tunnel syndrome, respiratory distress, lymphadenopathy, proteinuria, and mild transaminase elevation. Most patients improved promptly with discontinuation of fluoxetine and/or adjunctive treatment with antihistamines or steroids, and all patients experiencing these events were reported to recover completely. In premarketing clinical trials, 2 patients are known to have developed a serious cutaneous systemic illness. In neither patient was there an unequivocal diagnosis, but one was considered to have a leukocytoclastic vasculitis, and the other, a severe desquamating syndrome that was considered variously to be a vasculitis or erythema multiforme. Other patients have had systemic syndromes suggestive of serum sickness. Since the introduction of Prozac, systemic events, possibly related to vasculitis and including lupus-like syndrome, have developed in patients with rash. Although these events are rare, they may be serious, involving the lung, kidney, or liver. Death has been reported to occur in association with these systemic events. Anaphylactoid events, including bronchospasm, angioedema, laryngospasm, and urticaria alone and in combination, have been reported. Pulmonary events, including inflammatory processes of varying histopathology and/or fibrosis, have been reported rarely. These events have occurred with dyspnea as the only preceding symptom. Whether these systemic events and rash have a common underlying cause or are due to different etiologies or pathogenic processes is not known. Furthermore, a specific underlying immunologic basis for these events has not been identified. Upon the appearance of rash or of other possibly allergic phenomena for which an alternative etiology cannot be identified, Prozac should be discontinued. Potential Interaction with Thioridazine - In a study of 19 healthy male subjects, which included 6 slow and 13 rapid hydroxylators of debrisoquin, a single 25-mg oral dose of thioridazine produced a 2. The rate of debrisoquin hydroxylation is felt to depend on the level of CYP2D6 isozyme activity. Thus, this study suggests that drugs which inhibit CYP2D6, such as certain SSRIs, including fluoxetine, will produce elevated plasma levels of thioridazine (see PRECAUTIONS ). Thioridazine administration produces a dose-related prolongation of the QTc interval, which is associated with serious ventricular arrhythmias, such as torsades de pointes-type arrhythmias, and sudden death. This risk is expected to increase with fluoxetine-induced inhibition of thioridazineAbnormal Bleeding - Published case reports have documented the occurrence of bleeding episodes in patients treated with psychotropic drugs that interfere with serotonin reuptake. Subsequent epidemiological studies, both of the case-control and cohort design, have demonstrated an association between use of psychotropic drugs that interfere with serotonin reuptake and the occurrence of upper gastrointestinal bleeding.
Given that curtailment of freedom of speech is neither possible nor generally desirable buy 12.5 mg hyzaar amex, it cannot be expected that advertisement of CRT will stop generic hyzaar 12.5mg line. Professionals who are concerned about CRT have the responsibility of employing their own freedom of speech to present the facts to other professionals and to parents who consult them 50 mg hyzaar with mastercard, bearing in mind that the concepts and empirical evidence are not easy to summarize purchase 50mg hyzaar fast delivery. An important start would be for all relevant professional organizations to adopt resolutions rejecting CRT and to communicate those resolutions to the media. About the author: Jean Mercer, PhD, Professor of Psychology, Richard Stockton College, Pomona, New Jersey1. Manual for the Randolph Attachment Disorder Questionnaire. Comparative effectiveness of holding therapy with aggressivechildren. The Psychology of the Z-Process: Attachment and Activity. San Jose, Calif: San Jose State University Press; 1975. House of Cards: Psychology and Psychotherapy Built Upon Myth. Media watch: radio and television programs approve of coercive restraint therapies. Attachment, Trauma, and Healing: Understanding and Treating AttachmentDisorder in Children and Families. Washington, DC: Child Welfare League of America; 1998. What are the major types of complementary and alternative medicine? There are many terms used to describe approaches to health care that are outside the realm of conventional medicine as practiced in the United States. This fact sheet explains how the National Center for Complementary and Alternative Medicine (NCCAM), a component of the National Institutes of Health, defines some of the key terms used in the field of complementary and alternative medicine (CAM). Terms that are underlined in the text are defined at the end of this fact sheet. Complementary and alternative medicine, as defined by NCCAM, is a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine. While some scientific evidence exists regarding some CAM therapies, for most there are key questions that are yet to be answered through well-designed scientific studies--questions such as whether these therapies are safe and whether they work for the diseases or medical conditions for which they are used. The list of what is considered to be CAM changes continually, as those therapies that are proven to be safe and effective become adopted into conventional health care and as new approaches to health care emerge. Complementary medicine is used together with conventional medicine. Alternative medicine is used in place of conventional medicine. An example of an alternative therapy is using a special diet to treat cancer instead of undergoing surgery, radiation, or chemotherapy that has been recommended by a conventional doctor. Integrative medicine, as defined by NCCAM, combines mainstream medical therapies and CAM therapies for which there is some high-quality scientific evidence of safety and effectiveness. TopNCCAM classifies CAM therapies into five categories, or domains:Alternative medical systems are built upon complete systems of theory and practice. Often, these systems have evolved apart from and earlier than the conventional medical approach used in the United States. Examples of alternative medical systems that have developed in Western cultures include homeopathic medicine and naturopathic medicine. Examples of systems that have developed in non-Western cultures include traditional Chinese medicine and Ayurveda.