By T. Tyler. State University of New York at Buffalo.
Abstract: The syndrome of multiple personality is associated with a high incidence of physical and/or sexual abuse in childhood 60 mg raloxifene overnight delivery. Occasionally those with multiple personality abuse their own children discount 60mg raloxifene free shipping. Multiple personality is difficult to diagnose both because of the nature of the syndrome and because of professional reluctance order raloxifene 60mg online. Although multiple personality is most difficult to diagnose during childhood because of the subtlety of the syndrome purchase raloxifene 60 mg with mastercard. The much higher morbidity found in adult cases makes itimperative that it be diagnosed and treated early in order to avoid further abuse and greater morbidity and to shorten treatment time. This review describes the history, clinical features and treatment of multiple personality, particularly in children, in addition to exploring the professional reluctance to make the diagnosis. Introduction: MULTIPLE PERSONALITY DISORDER is of special interest to clinicians interested in child abuse and neglect because patients with multiple personality were almost invariably abused either physically or sexually when they were children. Perhaps most importantly, clinicians working in the area of child abuse have the opportunity of diagnosing incipient multiple personality in children and initiate early intervention leading to successful treatment. The history of the dissociative disorders, which include multiple personality, extends back into the New Testament times of the first century when numerous references to demon possession, a forerunner of multiple personality, were described [1, 2]. The phenomenon of possession continued to be prevalent until well into the 19th century and is still prevalent in certain areas of the world [2, 3]. However, beginning in the 18th century, the possession phenomenon began to decline and the first case of multiple was described by Eberhardt Gmelin in 1791. The first American case, that of Mary Reynolds, was first reported in 1815. The late 19th century saw a flurry of publications about multiple personality, but the relationship of multiple personality to child abuse was not generally recognized until the publication of Sybil in 1973. The growth of interest in multiple personality has paralleled that of incest with which it is closely related. The reports of both incest and multiple personality have greatly increased since 1970. Multiple personality is defined by the DSM-III as:The existence within the individual of two or more distinct personalities. Each individual personality is complex and integrated with its own unique behavior patterns and social relationships. Unfortunately the description of multiple personality in the DSM-111 has led, in part, to frequent misdiagnosis and under diagnosis. Multiple personality most often presents with depression and suicidality rather than personality changes and amnesia which are obvious clues to dissociation |3, 8]. The amnesia in multiple personality includes amnesia for traumatic experiences in the remote past and amnesia for recent events which occurred while the individual was dissociated into another personality. The amnesiac episodes generally last from a few minutes to a few hours but occasionally may last from a few days to a few months. The original personality is usually amnesiac for the secondary personalities while the secondary personalities may have varying awareness of one another. Sometimes a secondary personality may exhibit the phenomenon of co-consciousness and be aware of events even when another personality is dominant. Generally the original personality is rather reserved and depleted of affect. The secondary personalities usually express affects or impulses unacceptable to the primary personality such as anger, depression, or sexuality. Differences between personalities may be quite subtle or quite striking. Personalities may be of different age, race, sex, sexual orientation, or parentage from the original. Most often the personalities have chosen proper names for themselves. Psychophysiologic symptoms are extremely frequent in multiple personality. Headaches are extremely common as are hysterical conversion symptoms and symptoms of sexual dysfunction [3, 10].
Finally purchase 60 mg raloxifene amex, compulsive binge eating is a mental illness similar to addiction and so compulsive overeaters will often choose bingeing over other things such as friends cheap raloxifene 60 mg free shipping, family buy discount raloxifene 60mg line, work or school order 60 mg raloxifene fast delivery. Compulsive binge eating is often brought on and sustained by psychological stress and other problems. Unfortunately, the effect of binge eating itself may lead to additional psychological problems or make the existing ones worse. The effects of binge eating can include shame, disgust, anxiety, obesity and other factors that may make the binge eater feel bad about themselves and worsen their depression. For compulsive overeaters, this may even lead to suicidal thoughts. Additional psychological effects of binge eating include:Greater feelings of stressOver time, compulsive binge eating generally leads to obesity. For compulsive overeaters, these complications can include conditions leading to death. A lack of exercise increases the likelihood of serious medical problems accompanying binge eating. Other physical effects of binge eating disorder include: Nutritional deficienciesHTTP/1. Just overcoming the shame typically surrounding binge eating disorder is a huge step forward in binge eating treatment. Binge eating disorder is a mental illness and needs to be recognized as such by the overeater and those around them. It is with early intervention that treatment for binge eating disorder has the greatest chance of success. For those with severe health problems, a visit to a doctor will be the first step in treatment for binge eating disorder. The doctor will ask questions as part of the diagnosis process and run necessary tests to analyze any damage done by the binge eating disorder or associated conditions. Hospitalization is almost never needed in binge eating treatment unless other severe medical complications are present. The goal of treatment is to get control of binge eating behavior, return to a healthy diet and lose weight if necessary. The doctor will make a binge eating disorder treatment plan which may include one or more of the following: Medication is sometimes used as part of compulsive binge eating treatment. This is most common when depression or anxiety is a factor. Antidepressants are one type of medication that is prescribed for the treatment of binge eating disorder. Typical antidepressants include: Prozac - a selective serotonin reuptake inhibitor (SSRI)People with binge eating disorder often suffer from nutritional deficits as the foods they have binged on are typically high in fat and have few vitamins and minerals. Nutritional treatment for binge eating disorder attempts to create a healthy eating plan that will correct these deficits in the compulsive overeater. Additionally, it may help the compulsive overeater lose weight. In nutritional binge eating therapy, the diet focuses on gradual weight loss using nutritionally balanced meals and snacks. It may also include educating the binge eater about nutrition and helping them to make more nutritionally balanced food choices every day. Beating Ana: How to Outsmart Your Eating Disorder and Take Your Life BackHealthyPlace interviewed Ms Cutts and she talked about techniques to beat eating disorders. Watch the video on eating disorders recovery with author Shannon Cutts. Anorexia is not a diet, it is not a shallow attempt to be "model thin", and it is definitely not just about food. Carolyn Costin is extremely insightful and knowledgeable about the subject and she writes in a clear, accessible way. Reader Comment: "This is a deeply insightful book that speaks to women with disordered eating of all types and severities. Phillips, Roberto OlivardiaReader Comment: "The chapter notes contain at least 50 research papers that they have published in various scientific journals. Anorexia and bulimia are very complicated disorders, and different people can develop different types of eating disorders for different reasons.
A statistically significant greater number of patients treated with NUVIGIL at each dose showed improvement in overall clinical condition as rated by the CGI-C scale at final visit [Table 2] discount raloxifene 60 mg without a prescription. The two doses of NUVIGIL produced statistically significant effects of similar magnitudes on the CGI-C cheap raloxifene 60 mg with mastercard. Although a statistically significant effect on the MWT was observed for each dose purchase raloxifene 60mg online, the magnitude of effect was observed to be greater for the higher dose cheap raloxifene 60 mg with amex. Nighttime sleep measured with polysomnography was not affected by the use of NUVIGIL. The effectiveness of NUVIGIL in improving wakefulness in patients with excessive sleepiness associated with SWSD was demonstrated in a 12-week, multi-center, double-blind, placebo-controlled, parallel-group, clinical trial. A total of 254 patients with chronic SWSD were randomized to receive NUVIGIL 150 mg/day or placebo. All patients met the ICSD criteria for chronic SWSD [which are consistent with the American Psychiatric Association DSM-IV criteria for Circadian Rhythm Sleep Disorder: Shift Work Type]. These criteria include 1) either: a) a primary complaint of excessive sleepiness or insomnia which is temporally associated with a work period (usually night work) that occurs during the habitual sleep phase, or b) polysomnography and the MSLT demonstrate loss of a normal sleep-wake pattern (i. It should be noted that not all patients with a complaint of sleepiness who are also engaged in shift work meet the criteria for the diagnosis of SWSD. In the clinical trial, only patients who were symptomatic for at least 3 months were enrolled. Enrolled patients were also required to work a minimum of 5 night shifts per month, have excessive sleepiness at the time of their night shifts (MSLT score ?-T6 minutes), and have daytime insomnia documented by a daytime polysomnogram (PSG). Patients treated with NUVIGIL showed a statistically significant prolongation in the time to sleep onset compared to placebo-treated patients, as measured by the nighttime MSLT at final visit [Table 1]. A statistically significant greater number of patients treated with NUVIGIL showed improvement in overall clinical condition as rated by the CGI-C scale at final visit [Table 2]. Daytime sleep measured with polysomnography was not affected by the use of NUVIGIL. Average Baseline Sleep Latency and Change from Baseline at Final Visit (MWT and MSLT in minutes) Table 2. Clinical Global Impression of Change (CGI-C) (Percent of Patients Who Improved at Final Visit) NUVIGIL is indicated to improve wakefulness in patients with excessive sleepiness associated with obstructive sleep apnea/ hypopnea syndrome, narcolepsy and shift work sleep disorder. In OSAHS, NUVIGIL is indicated as an adjunct to standard treatment(s) for the underlying obstruction. If continuous positive airway pressure (CPAP) is the treatment of choice for a patient, a maximal effort to treat with CPAP for an adequate period of time should be made prior to initiating NUVIGIL. If NUVIGIL is used adjunctively with CPAP, the encouragement of and periodic assessment of CPAP compliance is necessary. In all cases, careful attention to the diagnosis and treatment of the underlying sleep disorder(s) is of utmost importance. Prescribers should be aware that some patients may have more than one sleep disorder contributing to their excessive sleepiness. The effectiveness of NUVIGIL in long-term use (greater than 12 weeks) has not been systematically evaluated in placebo-controlled trials. The physician who elects to prescribe NUVIGIL for an extended time in patients should periodically re-evaluate long-term usefulness for the individual patient. NUVIGIL is contraindicated in patients with known hypersensitivity to modafinil and armodafinil or its inactive ingredients. Serious rash requiring hospitalization and discontinuation of treatment has been reported in adults in association with the use of armodafinil and in adults and children in association with the use of modafinil, a racemic mixture of S and R modafinil (the latter is armodafinil). Armodafinil has not been studied in pediatric patients in any setting and is not approved for use in pediatric patients for any indication. No serious skin rashes have been reported in adult clinical trials (0 per 1,595) of armodafinil. However, cases of serious rash have been reported in adults in postmarketing experience. Because armodafinil is the R isomer of racemic modafinil, a similar risk of serious rash in pediatric patients with armodafinil cannot be ruled out.